期刊
CURRENT OPINION IN INFECTIOUS DISEASES
卷 29, 期 5, 页码 433-439出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QCO.0000000000000298
关键词
ELISA; indirect immunofluorescent assay; murine typhus; Orientia tsutsugamushi; PCR; rickettsia; scrub typhus; spotted fever
资金
- Wellcome Trust
- NIH/NIAID
- Li Ka Shing Foundation
- MDRIP
- National Institutes of Allergy and Infectious Diseases
- Bill and Melinda Gates Foundation
- Fisher Discovery Center (Johns Hopkins University)
- Department of Pathology, University of Maryland School of Medicine
- Uniformed Services University of the Health Sciences [PAT-74-3977]
Purpose of reviewWith improved malaria control, acute undifferentiated febrile illness studies in tropical regions reveal a startling proportion of rickettsial illnesses, especially scrub typhus, murine typhus, and spotted fever group rickettsioses. Laboratory diagnosis of these infections evolved little over the past 40 years, but combinations of technologies like PCR and loop-mediated isothermal amplification, with refined rapid diagnostic tests and/or ELISA, are promising for guidance for early antirickettsial treatment.Recent findingsThe long-term reliance on serological tests - useful only late in rickettsial infections - has led to underdiagnosis, inappropriate therapies, and undocumented morbidity and mortality. Recent approaches integrate nucleic acid amplification and recombinant protein-based serological tests for diagnosing scrub typhus. Optimized using Bayesian latent class analyses, this strategy increases diagnostic confidence and enables early accurate diagnosis and treatment - a model to follow for lagging progress in murine typhus and spotted fever.SummaryA laboratory diagnostic paradigm shift in rickettsial infections is evolving, with replacement of indirect immunofluorescence assay by the more objective ELISA coupled with nucleic acid amplification assays to expand the diagnostic window toward early infection intervals. This approach supports targeted antirickettsial therapy, reduces morbidity and mortality, and provides a robust evidence base for further development of diagnostics and vaccines.
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