Scrub typhus in Indonesia: A cross-sectional analysis of archived fever studies samples.

Publisher: Oxford University Press Country of Publication: England NLM ID: 7506129 Publication Model: Print Cited Medium: Internet ISSN: 1878-3503 (Electronic) Linking ISSN: 00359203 NLM ISO Abbreviation: Trans R Soc Trop Med Hyg Subsets: MEDLINE

Publication: 2013- : Oxford : Oxford University Press
Original Publication: 1920- : London : Royal Society of Tropical Medicine and Hygiene

Scrub Typhus*/epidemiology ; Scrub Typhus*/diagnosis ; Orientia tsutsugamushi*/immunology ; Orientia tsutsugamushi*/isolation & purification ; Immunoglobulin M*/blood ; Enzyme-Linked Immunosorbent Assay* ; Immunoglobulin G*/blood; Humans ; Indonesia/epidemiology ; Cross-Sectional Studies ; Female ; Male ; Seroepidemiologic Studies ; Antibodies, Bacterial/blood ; Adult ; Middle Aged

Background: Scrub typhus is an understudied vector-borne bacterial infection.
Methods: We tested archived fever samples for scrub typhus seropositivity to begin charting its geographic distribution in Indonesia. We analysed 1033 serum samples from three sites. IgM and IgG enzyme-linked immunosorbent assay (ELISA) against Orientia tsutsugamushi was performed using Karp, Kato, Gilliam, TA 716 antigens. To determine the cutoff in the absence of a presumed unexposed population and gold standard tests, we identified the visual inflection point, performed change point analysis, and used finite mixture models.
Results: The optical density cutoff values used for IgM and IgG were 0.49 and 0.13, respectively. Across all sites, IgM seropositivity was 4.6% (95% CI: 3.4 to 6.0%) while IgG seropositivity was 4.4% (95% CI: 3.3 to 5.8%). The overall seropositivity across sites was 8.8% (95% CI: 8.1 to 11.7%). The overall seropositivity for Jambi, Denpasar, Tabanan were 9.7% (95% CI: 7.0 to 13.3%), 8.0% (95% CI: 5.7 to 11.0%), 9.0% (95% CI: 6.1 to 13.0%), respectively.
Conclusions: We conclude that O. tsutsugamushi exposure in humans occurred at all sites analysed and could be the cause of illness in some cases. Though it was not the main cause of acute fever in these locations, it is still important to consider scrub typhus in cases not responding to beta-lactam antibiotics. Future seroprevalence surveys and testing for scrub typhus in acute febrile illness studies will be essential to understand its distribution and burden in Indonesia.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

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United Kingdom WT_ Wellcome Trust; U01 CK000577 United States CK NCEZID CDC HHS; 220211 United Kingdom WT_ Wellcome Trust

Keywords: Orientia tsutsugamushi; Indonesia; scrub typhus; serology

0 (Immunoglobulin M)
0 (Immunoglobulin G)
0 (Antibodies, Bacterial)

Date Created: 20240111 Date Completed: 20240501 Latest Revision: 20240503

20240503

PMC11062201

10.1093/trstmh/trad094

38205975