Diagnostic Value of CD4/CD8 in Scrub Typhus

Abstract

Scrub typhus is often misdiagnosed in febrile patients, leading to antibiotic abuse and multiple complications. We conducted a retrospective record review at the Fourth Affiliated Hospital of Guangxi Medical University in China. Data were collected on 52 patients with a confirmed diagnosis of scrub typhus and complete clinical data. In addition, data were collected on 52 patients with bloodstream infection, 25 patients with HIV infection, 112 patients with common community-acquired pneumonia (CCAP), and 36 patients with severe community-acquired pneumonia (SCAP) to serve as control groups. The peripheral blood CD4 and CD8 counts, CD4/CD8 ratio, C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, and β2 microglobulin levels; and the white blood cell count and neutrophil percentage were compared between the scrub typhus and the control groups. The value of these biomarkers in the diagnosis of scrub typhus was assessed using receiver-operating characteristic curve analysis. The scrub typhus group had a significantly lower CD4 count and CD4/CD8 ratio than the bloodstream infection, CCAP, and SCAP groups, and a significantly greater CD4 count and CD4/CD8 ratio than the HIV infection group. In contrast, the scrub typhus group had a significantly greater CD8 count than the bloodstream infection and CCAP and SCAP groups, and it had a lower level of CD8 than the HIV infection group. The areas under the curve of CD4/CD8 were more than 0.93 in the receiver-operating characteristic curve analysis. These findings suggest that the CD4/CD8 ratio is a useful ancillary test for diagnosing scrub typhus.

Figure 1.

The receiver-operating characteristic (ROC) analysis for scrub typhus and other groups. (A) ROC analysis for CD4, CD8, CD4/CD8, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and β2 microglobulin (β2MG) in scrub typhus vs. non-scrub typhus [including bloodstream infection, HIV infection, common community-acquired pneumonia (CCAP), and severe community-acquired pneumonia (SCAP)]. (B) ROC analysis for CD4, CD8, CD4/CD8, ALT, AST, and β2MG in scrub typhus vs. bloodstream infection. (C) ROC analysis for CD4, CD8, CD4/CD8, ALT, AST, and β2MG in scrub typhus vs. HIV infection. (D) ROC analysis for CD4, CD8, CD4/CD8, ALT, AST, and β2MG in scrub typhus vs. CCAP. (E) ROC analysis for CD4, CD8, CD4/CD8, ALT, AST, and β2MG in scrub typhus vs. SCAP. This figure appears in color at www.ajtmh.org.