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PubMed1988

[Non-gonococcal urethritis and cervicitis from Chlamydia trachomatis: evaluation by means of chlamydiazine and serology].

Infection from Chlamydia trachomatis (CT) in men with non gonococcal urethritis (NGU) and in women with cervicitis has been investigated by means of Chlamidiazime and serological tests. 32.5% of 120 men with NGU and 8.3% of 12 men with dysuria were positive to Chlamydiazine test. Serological test using anti-CT IgG antibodies gave positive results in 30% of men with NGU and 33.3% of men with dysuria. Positivity to higher-levels (1:64) of anti-CT IgG antibodies were demonstrated in 14.1% of NGU patients and 16.6% of men affected by dysuria. Of 11 women positive to Chlamydiazine test, 8 were affected by cervicitis and 3 had no symptoms. All female partners of Chlamydiazine-positive men with NGU resulted positive to Chlamydiazime test. Serological tests were more frequently positive in asymptomatic partners of men with NGU. These results give further evidence for the aetiological role of CT, and suggest that antigen detection assay is more sensitive in men with NGU and in women with symptomatic cervicitis. On the other hand, serological tests seem more useful in men with dysuria and in asymptomatic women.

Adolescent↗
PubMed1988

[Cyto-microbiologic study of cervico-vaginal specimens, associated with a serologic study to detect sexually transmissible diseases in Madagascan prostitutes].

A microbiological survey of cervical and vaginal smears associated with a serological survey of sexual diseases was carried out on 298 prostitutes at the four principal Malagasy sea ports. This survey leads us to these conclusions: The great frequency of specific inflammations (72.1%) with Trichomonas vaginalis in the first place (39.2%). The serological tests proved a high rate of positive treponemical serologies (25.2%), whose the half of the cases are evolutive forms. Nevertheless prevalence of HBs-antigene among this population does not exceed the rate recorded in the other African countries, while the rate of anti HIV antibodies' carriers is lower than the rates recorded in those African countries. A comparative survey with tests carried out at IPM on Malagasy women showed clearly higher figures of inflammations, cervical and vaginal infections and positive treponemical serologies among prostitutes.

Female↗
PubMed1987

Serological studies with influenza A(H1N1) viruses cultivated in eggs or in a canine kidney cell line (MDCK).

Pairs of influenza A(H1N1) viruses cultivated from the same clinical specimen in canine kidney (MDCK) cells or in embryonated hens' eggs can frequently be distinguished by their reactions with monoclonal antibodies to haemagglutinin and with antibodies in ferret or human sera. Egg-adapted virus, further passaged in MDCK cultures remained "egg-like" in serological characteristics indicating that the differences in their serological reactions were not a direct result of host cell-dependent glycosylation of the haemagglutinin. Haemagglutination-inhibiting (HI) or virus neutralizing antibodies in human sera can be detected more frequently, and to higher titre, in tests employing virus grown exclusively in MDCK cells than in tests with virus adapted to growth in embryonated eggs. Striking differences were detected in the serological reactions in HI tests when sera from ferrets infected with egg-grown virus were tested against a series of strains of influenza A(H1N1) virus isolated in 1983 and adapted to growth in eggs. In contrast, sera from ferrets infected with MDCK-derived virus failed to distinguish serologically between the same viruses that had been passaged exclusively in MDCK cells and also revealed relatively small differences between their egg-adapted counterparts.It was concluded that the cell substrate used for virus isolation and cultivation is a factor that should be considered when interpreting the results of strain characterization of influenza A(H1N1) isolates and in sero-surveys using these viruses.

Influenza A Virus, H1N1 Subtype↗
PubMed1987

[Interpretation of results of serologic analyses in large animal practices].

The backgrounds to and possibilities of serological studies for the purpose of establishing are reviewed, all this with regard to bovine disease. The serology of the virus infections infectious bovine rhinotracheitis (IBR), bovine viral diarrhoea (BVD), para-influenza virus 3 infection (PI3), bovine respiratory syncytial virus (BRS) and Chlamydia is discussed in greater detail. Likewise, the interpretation of serological findings in cases of brucellosis, leptospirosis and Johne's disease is dealt with. In addition, attention is paid to the results of serological testing in cases of lung-worm disease and fascioliasis.

