Rickettsiae in Myanmar

NCT03847870 | Completed

• 1 other identifier: OXTREC 552-18
• Study Type: observational
• Target: 700
• Locations: 1 country
• Sites: 1

Brief Summary

Rickettsial infections have been found to be the second most common cause of non-malarial febrile illness in Southeast Asia, just after dengue, and are largely neglected treatable causes of morbidity and mortality. The rickettsiae can be divided into three major groups: the scrub typhus group (STG), the typhus group (TG) and the spotted fever group (SFG). Rickettsial infections typically present with an acute fever and are difficult to diagnose due to the many different causes of undifferentiated fever in Southeast Asia. Rickettsial IgG seroprevalence, reflecting past infection, will give an estimate of the burden of rickettsial infections in the population. Background seroprevalence studies in countries around Myanmar have found high rates of rickettsial infections. Yet, in Myanmar there have been no prevalence studies on rickettsial infections since the Second World War. We plan to determine IgG levels to the three different groups of rickettsial infections in leftover blood samples in several clinics and hospitals in different regions of Myanmar.

Conditions

Rickettsiae Infections

Keywords

rickettsiae; seroprevalence

Outcome Measures

Primary Outcomes (1)

• Positive ELISA confirmed by positive IFA

  Proportion of patients with a positive IgG ELISA, subsequently confirmed with IFA, for scrub typhus (Orientia tsutsugamushi strains Karp, Kato, Gilliam and TA716), murine typhus (Rickettsia typhi strain type Wilmington), and spotted fever rickettsiosis (Rickettsia honei and Ricketsia conorii).

  January, 2020

Secondary Outcomes (1)

• Patient characteristics associated with rickettsial infections

  January, 2020

Interventions

MORU in-house ELISA test followed by IFA if positive DIAGNOSTIC_TEST

An in-house rickettsial IgG ELISA test will be used for this study to determine previous rickettsial infections by measuring IgG levels. All specimens will be tested for IgG antibodies using ELISA tests for scrub typhus (Orientia tsutsugamushi strains Karp, Kato, Gilliam and TA716), murine typhus (Rickettsia typhi strain type Wilmington), and spotted fever rickettsiosis (Rickettsia honei and Rickettsia conorii). If the sample tests positive, it will be retested for the same antigens using the IFA test. The sample will be considered positive if both the ELISA and the IFA are positive.

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The population investigated will be patients who had a leftover samples from routine clinical blood draw when attending seven different Medical Action Myanmar (MAM) clinics and hospitals in different regions of Myanmar with each site including approximately 100 patients.

You may qualify if:

• Male and female, all age groups, requiring a blood draw for a routine clinical purpose

You may not qualify if:

• Leftover blood sample of less than 500μL

Sponsors & Collaborators

• Myanmar Oxford Clinical Research Unit: lead
• National Health Laboratory, Myanmar: collaborator
• Magway General Hospital, Magway: collaborator
• Monywa Hospital, Sagaing: collaborator
• Mandalay General Hospital and University of Medicine, Mandalay: collaborator
• University of Medicine, Magway: collaborator
• Mahidol Oxford Tropical Medicine Research Unit: collaborator
• Medical Action Myanmar: collaborator

Study Sites (1)

Myanmar Oxford Clinical Research Unit

Yangon, Burma

Location

Related Publications (27)

• Acestor N, Cooksey R, Newton PN, Menard D, Guerin PJ, Nakagawa J, Christophel E, Gonzalez IJ, Bell D. Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review--terra incognita impairing treatment policies. PLoS One. 2012;7(9):e44269. doi: 10.1371/journal.pone.0044269. Epub 2012 Sep 6.

  PMID: 22970193 BACKGROUND

• Aung AK, Spelman DW, Murray RJ, Graves S. Rickettsial infections in Southeast Asia: implications for local populace and febrile returned travelers. Am J Trop Med Hyg. 2014 Sep;91(3):451-60. doi: 10.4269/ajtmh.14-0191. Epub 2014 Jun 23.

  PMID: 24957537 BACKGROUND

• Trung NV, Hoi LT, Thuong NTH, Toan TK, Huong TTK, Hoa TM, Fox A, Kinh NV, van Doorn HR, Wertheim HFL, Bryant JE, Nadjm B. Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever Among Rural and Urban Populations of Northern Vietnam. Am J Trop Med Hyg. 2017 May;96(5):1084-1087. doi: 10.4269/ajtmh.16-0399.

  PMID: 28500808 BACKGROUND

• Walker DH. Rickettsial diseases in travelers. Travel Med Infect Dis. 2003 Feb;1(1):35-40. doi: 10.1016/S1477-8939(03)00025-5.

  PMID: 17291879 BACKGROUND

• PicKard AL, McDaniel P, Miller RS, Uthaimongkol N, Buathong N, Murray CK, Telford SR 3rd, Parola P, Wongsrichanalai C. A study of'febrile illnesses on the Thai-Myanmar border: predictive factors of rickettsioses. Southeast Asian J Trop Med Public Health. 2004 Sep;35(3):657-63.

