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PubMedDate not supplied

Study on agglutinating factors from flocculent Saccharomyces cerevisiae strains.

The lectin-like theory suggest that yeast flocculation is mediated by an aggregating lectinic factor. In this study we isolated an agglutinating factor, which corresponds to lectin, from whole cells by treating the flocculent wild-type Saccharomyces cerevisiae NCYC 625 strain and its weakly flocculent mutant [rho degrees ] with EDTA and two non-ionic surfactants (Hecameg and HTAC). The dialysed crude extracts obtained in this way agglutinated erythrocytes and this hemagglutination was specifically inhibited by mannose and mannose derivatives. However, SDS-PAGE profiles showed that the three reagents had different effects on the yeast cells. The non-ionic surfactants appeared to be the most efficient, as their extracts possessed the highest specific agglutinating activity. The products released by the wild-type strain presented a higher specific agglutinating activity than those released by the [rho degrees ] mutant. Purification of the agglutinating factor from extracts of both strains by affinity chromatography revealed two active bands of relative mass of 26 and 47 kDa on SDS-PAGE. Mass spectrometry analysis by MALDI-TOF, identified a 26 kDa band as the triose phosphate isomerase (TPI) whereas a 47 kDa band was identical to enolase. Edman degradation showed that the N-terminal sequences of these proteins were similar to TPI and enolase, respectively. The difference in the flocculation behaviour of the two strains is due to changes in the protein composition of the cell wall and in the protein structure involved in cell-cell recognition.

Agglutinins↗
PubMed1985

Characterization of the platelet agglutinating activity of thrombospondin.

Thrombospondin (TSP) is a glycoprotein secreted from the alpha-granules of platelets upon activation. In the presence of divalent cations, the secreted protein binds to the surface of the activated platelets and is responsible for the endogenous lectin-like activity associated with activated platelets. Platelets fixed with formaldehyde following activation by thrombin are agglutinated by exogenously added TSP. Fixed, nonactivated platelets are not agglutinated. The platelet agglutinating activity of TSP is optimally expressed in the presence of 2 mM each of Mg2+ and Ca2+. Reduction of the disulfide bonds within the TSP molecule inhibits its platelet agglutinating activity. TSP bound to the surface of fixed, activated platelets can be eluted by the addition of disodium ethylenediaminetetraacetate. This approach was exploited to identify the region of the TSP molecule containing the platelet binding site. The binding site resides within a thermolytic fragment of TSP with Mr 140 000 but is not present in the Mr 120 000 fragment derived from the polypeptide of Mr 140 000. Since both the Mr 140 000 and 120 000 fragments contain fibrinogen binding sites, this finding suggests that the binding of TSP to the platelet surface requires interaction with other platelet surface components in addition to fibrinogen. The observation that fibrinogen only partially inhibits the TSP-mediated agglutination of fixed, activated platelets is consistent with this interpretation.

Blood Platelets↗
PubMed1976

V irus and lectin agglutination of erythrocytes: spin label study of membrane lipid-protein interactions.

Techniques of spin-label electron spin resonance have been used to prove changes in the structure of the lipid phase of erythrocyte membrane after agglutination by viruses and lectins. When chicken erythrocytes are agglutinated by Sendai and influenza viruses and by the lectins concanavalin A and wheat germ agglutinin, the membrane lipid phase becomes more fluid, as detected by three different lipophilic spin-laveled probes. Colchicine, vinblastine, and tetracaine inhibit the fluidization of chicken erythrocyte membrane by Sendai virus, whereas cytochalasin B has no effect. The effect of colchicine was time dependent, the initial inhibition decreasing with longer preincubation times. Extensive treatment of erythrocytes with proteases or neuraminidase, while not altering the bilayer structure, abolishes the effect of Sendai virus on the erythrocyte membrane, suggesting that a change in the interaction of the receptor protein with the lipid phase occurs upon virus attachment. Glutaraldehyde fixation increased the structural rigidity of the chicken erythrocyte membrane and inhibited the effect of viral agglutination. No change in bilayer structure was observed upon agglutination of human erythrocytes or the isolated plasma membranes of either human or chicken erythrocytes. This result is consistent with the drug sensitivity of the effects of agglutination upon chicken erythrocytes, since human erythrocytes and isolated membranes lack microtubule-like structures.