Animals↗
PubMed1985

Hepatitis B virus DNA detected in formalin-fixed liver specimens and its relation to serologic markers and histopathologic features in chronic liver disease.

To examine the relationship of hepatitis B virus (HBV) DNA sequences in the liver with histopathologic features and antigenic markers, the authors determined the hepatocytic status of viral DNA by in situ hybridization in formalin-fixed liver sections using a biotinylated probe in 45 patients with various chronic liver diseases. The results were compared retrospectively with the HBV serologic markers and histopathologic features including the presence of ground-glass cells or Shikata staining positivity. The specificity of this in situ detection of HBV DNA has been proven excellent in a double-blind control study in 18 patients in whom liver HBV DNA was also determined by DNA extraction, gel electrophoresis, and the Southern blotting technique. In 41 patients, the findings of HBV DNA and serologic markers were concordant (17 positive and 24 negative). Twelve of the 20 HBV-DNA-positive patients were HBsAg-positive (6 with chronic hepatitis, 3 with cirrhosis, and 3 with hepatocellular carcinoma). Ground-glass cells or Shikata positivity were found in 10 of these 12 patients. HBV DNA sequences were found in the liver of all patients with chronic liver disease and serologic positivity for HBV infection. In liver with normal histologic features, HBV DNA was not demonstrable, despite the positive anti-HBc and anti-HBs. However, a positive HBV DNA was found in 3 serologically negative patients. In another patient the interpretation of findings was impossible because of severe hemosiderosis. From this study, it is concluded that in situ detection of HBV DNA in formalin-fixed liver sections has a clinical value and is suitable for routine use.

Adolescent↗
PubMed1984

[Gougerot-Sjögren's syndrome. Clinical and biological correlations with the serology of Yersinia infections].

An unusual case of Sjögren's syndrome (SS) induced or revealed by a Yersinia pseudotuberculosis serotype IV infection has prompted the authors to undertake a retrospective study of 32 patients with that syndrome. High titers of antibodies to Y. pseudotuberculosis serotype IV (greater than 1/200 th) were found in 4 patients with primary Sjögren's syndrome and Sharp's syndrome. Seven other patients (5 with primary Sjögren's syndrome, 1 with systemic lupus erythematosus and 1 with Sharp's syndrome) had positive serology with low titres, of doubtful significance. Serology was negative in the 20 remaining patients. Nine out of 25 patients had anti-thyroid antibodies, and their relationship with positive Y. pseudotuberculosis IV serology is discussed. The responsibility of the infection in the induction or disclosure of Sjögren's syndrome may be considered. However, since the syndrome frequently develops before serology becomes positive (8/12 cases with a 1 to 6 years' follow-up), an alternative hypothesis would be that diminished digestive defences in Sjögren's syndrome result in an increased frequency of Yersinia infections.

Adult↗
PubMed1995

Serologic evidence of Chlamydia trachomatis infection and risk of preterm birth.

OBJECTIVE: To determine whether serologic evidence of Chlamydia trachomatis during pregnancy is a risk factor for preterm delivery (before 37 weeks' gestation). DESIGN: Chart review. SETTING: Antenatal clinics associated with a teaching hospital. PATIENTS: A group of 103 unselected consecutive patients presenting for routine prenatal care. OUTCOME MEASURES: Pregnancy outcome and C. trachomatis serologic status. RESULTS: A total of 21 women (20%) were found to be seropositive for IgG antibodies to C. trachomatis. They were similar to the seronegative women with respect to maternal age, parity, history of preterm birth, obstetric or medical problems, smoking status, history of drug abuse, educational status and psychosocial stressors. The seropositive women were significantly more likely than the seronegative women to have a preterm birth (24% [5/21] v. 7% [6/82]i p = 0.029, odds ratio 3.96, 95% confidence interval 1.08 to 14.57), an infant with a lower mean gestational age at birth (262 [standard deviation (SD) 19] days v. 273 [SD 15] days; p = 0.0052) and an infant with a lower mean birth weight (3125 [SD 692] g v. 3473 [SD 696] g; p = 0.0434). The positive predictive value of a seropositive result for preterm birth was 31% (5/16); the negative predictive value of a seronegative result for preterm birth was 8% (6/76). CONCLUSION: Women with serologic evidence of C. trachomatis may be at risk for preterm birth. Further study is required to determine whether serologic testing for C. trachomatis should be a routine part of prenatal care.

