{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:21:16Z","timestamp":1792790476566,"version":"4.5.0"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,6]]},"abstract":"<jats:p>Scrub typhus is caused by the intracellular bacterium <jats:italic>Orientia tsutsugamushi<\/jats:italic>. The 56-kDa type-specific antigen (TSA) displays a significant antigenic variation across different <jats:italic>O. tsutsugamushi<\/jats:italic> strains. To minimize the influence of the antigenic diversity of TSA on assay sensitivity, we developed a mixed-TSA enzyme-linked immunosorbent assay (mixed-TSA ELISA) using a mixture of recombinant TSAs of prototype (Karp, Gilliam, and Kato) and local (TW-1, TW-10, TW-19, and TW-22) <jats:italic>O. tsutsugamushi<\/jats:italic> strains as antigens to detect immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against <jats:italic>O. tsutsugamushi<\/jats:italic>. These four local strains covered a major part of the total genetic diversity of TSA gene of <jats:italic>O. tsutsugamushi<\/jats:italic> in Taiwan. A total of 109 acute-phase serum samples from <jats:italic>O. tsutsugamushi<\/jats:italic> polymerase chain reaction\u2013positive, scrub typhus patients, and 82 negative control serum samples from non-scrub typhus cases were used for evaluation of the recombinant TSA-based ELISA. We compared the performance of the mixed-TSA ELISA with immunofluorescence assay (IFA), which is considered the gold standard method for the serological diagnosis of scrub typhus. The results indicated that the sensitivity of IgM mixed-TSA ELISA (80.7%) was significantly higher than that of IgM IFA (68.8%). We demonstrated that the mixed-TSA ELISA had a high sensitivity and specificity and can be used for screening of scrub typhus patient in the early phase of the disease.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0391","type":"journal-article","created":{"date-parts":[[2018,12,11]],"date-time":"2018-12-11T07:01:01Z","timestamp":1544511661000},"page":"532-539","source":"Crossref","is-referenced-by-count":14,"title":["Evaluation of Enzyme-Linked Immunosorbent Assay Using Recombinant 56-kDa Type-Specific Antigens Derived from Multiple Orientia tsutsugamushi Strains for Detection of Scrub Typhus Infection"],"prefix":"10.4269","volume":"100","author":[{"given":"Su-Lin","family":"Yang","sequence":"first","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Republic of China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Hsien","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Public Health and Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang-Fei","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Republic of China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Yu","family":"Luo","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Republic of China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Yun","family":"Shu","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Republic of China;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Syst Bacteriol","first-page":"589","article-title":"Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov","volume":"45","author":"Tamura","year":"1995"},{"key":"b2","series-title":"Trav Med Infect Dis","first-page":"35","article-title":"Rickettsial diseases in travelers","volume":"1","author":"Walker","year":"2003"},{"key":"b3","series-title":"Clin Infect Dis","first-page":"S203","article-title":"Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi","volume":"48","author":"Kelly","year":"2009"},{"key":"b4","series-title":"Clin Infect Dis","first-page":"624","article-title":"Life-threatening scrub typhus in a traveler returning from 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