Kim Dong-Min, Park Chol-Jin, Lim Sung-Chul, Park Kyung-Hee, Jang Won-Jong, Lee Seung-Hyun
Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea.
Am J Clin Pathol. 2008 Oct;130(4):543-51. doi: 10.1309/X17HNNJKMYGHT4HP.
We assessed the clinical usefulness of immunohistochemical staining on skin biopsy specimens for the diagnosis of scrub typhus compared with indirect immunofluorescent antibody assay (IFA), the definitive diagnostic method for scrub typhus, in a prospective study of 125 patients with possible scrub typhus in 2005 and 2006. Skin biopsy specimens were obtained from 63 patients. To minimize the effects caused by antibiotics on immunohistochemical results, 46 patients were assessed before antibiotic administration (4 patients received antibiotic therapy before admission; 13 underwent skin biopsy after antibiotic administration at our hospital). Compared with IFA results, immunohistochemical results on maculopapular skin lesions demonstrated a sensitivity of 0.65 and a specificity of 1. Immunohistochemical results on eschars demonstrated a sensitivity of 1 and a specificity of 1. For immunohistochemical staining performed on skin lesions within 3 or 4 days of administration of antibiotics that are effective for Rickettsia, the antibiotics did not greatly influence diagnostic sensitivity. Immunohistochemical staining of skin biopsy specimens, particularly that of eschars, is sensitive and specific, and this technique can be reliable for confirming the diagnosis of scrub typhus.
在2005年和2006年对125例疑似恙虫病患者进行的一项前瞻性研究中，我们将皮肤活检标本的免疫组织化学染色与恙虫病的确诊诊断方法——间接免疫荧光抗体试验（IFA）相比较，评估其在恙虫病诊断中的临床实用性。从63例患者身上获取了皮肤活检标本。为尽量减少抗生素对免疫组织化学结果的影响，对46例患者在使用抗生素之前进行了评估（4例患者在入院前接受了抗生素治疗；13例在我院接受抗生素治疗后进行了皮肤活检）。与IFA结果相比，斑丘疹皮肤病变的免疫组织化学结果显示敏感性为0.65，特异性为1。焦痂的免疫组织化学结果显示敏感性为1，特异性为1。对于在使用对立克次体有效的抗生素后3或4天内对皮肤病变进行的免疫组织化学染色，抗生素对诊断敏感性影响不大。皮肤活检标本的免疫组织化学染色，尤其是焦痂的染色，具有敏感性和特异性，该技术在确诊恙虫病方面可能是可靠的。
