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PubMed1970

Role of Glycolipids and Phosphatidylglycerol in the Serological Activity of Mycoplasma pneumoniae.

Mycoplasma pneumoniae lipids were fractionated by combined silicic acid and diethylaminoethyl-cellulose chromatography. The lipid fractions were tested for complement-fixing activity and for blocking of metabolism-inhibiting antibodies in human and rabbit antisera to M. pneumoniae. Thin-layer chromatography and carbohydrate analysis of hydrolysates of the lipid fractions indicated that glycolipids were responsible for the specific serological activities of the lipid extracts of the organism. Phosphatidylglycerol, which accompanied the glycolipids, was serologically inactive when isolated free from glycolipids. Phosphatidylglycerol considerably enhanced the serological activity of the glycolipids, serving as an auxiliary lipid. Because of this auxiliary effect, minute quantities of contaminating glycolipids sufficed to render serological activity to "purified" phosphatidylgylcerol preparations, providing an explanation to the previous identification of the active lipid as a phospholipid.

Journal Article↗

PubMed1971

Serological cross-reaction between lipids of Mycoplasma pneumoniae and Mycoplasma neurolyticum.

The complement-fixing activity of crude lipid extracts of 10 Mycoplasma species was compared with that of whole organism antigens employing immune rabbit serum. Five species (M. pneumoniae, M. neurolyticum, M. granularum, M. laidlawii, and M. fermentans) showed serological activity, whereas the remaining five species (M. canis, M. felis, M. gallisepticum, M. hyorhinis, and M. pulmonis) did not show significant activity in their lipid fractions. The lipid fractions of the five species which had serological activity in their lipid fractions showed three groups of serological specificity. M. pneumoniae cross-reacted with M. neurolyticum, M. granularum cross-reacted with M. laidlawii, and M. fermentans showed specific activity. Acute and convalescent sera from human pneumonia patients from whom M. pneumoniae had been isolated showed antibody increases which could be measured nearly as well by lipids of M. neurolyticum as by those of M. pneumoniae. Only a few human convalescent sera showed antibody measureable by lipids of M. granularum, M. pneumoniae did not cross-react with M. neurolyticum by other serological parameters such as growth inhibition on agar or double immunodiffusion, indicating that only the lipid antigens of these two species cross-react.

Animals↗

PubMed1971

Bacteriophage attachment sites, serological specificity, and chemical composition of the lipopolysaccharides of semirough and rough mutants of Salmonella typhimurium.

Extracted lipopolysaccharides (LPS) from one smooth, one semirough, and five rough mutants of Salmonella typhimurium LT2 or LT7, for which the chemical structure of the polysaccharide chain had been elucidated by using methylation analysis, were characterized with passive hemagglutination inhibition and phage inactivation experiments. Each addition of a sugar residue to a LPS from chemotype Rc was reflected in changed serological reactivity and phage-inhibiting activity of a collection of bacteriophages of the isolated LPS. Thus, certain criteria can be established for a classification of rough mutants of S. typhimurium. The observation that the serological RII specificity corresponds to a completed common core polysaccharide was verified. The serological RI specificity was found in LPS with terminal d-galactose I residues. One of the mutants, SL733, yielded a LPS which cross-reacted with anti-O5 factor serum although the polysaccharide was virtually free from contaminating O-specific material. The O5 reactivity was destroyed by alkaline treatment of SL733 LPS. The smooth- and rough-specific Felix O-l (FO) and the rough-specific 6SR and Br2 phages were shown to have their receptors in the LPS. There was a good correlation between the adsorption rate constant to whole cells and the phage inhibiting activity of isolated LPS suggesting that the LPS exert the major influence on the attachment of these phages to the bacteria. The polysaccharide structures in the LPS necessary for attachment of the 6SR and Br2 phages were defined. It was found that measuring the phage-inhibiting properties of isolated LPS as PhI(50) (LPS concentration required to inactivate 50% of the phages under defined conditions) was a more sensitive method for a characterization of the LPS than the serological and chemical assays used.

Adsorption↗

PubMed1963

ANTIGENIC STRUCTURE OF ACTINOMYCETALES. VI. SEROLOGICAL RELATIONSHIPS BETWEEN ANTIGENIC FRACTIONS OF ACTINOMYCES AND NOCARDIA.

