Abstract
Scrub typhus, murine typhus, and leptospirosis are widely neglected infectious diseases caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively. Patients usually present with non-specific symptoms and therefore are commonly diagnosed with acute undifferentiated febrile illness. Consequently, patients face delayed treatment and increased mortality. Antibody-based serological test currently used as gold standard has limitations due to insufficient antibody titers, especially in the early phase of infection. In this study, we aimed to develop multiplex PCR to combine 3 primer pairs that target specific genes encoding 56-kDa TSA of O. tsutsugamushi, 17-kDa antigen of R. typhi, and LipL32 of L. Interrogans and evaluate its performance in comparison to the standard serological tests. Using EDTA blood samples of known patients, the sensitivity and specificity of our multiplex PCR was 100% and 70%, respectively. In addition, the assay was able to diagnose the co-infection of scrub typhus and leptospirosis. The assay may be useful in identifying causative agents during the early phase of these diseases, enabling prompt and appropriate treatment.
Highlights
Scrub typhus, murine typhus, and leptospirosis are widely neglected infectious diseases, especially in the tropical and temperate climate regions, caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively
Murine typhus, and leptospirosis are diagnosed as acute undifferentiated febrile illness
A novel multiplex PCR has been developed for detecting Orientia tsutsugamushi, Rickettsia typhi, and Leptospira interrogans that are simultaneously amplified in a single tube
Summary
Murine typhus, and leptospirosis are widely neglected infectious diseases, especially in the tropical and temperate climate regions, caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively. Clinical manifestations of scrub typhus, murine typhus, and leptospirosis, such as high fever, headache, muscular pain, and anorexia, are non-specific and usually diagnosed as acute undifferentiated febrile illness. These clinical manifestations range from mild, severe, to possibly fatal [6,7,8]. Eschar caused by chigger bite is a clinical appearance of scrub typhus; it is not always present. Due to clinical manifestations of these diseases being recognized as acute undifferentiated febrile illness and subsequently underdiagnosed, a rapid and reliable laboratory investigation is necessary for confirmation and treatment efficiency
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