Latar belakang: Tingginya insiden penyakit rickettsial di Asia Tenggara termasukIndonesia, memerlukan alat diagnostik yang cepat dan akurat untuk berbagai agenrickettsiosis yang termasuk dalam typhus group, spotted fever group dan scrub typhusgroup.Tujuan: Penelitian ini bertujuan untuk memberikan gambaran komprehensif mengenaiakurasi uji diagnostik multiplex real-time PCR untuk mendeteksi typhus grouprickettsia (TGR), spotted fever group rickettsia (SFGR) dan Orientia tsutsugamushi(Scrub Typhus Group/STG), pada pasien / sampel dengan penyakit demam akut.Sumber data: Pencarian daring yang sistematis di database PubMed, EBSCOhost,Scopus, dan Google Cendekia, menggabungkan istilah pencarian ‘multipleks real-timePCR’ ,‘ typhus group’, ‘spotted fever group’, dan ‘scrub typhus’.Kriteria kelayakan penelitian: Studi klinis yang memenuhi syarat adalah studi yangmeneliti reliabilitas uji multipleks real time PCR pada pasien / sampel dengan penyakitdemam akut.Penilaian studi: Kualitas metodologis dari studi yang dimasukkan dinilai denganmenggunakan The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2)Hasil: Diperoleh 2 artikel penelitian dengan kualitas sedang dan 1 artikel penelitiandengan kualitas baik. Hanya satu penelitian yang melaporkan nilai akurasi diagnostikmetode multiplex real – time PCR yang digunakan dengan nilai sensitivitas/spesifitasklinis 20% / 99% untuk TGR, 25%/98% untuk SFGR dan 27%/100% untuk STG (OT),dengan nilai prediksi positif/ nilai predeksi negatif sebesar 63%/ 92% untuk SFGR, 75%/ 87% untuk TGR dan 100% / 88% untuk OT(STG). Sementara kedua penelitian yanglain memberikan proporsi positif masing – masing 9 dari 12 (75%) sampel klinisterkonfirmasi positif dan 11 dari 319 (3%) sampel klinis pasien demam akut.Kesimpulan / signifikansi: Nilai sensitifitas klinis uji multiplex real-time PCR untukmendeteksi TGR, SFGR dan STG (Orientia tsutsugamushi) dari penelitian – penelitianyang diikutkan tinjauan sistematik ini masih rendah, namun memiliki spesifisitas klinisyang tinggi. Untuk ke depan, penting untuk mengembangkan uji multiplex real-timePCR dengan sensitifitas klinis yang tinggi untuk mendeteksi bakteri Rickettsia /Orientia pada fase akut sehingga pasien mendapat perawatan yang cepat dan tepat.

---

Background: The high incidence of rickettsiosis in Southeast Asia, including

Indonesia, necessitates rapid and accurate diagnostic tools for a broad range of

rickettsiosis agents, including typhus and spotted fever group and scrub typhus group.

Objectives: This study aimed to provide a comprehensive overview of multiplex realtime

PCR for detecting typhus group rickettsia (TGR), spotted fever group rickettsia

(SFGR) and Orientia tsutsugamushi (Scrub Typhus Group/STG) simultaneously, in

patients/samples with acute febrile illness.

Data sources: A systematic computerized search conduct in PubMed, EBSCOhost,

Scopus, and Google Scholar databases, combining the search term ‘multiplex real-time

PCR,’ ‘spotted fever group,’ ‘typhus group,’ and ‘scrub typhus.’

Study eligibility criteria: Clinical studies that investigate the reliability multiplex real

time PCR assay in patients/samples with acute febrile illness were eligible.

Study appraisal and synthesis methods: The methodological quality of the included

studies was assessed with the use of the The Quality Assessment of Diagnostic

Accuracy Studies 2 (QUADAS-2) checklist

Results: It was obtained two moderate quality articles and one good quality article.

Only one study reported diagnostic accuracy values of multiplex real-time PCR

methods used with clinical sensitivity / specificity values of 20% / 99% for TGR, 25% /

98% for SFGR and 27% / 100% for STG (OT), with positive predictive value / negative

predictive value of 63% / 92% for SFGR, 75% / 87% for TGR and 100% / 88% for OT

(STG). While the other two studies provided a positive proportion each 9 out of 12

(75%) clinical samples were confirmed positive and 11 out of 319 (3%) clinical samples

were acute fever patients.

Conclusion/significance: The clinical sensitivity values of real-time multiplex PCR

assay for detecting TGR, SFGR, and STG (Orientia tsutsugamushi) from studies

included in this systematic review are still low but have high clinical specificity. On the

forward, it is crucial to develop a multiplex real-time PCR test with high clinical

sensitivity to detect Rickettsia / Orientia bacteria in the acute phase so the patients

receive appropriate care.