Histopathological diagnosis of Japanese spotted fever using formalin-fixed, paraffin-embedded skin biopsy specimens: Usefulness of immunohistochemistry and real-time PCR analysis Tamakuma et al. Histopathological diagnosis of Japanese spotted fever

K. Tamakuma, Yasuyoshi Mizutani, M. Ito, Kazuya Shiogama, K. Inada, K. Miyamoto, H. Utsunomiya, F. Mahara, Y. Tsutsumi

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Abstract

Japanese spotted fever (JSF) is caused by Rickettsia japonica, and lethal cases are reported yearly in southwest Japan. We thus established the method of diagnosing JSF by immunohistochemistry (IHC) and real-time PCR (RT-PCR) using formalin-fixed, paraffin-embedded skin biopsy specimens. Two monoclonal antibodies were used for IHC, and the 17k genus common antigen gene served as the target of RT-PCR. We collected skin biopsy (n=61) and autopsy (n=1) specimens from 50 patients clinically suspected of JSF. Immunohistochemically, the rickettsial antigens were localized as coarse dots in the cytoplasm of endothelial cells and macrophages. Thirty-one seropositive cases plus one autopsy case (group A) and nine seronegative cases but with positive IHC and/or RT-PCR (group B) were judged as JSF. Nine cases were regarded as non-JSF disorders based on negative serology, IHC and RT-PCR (group C). Of 50 biopsies (eschar 34, eruptions 10, and scabs 6) from groups A and B, IHC and RT-PCR positivities were 94% (32/34) and 62% (21/34) for eschar, 80% (8/10) and 30% (3/10) for eruptions, and 33% (2/6) and 50% (3/6) for scabs. For IHC, eschar was most suitable, and scabs were insufficient. Unexpectedly, 18 biopsies happened to be fixed in 100% formalin, and this lowered the detection rate by RT-PCR, but IHC was tolerant. Sequence analysis using five skin biopsy specimens confirmed a 114bp DNA stretch homologous to that reported for the target gene of R. japonica. In 26 (84%) of the 31 seropositive patients, the diagnosis was made by IHC and/or RT-PCR earlier than serology.

Original languageEnglish
Pages (from-to)260-267
Number of pages8
JournalClinical Microbiology and Infection
Volume18
Issue number3
DOIs
Publication statusPublished - 01-01-2012

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Paraffin
Formaldehyde
Real-Time Polymerase Chain Reaction
Fever
Immunohistochemistry
Biopsy
Skin
Serology
Autopsy
vpr Genes
Antigens
Rickettsia
Sequence Analysis
Japan
Cytoplasm
Endothelial Cells
Macrophages
Monoclonal Antibodies
DNA
Genes

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Histopathological diagnosis of Japanese spotted fever using formalin-fixed, paraffin-embedded skin biopsy specimens: Usefulness of immunohistochemistry and real-time PCR analysis Tamakuma et al. Histopathological diagnosis of Japanese spotted fever",
abstract = "Japanese spotted fever (JSF) is caused by Rickettsia japonica, and lethal cases are reported yearly in southwest Japan. We thus established the method of diagnosing JSF by immunohistochemistry (IHC) and real-time PCR (RT-PCR) using formalin-fixed, paraffin-embedded skin biopsy specimens. Two monoclonal antibodies were used for IHC, and the 17k genus common antigen gene served as the target of RT-PCR. We collected skin biopsy (n=61) and autopsy (n=1) specimens from 50 patients clinically suspected of JSF. Immunohistochemically, the rickettsial antigens were localized as coarse dots in the cytoplasm of endothelial cells and macrophages. Thirty-one seropositive cases plus one autopsy case (group A) and nine seronegative cases but with positive IHC and/or RT-PCR (group B) were judged as JSF. Nine cases were regarded as non-JSF disorders based on negative serology, IHC and RT-PCR (group C). Of 50 biopsies (eschar 34, eruptions 10, and scabs 6) from groups A and B, IHC and RT-PCR positivities were 94{\%} (32/34) and 62{\%} (21/34) for eschar, 80{\%} (8/10) and 30{\%} (3/10) for eruptions, and 33{\%} (2/6) and 50{\%} (3/6) for scabs. For IHC, eschar was most suitable, and scabs were insufficient. Unexpectedly, 18 biopsies happened to be fixed in 100{\%} formalin, and this lowered the detection rate by RT-PCR, but IHC was tolerant. Sequence analysis using five skin biopsy specimens confirmed a 114bp DNA stretch homologous to that reported for the target gene of R. japonica. In 26 (84{\%}) of the 31 seropositive patients, the diagnosis was made by IHC and/or RT-PCR earlier than serology.",
author = "K. Tamakuma and Yasuyoshi Mizutani and M. Ito and Kazuya Shiogama and K. Inada and K. Miyamoto and H. Utsunomiya and F. Mahara and Y. Tsutsumi",
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T2 - Usefulness of immunohistochemistry and real-time PCR analysis Tamakuma et al. Histopathological diagnosis of Japanese spotted fever

AU - Tamakuma, K.

AU - Mizutani, Yasuyoshi

AU - Ito, M.

AU - Shiogama, Kazuya

AU - Inada, K.

AU - Miyamoto, K.

AU - Utsunomiya, H.

AU - Mahara, F.

AU - Tsutsumi, Y.

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Y1 - 2012/1/1

N2 - Japanese spotted fever (JSF) is caused by Rickettsia japonica, and lethal cases are reported yearly in southwest Japan. We thus established the method of diagnosing JSF by immunohistochemistry (IHC) and real-time PCR (RT-PCR) using formalin-fixed, paraffin-embedded skin biopsy specimens. Two monoclonal antibodies were used for IHC, and the 17k genus common antigen gene served as the target of RT-PCR. We collected skin biopsy (n=61) and autopsy (n=1) specimens from 50 patients clinically suspected of JSF. Immunohistochemically, the rickettsial antigens were localized as coarse dots in the cytoplasm of endothelial cells and macrophages. Thirty-one seropositive cases plus one autopsy case (group A) and nine seronegative cases but with positive IHC and/or RT-PCR (group B) were judged as JSF. Nine cases were regarded as non-JSF disorders based on negative serology, IHC and RT-PCR (group C). Of 50 biopsies (eschar 34, eruptions 10, and scabs 6) from groups A and B, IHC and RT-PCR positivities were 94% (32/34) and 62% (21/34) for eschar, 80% (8/10) and 30% (3/10) for eruptions, and 33% (2/6) and 50% (3/6) for scabs. For IHC, eschar was most suitable, and scabs were insufficient. Unexpectedly, 18 biopsies happened to be fixed in 100% formalin, and this lowered the detection rate by RT-PCR, but IHC was tolerant. Sequence analysis using five skin biopsy specimens confirmed a 114bp DNA stretch homologous to that reported for the target gene of R. japonica. In 26 (84%) of the 31 seropositive patients, the diagnosis was made by IHC and/or RT-PCR earlier than serology.

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