Kwapinski, J. B. (University of New England, Armidale, N.S.W., Australia). Antigenic structure of Actinomycetales. VI. Serological relationships between antigenic fractions of Actinomyces and Nocardia. J. Bacteriol. 86:179-186. 1963.-A total of 52 chemical fractions were obtained by a comprehensive technique of preparation from three strains of Actinomyces and three strains of Nocardia. The chemical and serological structures and specificities of disintegrated cells, cell walls, cytoplasms, and individual fractions were thoroughly studied. Cytoplasmic materials were found to be serologically alike or identical. The polysaccharide fractions, extracted from cell walls with alkali, formamide, and phenol, proved to be serologically related. Fractions prepared from the Nocardia by extractions in hot and concentrated solutions of acetic acid and sodium hydroxide, as well as the second protein fraction and the acetate-extracted polysaccharides of both the Nocardia and Actinomyces, proved to be genus-specific.

Actinomyces↗

PubMed1964

EVALUATION OF SEROLOGICAL AND CULTURAL METHODS FOR THE DIAGNOSIS OF CHRONIC SALMONELLOSIS IN MICE.

Morello, Josephine A. (Boston University School of Medicine, Boston, Mass.), Teresa A. Digenio, and Edgar E. Baker. Evaluation of serological and cultural methods for the diagnosis of chronic salmonellosis in mice. J. Bacteriol. 88:1277-1282. 1964.-Mice were infected by inoculation of varying doses of a virulent culture of Salmonella typhimurium directly into the stomach. Feces were cultured at intervals on Brilliant Green and Eosin Methylene Blue Agar. Most survivors shed organisms consistently during the early stage of infection, but, after 1 month, a large number had become intermittent shedders. These animals would have been considered salmonella-free if cultured at a time when they were not shedding the organism. Serological tests to detect antibodies in their sera, therefore, were investigated. Standard agglutination, and hemagglutination and hemolytic tests with the use of sheep erythrocytes modified with extracts of S. typhimurium, were performed with sera from infected mice. It was possible to detect smaller amounts of antibody in the sera by means of the hemolytic test, and this test was often positive when the others were negative. Antibodies detectable by the hemolytic test appeared within 21 days after inoculation, and were present in the sera of surviving animals for 3 months or longer. All animals known to be infected gave positive serological reactions. Cultural techniques were most satisfactory for detection of salmonellosis during early stages of infection, and serological tests were of primary value at later intervals. Concurrent use of both techniques ensured discovery of the largest number of infected animals.

Agglutination↗

PubMed1979

Reticulate bodies as single antigen in Chlamydia trachomatis serology with microimmunofluorescence.

Formalin-fixed, purified reticulate bodies (RB) of Chlamydia trachomatis immunotype C/TW-3/OT were used as a serological test antigen in the microimmunofluorescence test. The sensitivity and specificity of the RB antigen were compared to elementary bodies (EB) used as antigens in the detection of C. trachomatis antibodies in human sera by microimmunofluorescence. RB reacted with all known C. trachomatis immunotypes with the same sensitivity as the homotypic EB. In routine serology with sera and endocervical secretions, the RB antigen had a sensitivity similar to that of the EB in detecting serum antibodies, endocervical secretion antibodies, and antibodies of immunoglobulin M and G classes. No false-positive reactions were detected with control sera. All positive reactions showed type-specific antibodies against an EB immunotype. RB seemed to demonstrate chlamydial group reactivity; sera from 10 psittacosis patients diagnosed clinically and serologically by complement fixation showed five positive, three equivocal, and two negative reactions. By immunofluorescence, RB appeared as distinct rings demonstrating uniform peripheral surface fluorescence at their rims. The EB appeared as pinpoint-sized dots. C/TW-3/OT RB used as a single test anitgen should provide a simple and sensitive serological assay for the detection of C. trachomatis antibody.

Antibodies, Bacterial↗

PubMed1990

Serological response to Chlamydia pneumoniae infection.

