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Observations on false positive reactions in the rapid NOW Filariasis card test.

The NOW Filariasis card test is a useful tool for rapid field diagnosis of Wuchereria bancrofti infection, based on detection of specific circulating filarial antigen (CFA) in the patients' blood. Concern has been raised that a high proportion of infection negative individuals develop false positive reactions in these tests when the test cards are left for a prolonged period before being examined. We carried out a survey in an endemic Tanzanian village to investigate this phenomenon. Individuals who were positive in the NOW Filariasis test at 10 min after specimen application were also positive in the TropBio ELISA for CFA, and thus appeared to be truly positive. Many of the test cards that were negative at 10 min developed a positive line later, but these lines appeared to be falsely positive when the TropBio test was used as the gold standard. Close examination revealed that true and false positivity lines could be distinguished on their shape and colour. The study thus reaffirmed that test cards should be read after 10 min to avoid false positives, but it also indicated that experienced test card users should be able to make a correct diagnosis even at a later time.

Adolescent↗

Definition of false-positive reactions in screening for hepatitis C virus antibodies.

The rate of false-positive hepatitis C virus enzyme immunoassay results was determined to be at least 10% among 1,814 reactive serum samples based on (i) negative results in an independent confirmation assay, (ii) negative PCR results, and (iii) no patients developing clinical or biochemical signs of hepatitis during a 1-year follow-up.

False Positive Reactions↗

False-positive reactions in the latex agglutination test for Cryptococcus neoformans antigen.

The latex agglutination test for Cryptococcus neoformans antigen is a simple and rapid procedure for the diagnosis of cryptococcal meningitis. Although the test is sensitive, care must be taken to prevent contamination of the sample, which may result in false-positive reactions. It was discovered in our laboratory that immersion of a platinum wire inoculating loop into a sample of cerebrospinal fluid prior to testing introduced interfering substances leading to nonspecific agglutination. After further studies, it was determined that trace amounts of surface condensation (syneresis fluid) from agar, either added to the cerebrospinal fluid or adhering to the loop, were the probable source of contamination. It is suggested that the latex agglutination test for C. neoformans antigen be performed prior to culture or on a separate sample.

Antigens, Fungal↗

A Shared noncapsular antigen is responsible for false-positive reactions by Staphylococcus epidermidis in commercial agglutination tests for Staphylococcus aureus.

Many of the commercial slide agglutination tests for Staphylococcus aureus incorporate antibodies against cell surface antigens associated with methicillin resistance, including capsular polysaccharides and an uncharacterized antigen, serotype 18. These tests are more sensitive than the first-generation agglutination procedures that detected only bound coagulase and protein A, but they suffer from false-positive reactions with some coagulase-negative staphylococci. The aim of this study was to elucidate the mechanism for false-positive agglutination by S. epidermidis in these tests. A group of methicillin-resistant S. aureus (MRSA) isolates, including a serotype 18 strain, that were not detectable in the first-generation tests were found to be of capsular polysaccharide type 8. All of these isolates were deficient in bound coagulase and/or protein A, and they possessed a heat-stable, proteinaceous antigen that was absent from a prototype capsule type 8 strain. Enzyme-linked immunosorbent assay and agarose gel immunodiffusion experiments demonstrated that this proteinaceous antigen was also present on both methicillin-sensitive and methicillin-resistant S. epidermidis clinical isolates. S. epidermidis strains that gave false-positive agglutination test results had a considerably higher level of this antigen than strains that gave the correct negative result. These findings reveal the importance of the careful selection of MRSA strains for raising anti-capsular type 8 antibodies for use in agglutination tests. Strains devoid of the antigen shared with S. epidermidis should be used to eliminate potential cross-reactions with this coagulase-negative coccus.

Agglutination Tests↗

Rubella hemagglutination-inhibition test: false-positive reactions in sera contaminated with bacteria.

