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Determination of cut-off of diagnostic ELISA for Scrub typhus in endemic setup: Central India

1 Division of In-vivo Research, ICMR- National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
2 Division of Virology & Zoonoses, ICMR-NIRTH, Jabalpur, India
3 Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
4 Division of Genetic disorder; Division of Vector borne diseases, ICMR-NIRTH, Jabalpur, India

Correspondence Address:
HV Manjunathachar,
Scientist-B, Division of In-vivo Research, ICMR- National Institute of Research in Tribal Health (NIRTH), Jabalpur-482003, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-9062.316272

Serology remains the mainstay for diagnosis of scrub typhus. In central India, diagnosis of this neglected emerging zoonotic disease suffers due to lack of standardized region-specific cutoff value and diagnostic test. Henceforth, standardized region-specific cutoff value for diagnostic ELISA play a significant role in initial treatment of patients and to differentiate other febrile diseases in the endemic setup. A total of 144 patients of all age groups with acute undifferentiated febrile illness patients, forty healthy controls, dengue and chikungunya positive thirty-five samples in each category, respectively were enrolled in the study and subjected to IgM ELISA (InBioS, International, Inc.). Samples showing OD value more than 0.5 in IgM ELISA were subjected to nested PCR. Receiver operating characteristic (ROC) curve and healthy volunteer samples mean with + 3 SD were both considered to generate region specific cutoff OD value. A total of 48 patients were diagnosed as cases of scrub typhus through IgM ELISA. Out of 48 samples, 30 were positive by nested PCR. The ROC curve analysis revealed a diagnostic ELISA cutoff value of 0.73 with sensitivity and specificity of 95% and 100%, respectively. The cut off arrived from healthy volunteer is mean OD + 3 SD is 0.72. Considering the significance of scrub typhus diagnosis for treatment and to understand disease dynamics region wise, the cutoff value of >0.72 for diagnostic ELISA for Madhya Pradesh, India can be used.

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