The human serological response was analyzed by using sera from patients who were serologically positive but isolation negative for Chlamydia pneumoniae and from patients with proven C. pneumoniae infection based on serology and isolation. To assess whether seroreactivity to C. pneumoniae proteins had potential diagnostic value, the cross-reactivities of these sera to other Chlamydia species and of sera from patients infected with C. trachomatis and C. psittaci to C. pneumoniae proteins were determined. In all serum samples from patients with proven C. pneumoniae infections, reactivities were seen with 98-, 68-, 60-, 39.5-, and 30-kilodalton proteins. Similar patterns were seen in sera from patients who were serologically positive and isolation negative. The onset of seropositivity for C. pneumoniae was accompanied by reactivities against presumably shared chlamydial antigens and a C. pneumoniae-specific 98-kilodalton protein.

Animals↗

PubMed1997

Pitfalls and fallacies of cat scratch disease serology: evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay.

The diagnostic value of the detection of immunoglobulin G (IgG) and IgM by Bartonella henselae-based indirect fluorescence assay (IFA) and enzyme-linked immunoassay (EIA) for the diagnosis of cat scratch disease (CSD) was evaluated. The IFA was performed either with B. henselae that was cocultivated for a few hours with Vero cells or with noncocultivated B. henselae as the antigen. Additionally, the performance of a Bartonella PCR hybridization assay based on the 16S rRNA gene was determined and compared with those of the serologic assays. The study group consisted of 45 patients suspected of suffering from CSD by fulfilling one or more of the classical criteria. The specificities of the immunoassays were set at > or = 95% by analysis of sera from 60 healthy blood donors. It is shown that the sensitivities of the IgG assays are very low (40.9% for the IFA with noncocultivated B. henselae as antigen) and that those of the IgM assays are higher (71.4% for the EIA) for patients who fulfilled two or more criteria for CSD. The IgM EIA showed the highest sensitivity: 71.4% in patients with two or more criteria for CSD and 80.6% for patients with a positive Bartonella PCR result. The results indicate that the specificities of both IFA and EIA IgG serologies and the sensitivity of the IFA IgM serology need to be improved. The PCR hybridization assay showed a sensitivity of 86.4% for patients who fulfilled two or more criteria for CSD and 100% for seven patients who fulfilled three or more criteria. The kinetics of IgG and IgM antibody production were studied in 18 patients with CSD on the basis of a positive B. henselae IFA IgM serology. The results indicate that there is no standard course of anti-B. henselae IgG and IgM production in patients with CSD, because some patients produced high levels of both IgG and IgM, others produced only high levels of IgM, and a few patients produced only low levels of antibodies.

Antibodies, Bacterial↗

PubMed1998

Hepatitis C virus infections in dialysis centers in The Netherlands: a national survey by serological and molecular methods.

A national survey of hepatitis C virus (HCV) infections among dialysis patients in The Netherlands was performed. The study involved 2,653 patients (2,108 hemodialysis patients and 545 chronic ambulatory peritoneal dialysis [CAPD] patients) from 39 of the 49 dialysis centers in the country. Patient sera were analyzed by both serological and molecular methods. Screening by a third-generation enzyme immunoassay (EIA) yielded 79 reactive sera. The presence of anti-HCV antibodies was confirmed in 70 patients by a line immunoassay. All seropositive samples were tested by reverse transcriptase PCR, and 57 samples were found to contain HCV RNA. Of the nine EIA-positive and line immunoassay-negative or indeterminate samples, four were HCV RNA positive. All seronegative samples were screened for the presence of HCV RNA in pools of five sera. Of 2,576 antibody-negative samples, 6 contained HCV RNA. All antibody-positive and RNA-positive samples were also tested by a second serological assay. The prevalence of HCV infections among Dutch dialysis patients as determined by serology or the presence of HCV RNA was 3% (80 of 2,653), i.e., 3.5% (73 of 2,108) in patients treated on hemodialysis and 1.3% (7 of 545) in patients on CAPD. Of these 80 HCV-infected dialysis patients, 67 (84%) were HCV RNA positive. Serological screening alone would have diagnosed only 70 infected patients. Therefore, antibody screening combined with detection of HCV RNA should be considered as the "gold standard" for diagnosing HCV infection in dialysis patients. The prevalence of HCV-infected patients in Dutch dialysis centers ranged from 0 to 8%, suggesting the existence of local risk factors for acquiring HCV infection. Genotyping analysis by reverse hybridization line probe assay revealed the presence of genotypes la (23%), 1b (46%), 2 (3%), 2a (13%), 2b (1%), 3a (7%), and 4a (4%). In four (6%) samples multiple genotypes were detected. The genotype distribution of HCV isolates among Dutch dialysis patients was similar to the distribution among nondialysis patients from the Benelux, except for subtype 1a, which was significantly more prevalent among dialysis patients. In only one center, a high prevalence of an uncommon genotype was suggestive of infection from a common source.