Animals↗
PubMed2000

Rotavirus detection using ultrasound enhanced latex agglutination and turbidimetry.

Application of a non-cavitating ultrasonic standing wave to suspended microparticles brings the particles into close approximation and has been used previously to enhance the performance of several diagnostic agglutination tests. The sensitivity of rotavirus detection by ultrasound enhanced latex agglutination was compared with conventional test-card agglutination. Application of ultrasound gave a 32-fold improvement in the sensitivity of detection of rotavirus antigen in buffer compared with the test card method. A novel turbidimetric approach was used to measure agglutination occurring following the test-card procedure (in place of visual examination) and following exposure of commercial rotavirus latex reagents to a 4.5 MHz ultrasonic field (in place of microscopy). The sensitivity enhancement over the conventional method achievable through ultrasonic exposure was comparable whether agglutination measurements were made visually or turbidimetrically and demonstrates the potential for turbidimetry in combination with the ultrasonic method. Turbidimetry offers an alternative to visual assessment that may be more easily incorporated into automated systems.

Antigens, Viral↗
PubMed1979

Correlation between concanavalin A agglutinability and cytotoxic sensitivity to antiserum against tumor-associated antigen in rat fibrosarcoma cells.

An ip transplantation of 3-methylcholanthrene-induced, transplanted fibrosarcoma KMT-17 cells (1 X 10(8)) grew rapidly and killed syngeneic WKA rats in 3-4 days. Agglutinability induced by concanavalin A (Con A) and antigenic expression of KMT-17 cells were investigated in relation to days after ip transplantation. Agglutinability was highest in 1-day-old cells and lowest in 3-day-old cells. The agglutinability of 3-day-old cells increased again when these cells were transplanted into normal rats. The cytotoxic sensitivity of tumor cells to antiserum against tumor-associated surface antigen (TASA) changed simultaneously with the degree of Con A agglutinability. This phenomenon disappeared after artificial infection of tumor cells with Friend murine leukemia virus. The result of the quantitative absorption test at 4 degrees C overnight was that 1- and 3-day-old cells did not differ in their absorbing capacities to anti-TASA sera. However, when the absorption test was done at 37 degrees C for 60 minutes, 1-day-old cells had approximately 16 times more absorbing capacity than 3-day-old cells. However, the cytotoxic sensitivity to antiserum against histocompatibility antigen did not change, regardless of the number of days after ip transplantation. Analysis based on the quantitative absorption test revealed no difference in antibody-absorbing capacities between 1- and 3-day-old cells at both 4 degrees C and 37 degrees C. The relationship between Con A agglutinability and cytotoxic sensitivity to anti-TASA serum is discussed from the viewpoint of "lateral receptor mobility" on the cell surface.

Animals↗
PubMed1980

C-Reactive protein induced agglutination of lipid suspensions prepared in the presence and absence of phosphatidylcholine.

CRP-induced agglutination of lipid suspensions prepared in the presence and absence of phosphatidylcholine was studied by a newly devised quantitative method. CRP caused as much agglutination of suspensions composed of egg yolk phosphatidylcholine, cholesterol, and Span 60 as of those composed of cholesterol and Span 60, suggesting that phosphocholine residues of phosphatidylcholine are not important as binding sites for CRP. Agglutination of suspensions prepared without phosphatidylcholine was inhibited by phosphocholine, indicating that the inhibition by phosphocholine is non-competitive. Although phosphatidylcholine is not an essential component for agglutination of suspensions, it may modify the mode of interaction of CRP with its binding site on lipid suspensions, since the sensitivity of the agglutination to phosphocholine and the Ca2+ requirement were influenced by the presence of phosphatidylcholine in the suspensions.

C-Reactive Protein↗
PubMed1996

Case report: immunoglobulin M-mediated, temperature-dependent neutrophil agglutination as a cause of pseudoneutropenia.

