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Open Access Short Report

Clinically helpful rickettsial disease diagnostic IgG titers in relation to duration of illness in an endemic setting in Sri Lanka

Ranjan Premaratna1*, Sanjaya Weerasinghe1, Amanda Ranaweera1, TGA Nilmini Chandrasena2, Narasinghe W Bandara3, Gregory A Dasch4 and H Janaka de Silva1

Author Affiliations

1 Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka

2 Department of Parasitology, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka

3 Department of Microbiology, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka

4 Rickettsial Zoonoses Branch, CDC, Atlanta, GA, USA

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BMC Research Notes 2012, 5:662  doi:10.1186/1756-0500-5-662

Published: 30 November 2012

Abstract

Background

Although an initial IFA-IgG titer greater or equal to 1/64 or 1/128 is considered positive in presumptive diagnosis, in clinical practice in an endemic setting for rickettsioses in Sri Lanka, some patients with IFA-IgG titer of 1/128 for either spotted fever group (SFG) or scrub typhus (ST) did not respond to treatment.

Findings

To determine a clinically helpful diagnostic algorithm, IFA-IgG results of serologically confirmed treatment responders were analyzed in relation to duration of illness at sampling. Of 146 suspected SFG, 3 responders of 25 patients had titers ≤1/128 with < 7 days of illness while all 9 with titers ≥1/256 responded (false negative with 1/256 cutoff was 12%, false positive was 0%). For illness > 7 days, the false negative and positive rates were 4.3% (3/59) and 11.3% (6/53). Of 115 suspected ST, false negative and positive rates with ≥1/256 cutoff at <7 days of illness were 14.2% (2/14) and 0% (0/8) respectively while > 7 days, false negative and positive rates were 2% (1/51) and 0% (0/42).

Conclusions

For clinical decision making, duration of illness at sampling is important in interpreting serology results in an endemic setting. If sample is obtained ≤7 day of illness, an IgG titer of ≤1/128 requires a follow up sample in the diagnosis and > 7 days of illness, a single ≥1/256 titer is diagnostic for all ST and 90% of SFG.

Keywords:
Diagnosis Rickettsioses; IFA-IgG; Endemic; Sri Lanka; Orientia tsutsugamushi; Spotted fever