Adult↗
PubMed1995

Serology as a valid screening test for Helicobacter pylori infection in asymptomatic subjects.

Serologic testing is generally accepted as a valid noninvasive screening method for the detection of a Helicobacter pylori infection. To validate serology as an appropriate screening test for H pylori infection in symptom-free subjects, a recent-generation enzyme-linked immunosorbent assay for the detection of H pylori-specific IgG was performed in a large series of asymptomatic women. Blood samples for H pylori serology were taken from 542 apparently healthy women (aged 20 to 40 years) during prenatal screening. In this group, 120 (22.1%) had a positive titer for H pylori. We observed a significantly higher overall prevalence of H pylori seropositivity in nonwhites (62.3%) when compared with Belgian-born whites (17.8%). In both groups there was a significant increase in seropositivity with increasing age. To investigate the correlation between a positive enzyme-linked immunosorbent assay and the actual presence of an active H pylori infection, carbon 13-labeled urea breath tests were performed in 85 seropositive and in 65 randomly selected seronegative subjects. These breath tests were positive in 82 (96.5%) of 85 seropositive and in none of the seronegative subjects, reflecting an actual presence of H pylori in the gastric mucosa of the seropositive women. We conclude that in our population of H pylori-seropositive subjects positive serologic findings correlates extremely well with an active infection with this bacterium. However, because all subjects who were investigated were actually symptom-free, it still should be determined whether these patients should undergo upper gastrointestinal endoscopy and/or be treated with an eradication therapy against H pylori. Further long-term follow-up studies will be required to answer this question.

Adult↗
PubMed1993

Serologic testing for sexually transmitted diseases.

This article addresses current issues regarding serologic testing for selected STDs, particularly those for which serologic testing has been useful for diagnosis, monitoring therapy, or seroepidemiology. For each selected pathogen, the authors discuss the strengths and weaknesses of the serologic tests as diagnostic assays, as measures of disease incidence and relevance, and as prospective markers identifying risk alterations in a given population. Also, for some conditions such as syphilis, the usefulness of serology as a measure of therapy or success of disease intervention is briefly outlined.

Chancroid↗
PubMed1995

HEPAXPERT-III: knowledge-based interpretation of serologic tests for hepatitis A, B, C, and D.

1. The HEPAXPERT-III SYSTEM. HEPAXPERT-III--the successor of HEPAXPERT-I[1] and HEPAXPERT-II [2]--is a routinely-used, integrated medical database and knowledge-based system that stores and interprets the results of serologic tests for infection with hepatitis A, B, C, and D viruses. The following tests are included: Anti-HAV, IGM anti-HAV, and HAV in stool; HBsAg, anti-HBs, anti-HBc, IGM anti-HBc, HBeAg, anti-HBe, and anti-HBs titre; Anti-HCV, HCV-immunoblot, and HCV-PCR; Delta-Ag and anti-delta. HEPAXPERT-III provides the following functions: a) screen input of patient's personal data (patient ID, surname, first name, name at birth, date of birth, and sex), administrative data (department requiring the tests and date of specimen sample), and medical data (results of serologic tests); and/or b) automatic transfer of patient's personal, administrative, and medical data by connecting HEPAXPERT-III to a laboratory information system, a hospital information system, or an automated laboratory analyzer; and c) automatic generation of interpretive reports of the obtained serologic findings, including an analysis of possible virus exposition, immunity, disease stage, prognosis, and degree of infectiousness. HEPAXPERT-I and HEPAXPERT-II have been routinely used at the Vienna General Hospital, the teaching hospital of the University of Vienna Medical School. The interpretive reports are well-accepted and lead to several improvements in patient care [3]. HEPAXPERT-III will not only extend the scope of interpretation to hepatitis C and D serologic tests, but will also offer a state-of-the-art graphical user interface. 2. HARDWARE AND SOFTWARE. IBM-compatible personal computer (minimum 80386 SX processor), 8 MB RAM (OS/2) and 4 RM RAM (MS-Windows), resp., graphic adapter (minimum 640x480) and printer supported by OS/2 and MS-Windows 3.1, resp., IBM OS/2-2.1 or higher and MS-Windows 3.1 or higher, resp., and for the OS/2 version IBM Database 2 (DB2/2).