Ambulatory Care Facilities↗

PubMed2000

Serological relationships of Cryptococcus spp.: distribution of antigenic factors in Cryptococcus and intraspecies diversity.

The antigenic formulas of 34 species in the genus Cryptococcus were determined by using type strains and eight factor sera prepared from adsorption experiments with Cryptococcus neoformans serotypes. These antigenic factors were shared by 19 species. The strains used could be divided into eight serological groups. The patterns of groups 1, 2, 3, 5, and 6 were the same as the patterns of C. neoformans serotypes A, D, A-D, B, and C, respectively. The species belonging to group 4 reacted to factor sera 1, 2, and 3. Group 7 contained one species that reacted only to factor serum 1. The 15 species in group 8 did not react to any of the factor sera used. Compared to the reported molecular phylogenetic tree, the serological and phylogenetic data were correlated in the Filobasidium lineage. All the members of the albidus clade in the Filobasidium lineage had antigens 1, 2, and 3, and all the strains in the magnus clade belonged to serogroup 8. Moreover, intraspecies diversity was examined using strains of C. curvatus, C. humicolus, and C. laurentii. Serological heterogeneity was observed in the species C. humicolus and C. laurentii, as well as in phylogenetic relationships previously published. Using serological features, similarities and differences between Cryptococcus species were demonstrated. Our study contributes to a better description of the genus Cryptococcus and related species phenotypically and phylogenetically.

Agglutination Tests↗

PubMed2001

Assessment of Helicobacter pylori vacA and cagA genotypes and host serological response.

Helicobacter pylori strains can be distinguished by genotyping of virulence-associated genes, such as vacA and cagA. Because serological discrimination between strain types would reduce the need for endoscopy, 61 patients carrying H. pylori were studied by vacA and cagA genotyping of H. pylori in gastric biopsy specimens and by detection of specific serum antibodies. Serological responses to H. pylori were determined by Helicoblot (versions 2.0 and 2.1). Antibodies to CagA also were determined by a rapid anti-CagA assay (Pyloriset screen CagA) as well as by two noncommercially developed enzyme immunoassays, each using a recombinant CagA protein. Assessment of performance of the Helicoblot assays indicated substantial interobserver variation, with kappa values between 0.20 and 0.93. There was no relationship between the serological profiles on the Helicoblot and the genotypes from the same patients, except for strong associations between the presence of anti-CagA and the cagA-positive and vacA s1 H. pylori genotypes. Detection of anti-CagA by the five different assays varied considerably, with kappa values ranging from 0.21 to 0.78. Using the cagA genotype as the "gold standard," the sensitivity and specificity of the anti-CagA assays varied from 71.4 to 85.7% and from 54.2 to 100%, respectively. Thus, serological profiles of antibodies to H. pylori are heterogeneous and, with the exception of anti-CagA antibodies, show no relation to the H. pylori vacA and cagA genotypes. Detection of anti-CagA antibodies is strongly dependent on the test used.

Antibodies, Bacterial↗

PubMed1979

Pleocytosis and immunoglobulin changes in cerebrospinal fluid and herpesvirus serology in patients with Guillain-Barré syndrome.

