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

Abstract

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, 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, 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