Korean J Lab Med.  2009 Apr;29(2):116-121. 10.3343/kjlm.2009.29.2.116.

Incidence and Type of Monoclonal or Biclonal Gammopathies in Scrub Typhus

• Cho JH
• Park DS

• KMID: 854967
• DOI: http://doi.org/10.3343/kjlm.2009.29.2.116

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-lambda, 40%; IgG-kappa, 30%; IgM-kappa, 10%; IgM-lambda, 10%; IgA-kappa, 5%; IgA-lambda, 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.

Keyword

Monoclonal Gammopathy; Biclonal Gammopathy; Orientia tsutsugamushi; Scrub typhus

MeSH Terms

Adult
Aged
Humans
Immunoglobulin A/blood
Immunoglobulin G/blood
Immunoglobulin Heavy Chains/blood
Immunoglobulin Light Chains/blood
Immunoglobulin M/blood
Incidence
Middle Aged
Orientia tsutsugamushi/immunology
Paraproteinemias/complications/*diagnosis/epidemiology/immunology
Retrospective Studies
Scrub Typhus/complications/*diagnosis/immunology

Reference

1.Amara S., Dezube BJ., Cooley TP., Pantanowitz L., Aboulafia DM. HIV-associated monoclonal gammopathy: a retrospective analysis of 25 patients. Clin Infect Dis. 2006. 43:1198–205.

2.Sève P., Turner R., Stankovic K., Perard L., Broussolle C. Transient monoclonal gammopathy in a patient with Bartonella quintana endocarditis. Am J Hematol. 2006. 81:115–7.

3.Guastafierro S., Sessa F., Tirelli A. Biclonal gammopathy and platelet antibodies in a patient with chronic hepatitis C virus infection and mixed cryoglobulinemia. Ann Hematol. 2000. 79:463–4.

4.Krause R., Auner HW., Daxböck F., Mulabecirovic A., Krejs GJ., Wenisch C, et al. Monoclonal and biclonal gammopathy in two patients infected with Bartonella henselae. Ann Hematol. 2003. 82:455–7.

5.Seong SY., Choi MS., Kim IS. Orientia tsutsugamushi infection: overview and immune responses. Microbes Infect. 2001. 3:11–21.

6.Kim MJ., Kim MK., Kang JS. An epitope shared by cellular cytokeratin and Orientia tsutsugamushi. Microb Pathog. 2006. 41:125–32.

7.Choi BM., Kim DS., Lee HS., Choi SI. A case of multiple myeloma with biclonal (IgG-κ and IgA-κ) M-proteins. Korean J Clin Pathol. 1998. 18:3104. (최병문, 김달식, 이혜수, 최삼임. IgG-kappa 및 IgAkappa형의 2클론성 M-단백을 동반한 다발성 골수종 1예. 대한임상병리학회지 1998;18: 310-4.).

8.Choi JH., Oh HA., Lee G., Lee SY., Kim BD., Ryu HM, et al. A case of multiple myeloma with biclonal gammopathy. Korean J Hematol. 2000. 35:307–10. (최재혁, 오현아, 이구, 이상엽, 김병덕, 류헌모등. 양클론성 감마글로불린 장애(Biclonal Gammopathy)를 보이는 다발성 골수종 1예. 대한혈액학회지 2000;35: 307-10.).

9.Ahn JY., Kim YS., Kim HJ., Song DH., Baek SH. A case of biclonal gammopathy in psoriatic patient with methotrexate treated megaloblastic anemia. Korean J Hematol. 1992. 27:111–6. (안지영, 김연선, 김휘준, 송동화, 백승호. Methotrexate 치료로 인하여 거대적아구성 빈 혈을 보인 건선 환자에서 biclonal gammopathy 1예. 대한혈액학회지 1992;27: 111-6.).

10.Cha YJ., Paik NH., Park AJ. Incidence of M-components in 9813 sera. Korean J Clin Pathol. 1987. 7:191–6. (차영주, 백남희, 박애자. Monoclonal gammopathy의 발생빈도에 관한 연구. 대한임상병리학회지 1987;7: 191-6.).

11.Kyle RA., Rajkumar SV. Monoclonal gammopathy of undetermined significance. Clin Lymphoma Myeloma. 2005. 6:102–14.

12.Lolin YI., Chow J., Wickham NW. Monoclonal gammopathy of unknown significance and malignant paraproteinemia in Hong Kong. Am J Clin Pathol. 1996. 106:449–56.

13.Hargreaves RM., Lea JR., Griffiths H., Faux JA., Holt JM., Reid C, et al. Immunological factors and risk of infection in plateau phase myeloma. J Clin Pathol. 1995. 48:260–6.

14.Fiorino AS., Atac B. Paraproteinemia, plasmacytoma, myeloma and HIV infection. Leukemia. 1997. 11:2150–6.

15.Musto P. Hepatitis C virus infection and B-cell non-Hodgkin's lymphomas: more than a simple association. Clin Lymphoma. 2002. 3:150–60.

16.Landau DA., Saadoun D., Calabrese LH., Cacoub P. The pathophysiology of HCV induced B-cell clonal disorders. Autoimmun Rev. 2007. 6:581–7.

17.Grogg KL., Miller RF., Dogan A. HIV infection and lymphoma. J Clin Pathol. 2007. 60:1365–72.

18.Vaiopoulos G., Sideris P., Anargyrou K., Melas P., Plessas N., Konstantopoulos K. Transient monoclonal hypergammaglobulinemia during the course of a rickettsia infection. Infection. 2002. 30:249–50.

19.International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003. 121:749–57.

20.Jung S., Kim M., Lim J., Kim Y., Han K., Min CK, et al. Serum free light chains for diagnosis and follow-up of multiple myeloma. Korean J Lab Med. 2008. 28:169–73. (정선경, 김명신, 임지향, 김용구, 한경자, 민창기 등. 다발성골수종 환자의 진단 및 치료효과 추적을 위한 혈청 유리형경쇄정량검사의의의. 대한진단검사의학회지 2008;28: 169-73.).