  PMID: 15689083 BACKGROUND

• Saraswati K, Day NPJ, Mukaka M, Blacksell SD. Scrub typhus point-of-care testing: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018 Mar 26;12(3):e0006330. doi: 10.1371/journal.pntd.0006330. eCollection 2018 Mar.

  PMID: 29579046 BACKGROUND

• Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: A systematic review. PLoS Negl Trop Dis. 2017 Sep 25;11(9):e0005838. doi: 10.1371/journal.pntd.0005838. eCollection 2017 Sep.

  PMID: 28945755 BACKGROUND

• Taylor AJ, Paris DH, Newton PN. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015 Aug 14;9(8):e0003971. doi: 10.1371/journal.pntd.0003971. eCollection 2015.

  PMID: 26274584 BACKGROUND

• Civen R, Ngo V. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis. 2008 Mar 15;46(6):913-8. doi: 10.1086/527443.

  PMID: 18260783 BACKGROUND

• Uchiyama T. Tropism and pathogenicity of rickettsiae. Front Microbiol. 2012 Jun 25;3:230. doi: 10.3389/fmicb.2012.00230. eCollection 2012.

  PMID: 22737150 BACKGROUND

• Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, Chierakul W, Suwancharoen D, Silpasakorn S, Saisongkorh W, Peacock SJ, Day NP, Suputtamongkol Y. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007 Sep;51(9):3259-63. doi: 10.1128/AAC.00508-07. Epub 2007 Jul 16.

  PMID: 17638700 BACKGROUND

• Blacksell SD, Lim C, Tanganuchitcharnchai A, Jintaworn S, Kantipong P, Richards AL, Paris DH, Limmathurotsakul D, Day NPJ. Optimal Cutoff and Accuracy of an IgM Enzyme-Linked Immunosorbent Assay for Diagnosis of Acute Scrub Typhus in Northern Thailand: an Alternative Reference Method to the IgM Immunofluorescence Assay. J Clin Microbiol. 2016 Jun;54(6):1472-1478. doi: 10.1128/JCM.02744-15. Epub 2016 Mar 23.

  PMID: 27008880 BACKGROUND

• Phetsouvanh R, Thojaikong T, Phoumin P, Sibounheuang B, Phommasone K, Chansamouth V, Lee SJ, Newton PN, Blacksell SD. Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg. 2013 May;88(5):932-936. doi: 10.4269/ajtmh.12-0325. Epub 2013 Mar 11.

  PMID: 23478577 BACKGROUND

• Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion. Clin Infect Dis. 2007 Feb 1;44(3):391-401. doi: 10.1086/510585. Epub 2007 Jan 3.

  PMID: 17205447 BACKGROUND

• Blacksell SD, Tanganuchitcharnchai A, Nawtaisong P, Kantipong P, Laongnualpanich A, Day NP, Paris DH. Diagnostic Accuracy of the InBios Scrub Typhus Detect Enzyme-Linked Immunoassay for the Detection of IgM Antibodies in Northern Thailand. Clin Vaccine Immunol. 2015 Dec 9;23(2):148-54. doi: 10.1128/CVI.00553-15. Print 2016 Feb.

  PMID: 26656118 BACKGROUND

• Blacksell SD, Kingston HWF, Tanganuchitcharnchai A, Phanichkrivalkosil M, Hossain M, Hossain A, Ghose A, Leopold SJ, Dondorp AM, Day NPJ, Paris DH. Diagnostic Accuracy of the InBios Scrub Typhus Detect ELISA for the Detection of IgM Antibodies in Chittagong, Bangladesh. Trop Med Infect Dis. 2018 Sep 1;3(3):95. doi: 10.3390/tropicalmed3030095.

  PMID: 30274491 BACKGROUND

• Lim C, Paris DH, Blacksell SD, Laongnualpanich A, Kantipong P, Chierakul W, Wuthiekanun V, Day NP, Cooper BS, Limmathurotsakul D. How to Determine the Accuracy of an Alternative Diagnostic Test when It Is Actually Better than the Reference Tests: A Re-Evaluation of Diagnostic Tests for Scrub Typhus Using Bayesian LCMs. PLoS One. 2015 May 29;10(5):e0114930. doi: 10.1371/journal.pone.0114930. eCollection 2015.

  PMID: 26024375 BACKGROUND

• Pote K, Narang R, Deshmukh P. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India. Indian J Med Microbiol. 2018 Jan-Mar;36(1):108-112. doi: 10.4103/ijmm.IJMM_17_405.

  PMID: 29735837 BACKGROUND

• Rawat V, Singh RK, Kumar A, Singh Y, Chaturvedi P, Saxena SR, Varshney U. Diagnostic validation of IgM and IgG ELISA and real-time PCR in detecting scrub typhus infection in endemic regions. J Vector Borne Dis. 2018 Apr-Jun;55(2):165-167. doi: 10.4103/0972-9062.242565. No abstract available.

  PMID: 30280716 BACKGROUND

• Yang SL, Tsai KH, Chen HF, Luo JY, Shu PY. 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. Am J Trop Med Hyg. 2019 Mar;100(3):532-539. doi: 10.4269/ajtmh.18-0391.

