Incidence and Type of Monoclonal or Biclonal Gammopathies in Scrub Typhus

Ji Hyun Cho; Do Sim Park

doi:10.3343/kjlm.2009.29.2.116

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Cho and Park: Incidence and Type of Monoclonal or Biclonal Gammopathies in Scrub Typhus

Original Article

Korean J Leg Med 2009;29(2):116-121.

Published online: 14 February 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.2.116

Incidence and Type of Monoclonal or Biclonal Gammopathies in Scrub Typhus

Ji Hyun Cho, M.D.^1,², Do Sim Park, M.D.^1,^2,

¹Department of Laboratory Medicine, School of Medicine, Wonkwang University, Iksan, Korea

²Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University, Iksan, Korea

Corresponding author: Do Sim Park, M.D. Department of Laboratory Medicine, Wonkwang Medical School, 344-2 Shinyong-dong, Iksan, Korea Tel: +82-63-859-1863, Fax: +82-63-842-3786 E-mail: email@wku.ac.kr

Received 29 December 200819 February 2009 Accepted 7 March 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Korea is an endemic area of scrub typhus and it is a common seasonal febrile illness. Although, various humoral immune responses to scrub typhus have been documented, no association between gammopathy and scrub typhus has ever been reported. We analyzed the incidences and types of monoclonal and biclonal gammopathies in scrub typhus for better coping with those gammopathies in scrub typhus.

Methods

Anti-Orientia tsutsugamushi antibody-positive sera identified by indirect immunofluorescence assay were acquired from 40 patients with confirmed scrub typhus. Monoclonal and biclonal gammopathies were screened by protein electrophoresis and were confirmed using immunofixation electrophoresis (IFE). Laboratory findings on admission of the patients with monoclonal or biclonal gammopathy were investigated retrospectively to characterize the gammopathies.

Results

Monoclonal or biclonal gammopathies were detected in 30% (12/40) of patients with scrub typhus (IgG-λ, 40%; IgG-κ, 30%; IgM-κ, 10%; IgM-λ, 10%; IgA-κ, 5%; IgA-λ, 5%). Concentrations of clonal immunoglobulin were less than 3 g/dL in all gammopathies, and hypercalcemia was not detected in any of the patients.

Conclusions

Our results suggest possible association between gammopathies and scrub typhus. Further studies in larger series will be needed for exact incidence and clinical course of gammopathies in scrub typhus.

Keywords: Monoclonal Gammopathy, Biclonal Gammopathy, Orientia tsutsugamushi, Scrub typhus

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Table 1.

Incidence of monoclonal/biclonal gammopathies in scrub typhus patients

	Total scrub typhus (N=40)	Scrub typhus with MG/BG (N=12)	Scrub typhus without MG/BG (N=28)
30≤Age<50	10	0	10
50≤Age<70	20	7	13
70≤Age<81	10	5	5
M/F	20/20	7/5	13/15
% of MG	10 (4/40)	33 (4/12)	0 (0/28)
% of BG	20 (8/40)	67 (8/12)	0 (0/28)

Abbreviations: MG, monoclonal gammopathy; BG, biclonal gammopthy; M, male; F, female.

Table 2.

Clinical and laboratory findings of scrub typhus patients with monoclonal/biclonal gammopathies

MG/BG	No. of case	Age (yr)	Sex	Eschar site	Clinical presentations	Initial Hb/Cr/total calcium (g/dL)/(mg/dL)/(mg/dL)	Type of monoclonal component	Immunoglobulin (mg/dL)	Titer of anti-O.tsutsugamushi antibody
MG	1	56	M	Leg	Fe, R, My, H, D, Ence	WNL/2.2/WNL	IgG-κ	IgG (WNL)	1:1,280
	2	78	M	Chest	Fe, R, My, C, pneumonia	WNL/WNL/WNL	IgG-λ	IgG (1950)	1:1,280
	3	67	M	Shoulder	Fe, R, My, LAP	10.5/WNL/WNL	IgG-λ	IgG (WNL)	1:5,120
	4	67	F	Leg	Fe, R, My, C	WNL/WNL/7.2	IgG-λ	IgG (WNL)	1:2,560
BG	5	55	M	Abdomen	Fe, R, My, H, D, Ence	WNL/WNL/WNL	IgG-κ, IgG-λ	IgG (WNL)	1:10,240
	6	58	M	Flank	Fe, R, My, arrhythmia	WNL/WNL/WNL	IgG-κ, IgG-λ	IgG (1904)	1:2,560
	7	70	F	Leg	Fe, R, My, H, D, Ence	WNL/WNL/7.6	IgG-κ, IgG-λ	IgG (1981)	1:2,560
	8	80	F	Chest	Fe, R, My, effusion, LAP	WNL/1.9/WNL	IgG-κ, IgG-λ	IgG (1836)	1:5,120
	9	78	M	Back	Fe, R, V, UGI bleeding	6.3/WNL/WNL	IgG-κ, IgM-λ	IgG (1690), IgM (577)	1:1,280
	10	60	F	Arm	Fe, My, H, general edema	WNL/WNL/WNL	IgG-λ, IgM-κ	IgG (WNL), IgM (320)	1:2,560
	11	65	F	Back	Fe, R, My, pneumonia	WNL/WNL/WNL	IgA-κ, IgA-λ	IgA (1894)	1:5,120
	12	71	M	Arm	Fe, R, My, pneumonia	WNL/WNL/WNL	IgM-κ, IgM-λ	IgM (631)	1:5,120

Abbreviations: Hb, hemoglobin; Cr, creatinine; Fe, fever; R, rash; My, myalgia, H, headache; D, drowsiness; Ence, encephalopathy; LAP, lymphadenopathy; C, cough; effusion, pleural effusion; V, vomiting; UGI, upper gastrointestinal; WNL, within normal limit; See Table 1.

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