We have shown that bacterial contamination of sera can have a marked influence on the results of the rubella hemagglutination-inhibition (HI) test. In addition to increasing the levels of nonspecific agglutinins, a number of common bacterial species tested had a significant effect on the HI titers. When sera free from rubella-specific antibodies were contaminated with Bacillus subtilis or Pseudomonas fluorescens, HI titers ranged from 16 to 128 (expressed as the reciprocal of the highest serum dilution completely inhibiting hemagglutination) after treatment with heparin/MnCl2. Our observations demonstrate, therefore, that bacterial contamination can be one of the causes of false-positive reactions in this test.

Bacillus subtilis↗

False positive reaction of the immunohistochemistry technique using anti-BCG polyclonal antibodies to identify Mycobacterium leprae in wild nine-banded armadillos.

The authors studied 66 wild nine-banded armadillos from Brazil. The ear samples were collected and Ziehl-Neelsen or Fite-Faraco stains were performed, as well as immunostaining using polyclonal BCG antibody, to avaluate the presence of the Mycobacterium leprae. The AFB were not detected by the Ziehl-Neelsen or Fite-Faraco staining, neither immunoexpression of the BCG marker. However, many normal structures from the ears of the nine-banded armadillos, such as condrocytes, condroblasts, fibroblasts and endothelial cells, and Gram positive bacteria cocci, showed false positive reaction by the BCG marker. The authors discuss the use of the immunohistochemical studies with the polyclonal BCG antibody to identify M. leprae antigens in wild armadillos.

Animals↗

False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology tests.

Sera from 628 nonsyphilitic individuals were tested with the Rapid Plasma Reagin-Card, Fluorescent Treponemal Antibody-Absorbed, and Hemagglutination Treponemal Test for Syphilis tests to ascertain the comparative specificity of these tests. Many sera were also tested with the quantitative Venereal Disease Research Laboratory test. Sera included in the study were from both normal individuals and patients with a variety of illnesses and conditions. The Hemagglutination Treponemal Test for Syphilis gave the lowest overall percentage of false-positive reactions (1.6%), followed by the Fluorescent Treponemal Antibody-Absorbed test (3.3%) and the Rapid Plasma Reagin-Card test (10.8%).

Adult↗

False-positive reactions with enzyme-linked immunosorbent assay of Mycobacterium tuberculosis antigens in pleural fluid.

The value of enzyme-linked immunosorbent assay (ELISA) for the diagnosis of tuberculous pleural effusion has not been defined. We performed ELISA by a double antibody sandwich technique with anti-BCG antibody in the solid phase to detect Mycobacterium tuberculosis antigen in pleural fluid from 36 patients with pleural effusion (tuberculosis 15, lung cancer 12, miscellaneous 9). Pleural fluids from 12 of the tuberculosis patients, 12 of the cancer patients and one patient in the miscellaneous group had optical densities above the cut-off point. False-positive reactions in patients with lung cancer limit the usefulness of ELISA with conventional anti-BCG antibody for detection of M. tuberculosis antigen.

Adult↗

Rheumatoid factor-like reactants in sera proven to transmit non-A, non-B hepatitis: a potential source of false-positive reactions in non-A, non-B assays.

Convalescent phase non-A, non-B (NANB) human and chimpanzee sera were utilized in a solid-phase radioimmunoassay (RIA) in an attempt to identify a specific NANB antigen in human plasma, plasma-derived pellets and NP-40 disrupted pellets proven to transmit NANB infection to chimpanzees. RIA reactivity was noted in 5 of 8 pedigreed NANB infectious plasmas, but did not appear to be virus-specific. The RIA reactive fraction: (i) had a density of 1.27 to 1.32 gm per cm3 in cesium chloride; (ii) showed immunoreactivity corresponding to normal IgM, but peak RIA activity coincided with an aberrant IgM having a peak sedimentation coefficient of 56 S, and (iii) eluted at higher pH (5.6 to 5.0) than normal IgM on chromatofocusing columns. The reactant shared properties with rheumatoid factor in that it was absorbed by aggregated IgG and was unstable to 2-mercaptoethanol, but it did not react in standard agglutination tests for rheumatoid factor. The reactant was detected in both the acute and chronic phase of NANB infections in chimpanzee and man. By reacting with IgG in presumptive NANB convalescent sera, this aberrant rheumatoid factor could simulate a NANB antigen and represent a cause of false-positive reactions in putative NANB assays.

Animals↗