The authors report the case of a 77-year-old man in whom intermittent neutropenia developed during a prolonged hospitalization. Laboratory records revealed wide variations in the patient's routine leukocyte counts. Examination of the peripheral smear revealed clumps of 2-3 polymorphonuclear leukocytes throughout the slide and large aggregates (> 50 cells) along the smear edges. Neutrophil clumping also was observed in blood anticoagulated with citrate or heparin. Replacement of patient plasma with saline prevented agglutination. Addition of patient plasma or serum to normal cells induced neutrophil agglutination. Holding the patients blood at 37 degrees C prevented agglutination, which occurred spontaneously and more exuberantly as the temperature was reduced to 22 degrees C. Flow cytometry revealed immunoglobulin M on neutrophil surfaces. Spontaneous agglutination resolved 6 months after resection of the patient's subsequently diagnosed colon cancer. This is the first report of immunoglobulin M-induced neutrophil clumping occurring in the setting of malignancy, and the first reported immunoglobulin M not to require ethylenediaminetetraacetic acid as a cofactor for agglutination.

Adult↗
PubMed1992

Assessment of a rapid latex agglutination test for group B streptococcal colonization of the genital tract.

OBJECTIVE: The purpose of this study was to determine the reliability of a rapid enzyme extraction-latex agglutination test in detecting intrapartum colonization of the maternal genital tract by group B streptococci. METHODS: Swabs of vaginal secretions were obtained from 314 patients in labor with either ruptured or intact membranes. Four tests were performed on each specimen: 1) qualitative culture on blood agar, 2) semiquantitative culture on blood agar, 3) culture in selective Todd-Hewitt broth, and 4) latex agglutination preceded by enzyme extraction. RESULTS: The prevalence of positive cultures was 29%. When compared with culture in Todd-Hewitt broth, the latex agglutination test had a sensitivity of 30%, specificity 93%, positive predictive value 64%, and negative predictive value 76%. In patients with heavy colonization the test had a sensitivity of 76%, compared with 17% in patients with light growth (P less than .001). The lower limit of sensitivity of the test was 4 x 10(5) cfu/mL. The performance of the test was not affected by rupture of the membranes. CONCLUSION: Although the latex agglutination test is reasonably sensitive in detecting heavy colonization, low overall performance combined with technical difficulties in assessment of particle agglutination make the test unsuitable for general screening.

Evaluation Studies as Topic↗
PubMed2006

Evaluation of six agglutination tests for Staphylococcus aureus identification depending upon local prevalence of meticillin-resistant S. aureus (MRSA).

Most routine laboratory detection of Staphylococcus aureus isolates is based on rapid agglutination test systems. Failure of agglutination assays to identify meticillin-resistant S. aureus strains (MRSA) has been demonstrated. The aim of this study was to evaluate six commercially available agglutination tests for the detection of meticillin-sensitive S. aureus (MSSA) and mecA-positive MRSA strains. The Dry Spot Staphytect Plus test (Oxoid), the Pastorex Staph Plus test (Bio-Rad), the Slidex Staph-Kit and Slidex Staph Plus test (bioMérieux), the Staphaurex Plus test (Remel) and the Staphylase Test (Oxoid) were used. As determined by pulsed field gel electrophoresis, 52 distinct MRSA strains from five countries, 83 MSSA strains and 150 coagulase-negative staphylococci were included. Species identification and determination of susceptibility patterns were performed using colony morphology, Gram stain, catalase testing, tube coagulase testing, DNase testing, mannitol fermentation, susceptibility testing towards oxacillin by Etest, coagulase gene PCR, fibrinogen receptor gene PCR and PCR of the mecA gene. Sensitivity of the agglutination tests ranged from 82.7 to 100.0 % for MRSA strains and 92.8 to 100.0 % for MSSA strains, respectively. Specificity of the test systems ranged from 91.3 to 99.1 %. None of the six agglutination assays produced correct reactions for all staphylococci tested. Only the Dry Spot Staphytect Plus test correctly identified all 52 MRSA strains. For the other tests kits, sensitivity of MRSA detection was lower than for MSSA isolates. Depending upon the local MRSA prevalence and the parameter of interest (sensitivity or specificity), these test systems may be useful for routine diagnostic purposes.

Anti-Bacterial Agents↗
PubMed1978

Isolation and Characterization of Factors in Sweet Potato Root Which Agglutinate Germinated Spores of Ceratocystis fimbriata, Black Rot Fungus.