  PMID: 30526730 BACKGROUND

• Tshokey T, Stenos J, Durrheim DN, Eastwood K, Nguyen C, Graves SR. Seroprevalence of rickettsial infections and Q fever in Bhutan. PLoS Negl Trop Dis. 2017 Nov 27;11(11):e0006107. doi: 10.1371/journal.pntd.0006107. eCollection 2017 Nov.

  PMID: 29176880 BACKGROUND

• Khan SA, Bora T, Chattopadhyay S, Jiang J, Richards AL, Dutta P. Seroepidemiology of rickettsial infections in Northeast India. Trans R Soc Trop Med Hyg. 2016 Aug;110(8):487-94. doi: 10.1093/trstmh/trw052. Epub 2016 Sep 12.

  PMID: 27618917 BACKGROUND

• Maude RR, Maude RJ, Ghose A, Amin MR, Islam MB, Ali M, Bari MS, Majumder MI, Tanganuchitcharnchai A, Dondorp AM, Paris DH, Bailey RL, Faiz MA, Blacksell SD, Day NPJ. Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh. Am J Trop Med Hyg. 2014 Sep;91(3):580-583. doi: 10.4269/ajtmh.13-0570. Epub 2014 Aug 4.

  PMID: 25092819 BACKGROUND

• MACKIE TT. Observations on tsutsugamushi disease (scrub typhus) in Assam and Burma. Trans R Soc Trop Med Hyg. 1946 Aug;40:15-56. doi: 10.1016/0035-9203(46)90061-2. No abstract available.

  PMID: 20998610 BACKGROUND

• Ellis RD, Fukuda MM, McDaniel P, Welch K, Nisalak A, Murray CK, Gray MR, Uthaimongkol N, Buathong N, Sriwichai S, Phasuk R, Yingyuen K, Mathavarat C, Miller RS. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg. 2006 Jan;74(1):108-13.

  PMID: 16407353 BACKGROUND

• Watthanaworawit W, Turner P, Turner C, Tanganuchitcharnchai A, Richards AL, Bourzac KM, Blacksell SD, Nosten F. A prospective evaluation of real-time PCR assays for the detection of Orientia tsutsugamushi and Rickettsia spp. for early diagnosis of rickettsial infections during the acute phase of undifferentiated febrile illness. Am J Trop Med Hyg. 2013 Aug;89(2):308-310. doi: 10.4269/ajtmh.12-0600. Epub 2013 Jun 3.

  PMID: 23732256 BACKGROUND

• McGready R, Ashley EA, Wuthiekanun V, Tan SO, Pimanpanarak M, Viladpai-Nguen SJ, Jesadapanpong W, Blacksell SD, Peacock SJ, Paris DH, Day NP, Singhasivanon P, White NJ, Nosten F. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis. 2010 Nov 16;4(11):e888. doi: 10.1371/journal.pntd.0000888.

  PMID: 21103369 BACKGROUND

Study Officials

• Elizabeth Anne Ashley, Dr

  Myanmar Oxford Clinical Research Unit

  PRINCIPAL INVESTIGATOR

• Stuart Blacksell, Prof

  Mahidol Oxford Tropical Medicine Research Unit

  PRINCIPAL INVESTIGATOR

• Philip Elders, MSc

  Myanmar Oxford Clinical Research Unit

  STUDY DIRECTOR

• Wei Yan Aung Htay, Dr

  Myanmar Oxford Clinical Research Unit

  STUDY DIRECTOR

• Yin Yin Htwe, Dr

  National Health Laboratory, Myanmar

  STUDY DIRECTOR

• Myat Myat Moe, Dr

  Magway General Hospital, Magway

  STUDY DIRECTOR

• Wai Mon Kyaw, Dr

  Monywa Hospital, Sagaing

  STUDY DIRECTOR

• Ni Ni Zaw, Dr

  Mandalay General Hospital and University of Medicine, Mandalay

  STUDY DIRECTOR

• Win May Thein, Prof

  Mandalay General Hospital and University of Medicine, Mandalay

  STUDY DIRECTOR

• Thin Thin Nwe, Prof

  University of Medicine, Magway

  STUDY DIRECTOR

• Kyaw Soe, BSc

  Myanmar Oxford Clinical Research Unit

  STUDY DIRECTOR

• Ampai Tanganuchitcharnchai, BSc

  Mahidol Oxford Tropical Medicine Research Unit

  STUDY DIRECTOR

• Ni Ni Tun, Dr

  Myanmar Oxford Clinical Research Unit and Medical Action Myanmar

  STUDY DIRECTOR

• Frank Smithuis, Prof

  Myanmar Oxford Clinical Research Unit and Medical Action Myanmar

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 19, 2019
• First Posted: February 20, 2019
• Study Start: June 20, 2019
• Primary Completion: October 25, 2019
• Study Completion: October 25, 2019
• Last Updated: January 13, 2020

Record last verified: 2020-01

Locations

BU (1)