Tripathi Chandra Dev Pati, Singh Mastan, Agarwal Jyotsna, Kanta Chandra, Atam Virendra
Ph.D. Student, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Ex-Professor and Head, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
J Clin Diagn Res. 2017 Jun;11(6):DC04-DC09. doi: 10.7860/JCDR/2017/25926.10029. Epub 2017 Jun 1.
Spotted Fever Rickettsiosis (SFR), an acute febrile illness caused by , and which is associated with considerable morbidity and mortality. SFR is one of the most covert emerging infections of the present time which is prevalent in various parts of India as shown by the increase in the number of clinically diagnosed patients in various states except Uttar Pradesh.
To diagnose SFR in clinically suspected patients using serological tests and recognition of common epidemiologic situations and clinical manifestations of SFR in the state of Uttar Pradesh.
Patients of all age groups presented with a diagnosis of Pyrexia of Unknown Origin (PUO) from May 2013 to February 2015 were evaluated. Testing was done using a nonspecific Weil felix test followed by more specific Enzyme Linked Immunosorbent Assay (ELISA) and a gold standard Immunofluorescence Assay (IFA) test for specific IgM antibodies against . The data was statistically analysed on Graph Pad Prism (5.0) software by using Chi-square test.
Of the 432 patient samples tested by non specific Weil felix test, 200 (46.29 %) samples showed titre 1:80 or more and were taken as positive. Similarly out of the 432 blood samples tested by both ELISA and IFA based test against IgM antibody, only 115 (26.62%) samples were found to be positive and these samples were also positive by Weil felix. The common symptoms noted were fever, hepatomegaly, thrombocytopenia, lymphadenopathy and rashes, nausea followed by icterus, cyanosis, headache, oedema and abdominal pain. Eschar was found in only four (3.4%) patients. We also found that 31 patients with SFR also had associated co-infections like typhoid, malaria, dengue and hepatitis.
Our findings demonstrated that Weil Felix test can fill in as an underlying yet not sole strategy to perceive and analyse rickettsial ailments, as it needs specificity. So, it may be used to assess the burden in the area and later on other tests like ELISA or IFA can be added, as these are more specific diagnostic tests. Further, our results also showed that if a patient tests positive for the more common endemic infections, we must test for rickettsiosis so that appropriate treatment could be administered.
斑点热立克次体病（SFR）是一种由[具体病原体未给出]引起的急性发热性疾病，伴有相当高的发病率和死亡率。SFR是目前最隐匿的新发感染之一，在印度各地都有流行，除北方邦外，其他各邦临床诊断患者数量的增加就表明了这一点。
通过血清学检测诊断临床疑似患者的SFR，并识别北方邦SFR常见的流行病学情况和临床表现。
对2013年5月至2015年2月间诊断为不明原因发热（PUO）的各年龄组患者进行评估。检测采用非特异性外斐试验，随后进行更具特异性的酶联免疫吸附测定（ELISA）以及针对[具体病原体未给出]特异性IgM抗体的金标准免疫荧光测定（IFA）试验。数据使用Graph Pad Prism（5.0）软件通过卡方检验进行统计学分析。
在通过非特异性外斐试验检测的432份患者样本中，200份（46.29%）样本滴度达到1:80或更高，被判定为阳性。同样，在通过基于ELISA和IFA检测抗[具体病原体未给出]IgM抗体的432份血样中，仅115份（26.62%）样本呈阳性，且这些样本外斐试验也呈阳性。常见症状包括发热、肝肿大、血小板减少、淋巴结病和皮疹，继而是恶心，随后出现黄疸、发绀、头痛、水肿和腹痛。仅4例（3.4%）患者发现有焦痂。我们还发现31例SFR患者同时伴有伤寒、疟疾、登革热和肝炎等合并感染。
我们的研究结果表明，外斐试验可作为初步但非唯一的方法来识别和分析立克次体病，因为它缺乏特异性。因此，它可用于评估该地区的疾病负担，随后可增加ELISA或IFA等其他检测，因为这些是更具特异性的诊断检测。此外我们的结果还表明，如果患者检测出更常见地方感染呈阳性，必须检测是否感染立克次体病，以便进行适当治疗。