A factor which agglutinates the germinated spores of Ceratocystis fimbriata was isolated from the sweet potato root. The factor is a glycoprotein with a molecular weight of 1.6 x 10(6) daltons and required divalent cations such as Ca(2+), Mn(2+), Ni(2+), and Mg(2+) for activity. The activity of the factor was pH-dependent. The factor also agglutinated rabbit erythrocytes and is classified as a phytohemagglutinin or lectin. The factor agglutinated germinated spores of seven strains of C. fimbriata to almost the same degree. The factor showed differential agglutinating activity toward the strains in the presence of unidentified low molecular weight factor(s) in the sweet potato root. These results support our earlier suggestion that the spore-agglutinating factors in host plants function as the determinants of specificity in some host-parasite interactions.

Journal Article↗
PubMed1977

A latex agglutination test for rapid quantitative estimation of the plasmin-antipalsmin complex in human plasma.

An antiserum was raised in rabbits against human plasmin-antiplasmin complex and rendered specific for neoantigens of this complex by absorption with purified plasminogen and plasma. Polystyrene particles were coated with the specific antibodies and used in an agglutination test for the determination of plasmin-antiplasmin complex in the plasma from various patients. Purified plasmin-antiplasma complex at a concentration of 0.1-0.2 mg/l was found to cause a clear agglutination of the particles. Activation of fresh human plasma with urokinase caused progressive generation of agglutinating activity up to a plasma dilution of 1/480. Intravenous infusion of streptokinase into patients resulted in an increase of the plasmin-antiplasmin titre of at least 1/240. Sera from patients with rheumatoid factor also agglutinated the particles but this activity could be removed by absorbing rheumatoid factor on insolubilized human IgG. Out of 101 male and twenty-three female control subjects, only three men had a plasmin-antiplasmin titre above 1/16. Of 230 hospitalized patients, plasmin-antiplasmin titres of 1/40 or more were detected in twenty-five patients. Most of these patients had diseases which are frequently associated with in vivo coagulation or fibrinolysis, but among them there was only one who showed diffuse intravascular coagulation detectable by classical methods. In the absence of an increased plasmin-antiplasmin titre none of the haemostasis analyses were indicative of in vivo coagulation or fibrinolysis. Seven out of eight patients with diffuse intravascular coagulation of various origin had plasmin-antiplasmin titres of 1/80 or 1/160. Thus, the present latex agglutination test, owing to its simplicity and sensitivity, appears to be a practical routine screening test for detecting fibrinolytic activation in plasma.

Adolescent↗
PubMed1976

Groups of alpha-D- galactosyltransferase activity in sera of individuals with normal B phenotype. II. Relationship between transferase activity and red cell agglutinability.

In the Paris population of blood donors with normal B phenotype, two groups can be formed owing to their respective serum alpha-D-galactosyltransferase activity and red cell agglutinability with an anti-B antibody. Both parameters are closely correlated. The agglutinability groups partially overlap. In an African population from various ethnical origins, this correlation was observed only in some individuals. 11 among 20 subjects belonged to a third group defined by a high transferase activity. The third group with the strongest agglutinability previously described by GIBBS et al. [6] were not encountered. On the other hand, serum transferase activity varied inversely as agglutination scores with anti-H (Ulex). Both parameters are closely correlated but not in the same way in Caucasian as in African individuals. In the latter, this relation does not depend on the agglutinability group. The H antigen strength variability, according to ethnical origins, may explain these results.

ABO Blood-Group System↗
PubMed2005

Evaluation of latex agglutination kits for detection of fibrin(ogen) degradation products and D-dimer in healthy horses and horses with severe colic.

BACKGROUND: Fibrin(ogen) degradation products (FDPs) and D-dimer are sensitive indicators of excessive fibrinolysis due to disseminated intravascular coagulation (DIC) in dogs. To the authors' knowledge, latex-agglutination-based plasma FDP and D-dimer assays have not been validated for use in horses. OBJECTIVES: To determine: 1) sensitivity and specificity of latex agglutination serum and plasma FDP and D-dimer assays for diagnosis of DIC; and 2) their prognostic value in horses with severe colic. METHODS: At hospital admission and 24 hours later, blood was collected from 30 healthy horses and 20 horses with severe colic. Horses fulfilling predefined laboratory criteria of DIC were enrolled, and their data were subcategorized by survival for analysis. Platelet counts were determined and coagulation panel testing was performed. Serum and plasma FDP concentrations were measured using separate latex agglutination kits. Plasma D-dimer concentration was measured using 3 latex agglutination kits and a card immunofiltration test. Test sensitivity and specificity results were determined for healthy horses and those with colic. Median test values were compared between colic survivors and nonsurvivors to evaluate the prognostic usefulness of all tests. RESULTS: Performance characteristics varied among assays and kit suppliers. The FDP assays had low sensitivity (<40%), whereas the most accurate D-dimer kit had 50% sensitivity and 97% specificity. High D-dimer concentration was the third most common hemostatic abnormality in horses with colic. Median antithrombin (AT) activity was significantly lower and activated partial thromboplastin time (aPTT) was significantly longer in nonsurvivors than survivors. CONCLUSIONS: Commercial latex-agglutination D-dimer assays might prove useful as adjunctive tests for the diagnosis of DIC in horses with severe colic; however FDP assays are invalid for this purpose. Low AT activity and prolonged aPTT at admission are associated with a poor prognosis in this patient population.

