Journal List > Korean J Lab Med > v.29(2) > 1011525

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

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.

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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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