Diagnosis, Computer-Assisted↗
PubMed1996

[Urease test, microbiologic tests, histologic and serologic tests for the evaluation of Helicobacter pylori infections in persons with peptic ulcer and gastritis].

The presence of Helicobacter pylori in the gastric mucosa of 150 patients with gastric, duodenal ulcer and endoscopic gastritis was investigated by rapid urease-based test, culture, histological examination and serology. Overall, 78% were positive for Helicobacter pylori by rapid urease-based test, 69.3% by culture, 53.7% by histological staining and 93.2% by serology (p < 0.001). The frequency of Helicobacter pylori was higher in patients with gastric or duodenal ulcer compared with those with endoscopic gastritis and those after gastric resection. However, the differences were significant only with reference to rapid urease-based test, (p < 0.02). The EIA (Roche) serological test had the highest sensitivity and the lowest specificity. This indicates the seed for serological kit to be independently evaluated on the population to be studied. The rapid urease-based test was simple, rapid and inexpensive, and it was more sensitive and equally specific compared with culture and Giemsa stain.

Adolescent↗
PubMed1997

Use of a generic polymerase chain reaction assay detecting human T-lymphotropic virus (HTLV) types I, II and divergent simian strains in the evaluation of individuals with indeterminate HTLV serology.

In countries with a low prevalence of human T-lymphotropic virus (HTLV) infection, indeterminate HTLV serologies are a major problem in blood bank screening because of the uncertainties about infection in these cases. The recent discovery of two new types of simian T-lymphotropic viruses (STLV), which give an HTLV-indeterminate serology, raises the question whether indeterminate serologies in humans may be linked to new types of HTLV. Starting from a Tax sequence alignment of all available primate T-cell lymphotropic virus strains (PTLV), including the two new types STLV-PH969 and STLV-PP1664, we developed generic and type-specific nested polymerase chain reactions (PCRs). The generic PCR proved to be highly sensitive and cross-reactive for all four types of PTLV, while the discriminatory PCRs had a high sensitivity and a specificity of 100%. There was no cross-reactivity with human immunodeficiency virus (HIV), ensuring correct interpretation of results from coinfected patients. Among the 77 serologically indeterminate samples tested, 6 were found to be HTLV-1 PCR positive and 1 was HTLV-II PCR positive. Sequencing of one of the HTLV-I PCR positives excluded PCR contamination, and revealed a divergent type of HTLV-I. The majority of the seroindeterminate samples (91%) were however HTLV-PCR negative, and no new types of HTLV were found. This new assay can identify otherwise undetected HTLV-I or HTLV-II infections and is a useful tool of screening for new types of HTLV among seroindeterminate samples.

Animals↗
PubMed1997

Comparison of serological results in the NIAID Multicenter Acellular Pertussis Trial with recent efficacy trials.

Comparison of the serological results from the NIAID-funded Multicenter Acellular Pertussis Trial (MAPT) and the efficacy trials are complicated by differences in assay methods, immunization schedules, vaccine lots and populations immunized. In spite of these differences, serological results closely approximating those obtained in the MAPT were found for most or all of the assayed antibodies in the Mainz and Erlangen studies. Serological results for some of the antigens included in the vaccines used in the Italian and Stockholm trials were similar to the MAPT results, while significant differences were noted with other antigens. Differences in immunization schedules and serological assay methods made comparisons between MAPT and the Gothenburg and Senegal trials more difficult. Our understanding of the efficacy trial results, and our ability to apply those results to the U.S. population, would be enhanced markedly by simultaneous re-analysis of stored sera from MAPT and selected efficacy trials. This goal should be given priority by the study organizers and sponsors.

Clinical Trials as Topic↗
PubMed1996

Serological IgG, IgM and IgA diagnosis and prognosis of mycobacterial diseases in routine practice.

