The objective of this study was to determine the optimal cutoff value of serum adenosine deaminase (ADA) activity for diagnosing scrub typhus in acute febrile patients, especially in the autumn. A total of 715 febrile patients were included; 286 of them were diagnosed with acute scrub typhus. The mean serum ADA activities in patients with and without scrub typhus were 42.8 ± 13.4 IU/L and 17.2 ± 11.5 IU/L, respectively. The optimal cutoff value for serum ADA activity was determined to be 25.0 IU/L with a sensitivity of 92.3%, specificity of 86.6%, and area under the curve of 89.4% using a receiver-operating characteristic curve analysis. The possibility of scrub typhus must be considered when acute febrile patients present with high ADA activity (>25 IU/L), especially in the autumn. Determining the optimal serum ADA activity cutoff value may help clinicians diagnose acute scrub typhus prior to serological confirmation.
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