Animals↗
PubMedDate not supplied

Comparison of latex agglutination, indirect hemagglutination, and ELISA techniques for the detection of Toxoplasma gondii-specific antibodies in the serum of cats.

The primary purpose of this study was to determine whether commercially available latex agglutination and indirect hemagglutination kits for the detection of Toxoplasma gondii-specific antibodies were capable of detecting T. gondii-specific immunoglobulin M (IgM) in the serum of cats. Serum samples from 35 cats containing either T. gondii-specific IgM, T. gondii-specific immunoglobulin G (IgG), or both were collected. Each serum sample was assayed using a latex agglutination kit, an indirect hemagglutination kit, an enzyme-linked immunosorbent assay (ELISA) for the detection of T. gondii-specific IgG, and an ELISA for the detection of T. gondii-specific IgM. When serum samples containing only T. gondii-specific IgM as determined by ELISA were assayed, the latex agglutination kit and the indirect hemagglutination kit detected antibodies in 33.3% and 13.3%, respectively. When T. gondii-specific IgG was present in a serum sample, the results from the latex agglutination kit, the indirect hemagglutination kit, and the IgG-ELISA were similar; however, there was a wide variation in titer magnitude results between the three assays. It was concluded that the latex agglutination kit and the indirect hemagglutination kit did not adequately detect T. gondii-specific IgM in feline serum.

Animals↗
PubMed1979

Properties of Streptococcus mutans grown in a synthetic medium: binding of glucosyltransferase and in vitro adherence, and binding of dextran/glucan and glycoprotein and agglutination.

The influence of culture media on various properties of Streptococcus mutans was investigated. Strains of S. mutans (serotypes c, d, f, and g) were grown in a complex medium (Todd-Hewitt broth [THB]) or a synthetic medium (SYN). The SYN cells, in contrast to THB cells, did not bind extracellular glucosyltransferase and did not produce in vitro adherence. Both types of cells possessed constitutive levels of glucosyltransferase. B13 cells grown in SYN plus invertase-treated glucose possessed the same level of constitutive enzyme as THB cells. In contrast to THB cells, the SYN cells of seven serotype strains did not agglutinate upon the addition of high-molecular-weight dextran/glucan. Significant quantities of lower-molecular-weight (2 x 10(4) or 7 x 10(4)) dextran and B13 glucan were bound by SYN cells. SYN cells agglutinated weakly in anti-glucan serum (titers, 0 to 16), whereas THB cells possessed titers of 32 to 256. Evidence for the existence of a second binding site in agglutination which does not possess a glucan-like polymer has been obtained. B13 cells grown in invertase-treated THB agglutinated to the same degree as normal THB cells. The nature of this site is unknown. SYN cells possess the type-specific polysaccharide antigen. B13 cells did not bind from THB a glycoprotein which reacts with antisera to the A, B, or T blood group antigens or which allows agglutination upon the addition of dextran. The results demonstrate that S. mutans grown in a chemically defined medium possesse markedly different biochemical and biological activities than cells grown in a complex organic medium.

Agglutinins↗
PubMed1982

Polymyxin B suppresses the endotoxin inhibition of concanavalin a-mediated erythrocyte agglutination.