The routine diagnosis of tuberculosis and other mycobacterial diseases based on organism identification was completed during a period of one year in 730 patients, with serological IgG, IgM and IgA determination of antibodies against antigen 60 from M. bovis , strain BCG. The analysis was performed on 10 groups of patients consisting of 1) inflammatory diseases of the respiratory tract, 2) pericarditis, myocarditis, lymphadenitis and CNS diseases, 3) chronic non-inflammatory diseases of kidneys, liver and pancreas, 4) non-inflammatory diseases of the heart, sarcoidosis and pneumoconiosis, 5) tumor, 6) healthy people with TB contact, 7) inactive TB, 8) culture-positive pulmonary and extra-pulmonary TB, 9) culture-negative TB and extra-pulmonary TB, and 10) potentially pathogenic mycobacteria. The specificity of the test (100% negative cases in Group 6, composed of healthy people) is estimated at about 90%, in accordance with determinations made in other laboratories. In non-tuberculous patients, the specificity varied according to the analysed groups. Group 1 was largely unspecific for IgM (76% positives) but the specificity was acceptable for IgG (6.2% positives ) and IgA (7.4% positives). Group 2 was similar to Group 1. Group 3 was associated with positive IgA titers. Group 4 was only exceptiony seropositive and Group 5 was positive mainly for IgA (11. 4%) associated with lower respiratory tract ailments. This unspecific seropositivity was attributed to inapparent infections by PPM whose colonisation was favored by the particular disease of the patients. The sensitivity of serological measurements applied to the diagnosis of TB patients and PPM patients was similar, regardless if the disease was pulmonary or non-pulmonary, regardless if cultures were positive or not and, in our hands, was low (positivity for IgA about 30 %, for IgM about 10% and for IgG about 30%). This poor sensitivity observed with people presenting for treatment is attributed to an immune depression occuring mainly in elderly patients. The remarkable sensitivity of the serological instrument applied to culture-negative pulmonary and non-pulmonary TB cases as well as PPM cases makes the test a good adjuvant in cases of suspicion of TB. The assessment of the serological status of people under chemotherapy is worth the analysis, a high IgG level being associated with immunocompetence while the absence of IgG antibodies and/or the presence of IgA antibodies denotes an immunologically misdirected response potentially opening the way to chronic infections.

Biomarkers↗
PubMed1997

[Evaluation of sensitivity, specificity and predictive value of six qualitative serological methods for the detection of Helicobacter pylori antibodies].

Screening tests for IG g antibodies against Helicobacter pylori are usefull for a long follow up of patients who were well eradicated. The aim of this study was to determinate and compared sensibility, specificity, positive and negative predictive value of six qualitative serological tests for IG g antibodies detection in the diagnosis of H. Pylori infections. Between May and October 1996 52 patients (30 males and 22 females; median age 42.4 years, range 21-68) with H. Pylori infection assessed on two antral and two corpus biopsies by means of Giema stain and a rapid urease test were tested for IG g antibodies detection. The serological tests used were: Inmunocomb II (Orgenics) Enzimo Inmuno Assay Inmunoadsorbent qualitative, Flex Pack (Smith Kline Diagnostics, Abbott) inmunocromatographic cualitative, Pylori Stat test (Biowhittaker) Enzimo Inmuno Assay (ELISA) qualitative, Premier (Meridian Diagnostics) Enzimo Inmuno Assay ELISA) qualitative. Pyloristest (Orion Diagnóstica) latex aglutination qualitative, H. Pylori (Bio Tre) Enzimo Inmuno Assay cualitative. 10 healthy subjects with negative gastric biopsies and negative rapid ureasa test were used as control group. The six evaluated serological tests have a comparable sensibility (89-95%) and specificity (77-83%) for the diagnosis of HP infection. The presence of specific HP antibodies in infected patients revealed a strong correlation with the histological demonstration of the microrganisms. We can recommend this qualitative serological tests due to their high sensibility and specificity, simplicity and low cost.

Adult↗
PubMed1998

[Efficacy of two gene species in the serological diagnosis of Borrelia burgdorferi infections].

