Am J Trop Med Hyg. 2013 Aug;89(2):308-310. doi: 10.4269/ajtmh.12-0600. Epub 2013 Jun 3.
One hundred and eighty febrile patients were analyzed in a prospective evaluation of Orientia tsutsugamushi and Rickettsia spp. real-time polymerase chain reaction (PCR) assays for early diagnosis of rickettsial infections. By paired serology, 3.9% (7 of 180) and 6.1% (11 of 180) of patients were confirmed to have acute scrub or murine typhus, respectively. The PCR assays for the detection of O. tsutsugamushi and Rickettsia spp. had high specificity (99.4% [95% confidence interval (CI): 96.8-100] and 100% [95% CI: 97.8-100], respectively). The PCR results were also compared with immunoglobulin M (IgM) immunofluorescence assay (IFA) on acute sera. For O. tsutsugamushi, PCR sensitivity was twice that of acute specimen IgM IFA (28.6% versus 14.3%; McNemar's P = 0.3). For Rickettsia spp., PCR was four times as sensitive as acute specimen IgM IFA (36.4% versus 9.1%; P = 0.08), although this was not statistically significant. Whole blood and buffy coat, but not serum, were acceptable specimens for these PCRs. Further evaluation of these assays in a larger prospective study is warranted.
180 例发热患者前瞻性评估东方体和立克次体属实时聚合酶链反应（PCR）检测方法用于立克次体感染的早期诊断。通过配对血清学检查，分别有 3.9%（7/180）和 6.1%（11/180）的患者确诊为急性斑疹伤寒或鼠型斑疹伤寒。用于检测东方体和立克次体属的 PCR 检测方法具有很高的特异性（99.4%[95%置信区间（CI）：96.8-100]和 100%[95%CI：97.8-100]）。PCR 结果还与急性血清的免疫球蛋白 M（IgM）免疫荧光分析（IFA）进行了比较。对于东方体，PCR 的敏感性是急性标本 IgM IFA 的两倍（28.6%对 14.3%；McNemar P=0.3）。对于立克次体属，PCR 的敏感性是急性标本 IgM IFA 的四倍（36.4%对 9.1%；P=0.08），尽管这没有统计学意义。全血和白细胞层，而不是血清，是这些 PCR 的可接受标本。需要在更大的前瞻性研究中进一步评估这些检测方法。