The lectin agglutinability of human erythrocytes has been utilized to examine interactions of gram-negative endotoxin with mammalian cell plasma membranes. Erythrocytes treated in buffer with Escherichia coli 0127:B8 lipopolysaccharide (LPS) or Salmonella minnesota Re595 glycolipid for 1 h became resistant to agglutination by the lectin concanavalin A (ConA) in buffer free of LPS or glycolipid. Polymyxin B, a cationic cyclic lipopeptide which specifically binds to the lipid A toxophore, was tested for possible effects on the LPS and glycolipid inhibition of Con A erythrocyte agglutination. The presence of polymyxin B during the initial 1-h treatment with LPS or glycolipid blocked the ability of the endotoxins to render erythrocytes refractory to agglutination by ConA. Inhibition by polymyxin B was stoichiometric, and in repeated experiments, LPS was completely suppressed in the hemagglutination assay at a polymyxin B:LPS weight ratio of 1:4.1 (increasing polymyxin concentration, constant LPS concentration) and 1:5.1 (constant polymyxin concentration, increasing LPS concentration). These stoichiometry values are similar to values obtained for inhibition by polymyxin B of LPS lymphoid cell activation. It was concluded, therefore, that endotoxin inhibition of ConA erythrocyte agglutination reflects interactions of erythrocyte membranes with the lipid A region of endotoxin. In addition, the stoichiometry of polymyxin B inhibition suggests a similar extent of lipid A-dependent LPS interaction with erythrocytes and lymphoid cells.

Concanavalin A↗
PubMed1966

Mycoplasma-latex agglutination reaction.

Morton, Harry E. (University of Pennsylvania, Philadelphia). Mycoplasma-latex agglutination reaction. J. Bacteriol. 92:1196-1205. 1966.-The building up of Mycoplasma cell mass through adsorption to carrier particles as a method for enhancing the agglutination reaction to identify Mycoplasma is described. Mycoplasma cells of human, avian, swine, goat, sewage, and tissue-culture origin were adsorbed to latex particles (0.81 mu) and then were agglutinated by immune sera. The adsorption was demonstrated by electron microscopy. Either the cells or their antibodies, depending on which came into contact with the latex particles first, were adsorbed. The test, completed in less than 2 hr, consisted of serially diluting immune sera with buffered saline, adding the antigen, incubating in a water bath, centrifuging, and reading the reaction under 50 x microscope magnification. The antigen in each reaction tube, representing the growth from about 1.6 ml of culture, was estimated to contain 23 mug of protein (approximately one-tenth the amount of Mycoplasma cells needed for a direct agglutination reaction). In the sera from rabbits undergoing immunization with Mycoplasma antigens, the presence of anti-Mycoplasma antibodies was detected much sooner in the Mycoplasma-latex agglutination reaction test than in the agar-gel diffusion reaction and the growth inhibition tests. Four different lots of latex particles showed excellent uniformity of behavior and stability during storage and testing.

Animals↗
PubMed1980

Commercial latex agglutination test for rapid diagnosis of group B streptococcal infection in infants.

Although latex agglutination assays for detection of a variety of bacterial antigens in body fluids from patients with systemic infection have been shown to be useful as rapid diagnostic techniques, lack of commercial availability has restricted their application. The Streptex latex test kit for the detection of group B streptococcal (GBS) antigen in admission body fluid specimens was evaluated for sensitivity and specificity in 54 infants with meningitis and in 10 infants with normal cerebrospinal fluid (CSF) parameters. GBS antigen was detected in 22 of 28 (78.6%) CSF specimens by latex agglutination and in 23 of 28 (82.1%) by countercurrent immunoelectrophoresis. Antigen was present in 21 of 28 (latex agglutination) and 19 of 26 (countercurrent immunoelectrophoresis) CSF specimens after the initiation of antimicrobial therapy. Heat-labile factors accounted for nonspecific agglutination reactions with latex suspensions other than group B in 3 of 28 CSF samples from patients with GBS meningitis. These nonspecific reactions were readily eliminated by heating specimens for 10 min at 100 degrees C. Fifteen patients with GBS meningitis had admission serum and urine samples collected in addition to CSF. Antigen was detected by latex agglutination and countercurrent immunoelelectrophoresis in 14 of 15 (93.3%) and 13 of 15 (86.7%) concentrated urine specimens, respectively, and in 12 of 15 (80%) CSF specimens and 4 of 15 (27%) sera by each method. These findings indicate that the Streptex latex test is a rapid, sensitive, and readily available method for detection of GBS antigen in admission body fluid specimens from infants with meningitis.

Antigens, Bacterial↗