BACKGROUND: There is phenotypic and genetic variability among the species Borrelia burgdorferi that produces Lyme disease. Three gene species and seven serotypes have been defined. AIM: To study the efficacy of two gene species in the serological diagnosis of Borrelia burgdorferi infections in Granada, Spain. MATERIAL AND METHODS: One thousand sixty nine sera coming from 1,251 subjects without Lyme borreliosis were analyzed. These subjects were studied for health or pregnancy controls, differential diagnosis of viral disease, diagnosis of syphilis, neurological or rheumatic diseases. In all samples, antibodies against Borrelia burgdorferi (B31 and Pko strains) and against Treponema pallidum were investigated. Screening tests (ELISA and hemagglutination) were followed by confirmations tests for positive samples (Western Blot IgG strain B31 and FTA-abs respectively). A clinical and laboratory follow up was done for subjects with positive serological tests. RESULTS: The global rate of positive antibodies against Borrelia burgdorferi B31 was 8.31% and against the strain Pko was 0.64%. Western blot was negative in 36% of subjects with positive ELISA B31. The distribution of antibodies against the strain B31 was acute herpes virus infection in 16%, gestation in 3%, HIV infection in 6.4%, T pallidum infection in 36%, rheumatic diseases in 25%, neurological diseases in 17.5% and health controls in 7.4%. The percentage of positive Western Blot analyzes were 0.8, 2.1 and 0.4% respectively. A reversion of positive ELISA tests was observed in 6 subjects. CONCLUSIONS: The disparity in rates of antibodies against Borrelia burgdorferi in different geographic regions may be due to differences in the serological tests used. The high rate of false positive ELISA tests underscores the need to use other serological tests.

Antibodies, Bacterial↗
PubMed1999

Protection against influenza after annually repeated vaccination: a meta-analysis of serologic and field studies.

BACKGROUND: According to common recommendations, influenza vaccination should be performed annually. It has been suggested that vaccination in previous years reduces vaccine efficacy in the long term. OBJECTIVE: To determine whether the protection of influenza vaccine decreases when vaccination is repeated annually. METHODS: Articles published between 1966 and 1997 were selected from MEDLINE. The end point for field studies was the influenza-related morbidity or mortality during influenza outbreaks (resulting in field protection rates). The end point for serologic studies was exceeding a protective postvaccination hemagglutination-inhibition titer (serologic protection rates). Protection rate differences between groups with single and multiple vaccinations were subjected to meta-analysis. RESULTS: Seven field studies (including 13 trials) supported the hypothesis that protection in multiple-vaccination groups is at least as good as that in single-vaccination groups. Ten trials with 5117 observations could be subjected to meta-analysis. The pooled protection-rate difference was close to 0 (1.1%; 95% confidence interval, -0.2% to 2.4%), thus detecting no difference between single or multiple vaccination. Twelve serologic studies (including 53 trials) showed heterogeneous results: 9 trials were significantly in favor of single vaccination, and 7 were in favor of multiple vaccination, but in most cases, there was no significant difference between the 2 vaccination groups. The pooled serologic protection-rate difference from 52 trials (12341 observations) was again close to 0 (1.7%; 95% confidence interval, -1.3% to 4.8%). CONCLUSIONS: We did not detect any evidence for a decreasing protection with annually repeated influenza vaccination. Annual vaccination should not be discouraged in populations at risk.

Antibodies, Viral↗
PubMed1998

Large-scale analysis of hepatitis C virus serological typing assay: effectiveness and limits.

The HCV (hepatitis C virus) Serotyping 1-6 Assay (Murex Laboratories) was evaluated on 303 French HCV-infected patients. Serological typing results were compared to the genotypes obtained from sequence analyses of the 5' noncoding regions of the virus genome from 46 HCV-infected patients, and assay specificity was found to be high (97.6%). The serological typing assay, run in 257 consecutive HCV-infected patients, yielded an assay sensitivity lower (70.6%) than that previously reported. This finding was attributed mainly to nonreactive sera from human immunodeficiency virus (HIV)-positive patients (P < 0.001) and perhaps reflected cryoglobulin positivity in others. No anti-type 6 reactivity was detected, and the overall serological type distribution values for types 1 to 5 were 67.3, 7.9, 16.4, 6.6, and 0.9%, respectively. A higher prevalence of type 4 was noted among HIV-infected patients (P < 0.001). In addition, serotype 2 was significantly more frequent in cryoglobulinemia positive than in cryoglobulinemia-negative patients (P < 0.05). Although an initial high level (7%) of mixed serological typing reactivities was found, after predilution of serum only two mixed infections could be confirmed (0.9%). It is suggested, therefore, that mixed reactivities have to be interpreted carefully and retested with prediluted serum, particularly when the optical density of the reactivity is > 2.5 or remains > 0.4 after competition with all type-specific peptides. The high specificity and relatively good sensitivity even in immunocompromised patients obtained with this assay indicate that it can be used routinely. Because response to treatment is linked to HCV type, this assay could be used to identify HCV serotype to guide therapeutic decisions.

Case-Control Studies↗