CD40LG and scrub typhus: This result is consistent with other studies that have identified ELISA as a reliable method for detecting IgM antibodies during the acute phase of scrub typhus [10,11]. Blacksell et al. demonstrated that IgM ELISA exhibits high sensitivity (93.5%) and specificity (91.1%) in diagnosing acute scrub typhus, making it a reliable method for detecting antibodies in endemic regions [12].