In a follow-up study of 24 patients with Guillain-Barré syndrome, 55% developed a cerebrospinal fluid (CSF) mononuclear pleocytosis, which persisted for 4 months or more. Raised index values of CSF-immunoglobulin G (IgG), CSF-IgA, and CSF-IgM, indicating synthesis of the immunoglobulin in question in the central nervous system, were found in 63, 35, and 25%, respectively. Agarose gel eletrophoresis revealed oligoclonal immunoglobulin in CSF in 21% and in both CSF and serum in another 21% of the patients. Twenty-five percent had abnormally low kappa/lambda ratios of CSF and/or serum, indicating synthesis of oligoclonal immunoglobulin, mainly of the lambda light-chain type. The inflammatory reaction in the central nervous system, as reflected by pleocytosis, immunoglobulin synthesis, and oligoclonal immunoglobulin, was not correlated to the severity or course of Guillain-Barré syndrome. A raised CSF-IgM index and oligoclonal immunoglobulin were found more often in the Guillain-Barré syndrome patients who displayed pleocytosis. All patients had or developed antibodies to Epstein-Barr virus. Three patients had serology indicating a primary infection, 11 patients had antibody changes indicating a reactivated infection, and 10 had serology indicating previous exposure. Two patients showed serological evidence for a primary cytomegalovirus infection, 2 had serology indicative of a reactivated infection, 12 had titers as caused by previous exposure, and 8 remained seronegative. Virus-specific IgM was measurable in all cases of primary infection. Neither primary or reactivated Epstein-Barr virus nor cytomegalovirus infections were obviously related to CSF pleocytosis.

Adult↗

PubMed1994

No effect of intramuscular gold therapy on serological parameters of Helicobacter pylori infection in patients with rheumatoid arthritis: a 12 month prospective study.

OBJECTIVES: To assess prospectively the influence of intramuscular gold therapy on Helicobacter pylori serology in patients with rheumatoid arthritis (RA). METHODS: Fifty patients with RA were started on intramuscular gold or chloroquine, as the control group and were followed serologically for H pylori infection for 12 months. RESULTS: Twelve patients treated with gold and eight control patients treated with chloroquine, all with serological evidence for H pylori infection, showed no significant decline of IgA and IgG anti-H pylori antibody levels or serum pepsinogen A and C levels. Total serum IgA and IgG levels declined significantly during gold therapy, while they remained unchanged during chloroquine therapy. CONCLUSIONS: Intramuscular gold therapy in patients with RA does not influence the serological parameters of H pylori infection.

Antibodies, Bacterial↗

PubMed1994

Serological screening suggests that adult coeliac disease is underdiagnosed in the UK and increases the incidence by up to 12%.

Because coeliac disease often presents atypically it is underdiagnosed. It is suggested that the detection rate may be increased by 12% if serology is used to identify cases of occult enteropathy. All adults noted incidentally to be R1 anti-reticulin antibody (ARA) positive in the course of routine autoantibody testing of 6532 sera over one year were followed. None of the eight patients with seropositive serum was suspected of having coeliac disease. All eight had high titres of IgA anti-gliadin and IgA anti-endomysial antibodies, neither of which is detected in a routine autoantibody test, in addition to IgA R1-ARA. On clinical review coeliac disease was considered probable in only one patient, but because of the strong serological evidence of gluten sensitivity, jejunal biopsy was advised in all eight. Seven agreed and all had villous atrophy and crypt hyperplasia in keeping with coeliac disease. Six of the seven presented initially with vague symptoms such as tiredness or arthralgia. These symptoms disappeared after several weeks of gluten withdrawal. Forty two sera showing reticulin staining patterns other than R1 were used as controls. Low titre IgA anti-gliadin was noted in two of 42 but none had IgA anti-endomysial antibody. These 42 cases were not recommended for biopsy. During our study 58 other new adult cases of coeliac disease were diagnosed, primarily on clinical rather than serological grounds, at the four hospitals that request autoantibody studies. Occult coeliac disease detected serologically thus increased the overall incidence of coeliac disease by 12% from 58 to 65 cases. R1-ARA, even in the absence of the expected symptoms and signs of coeliac disease, is an indication for jejunal biopsy and is a reliable indicator of occult coeliac disease.

Adolescent↗

PubMed1993

Serological differentiation between acute (late control) and endocarditis Q fever.

AIMS: To differentiate the serological profiles of chronic (endocarditis) Q fever from the late follow up of acute cases. METHODS: Twenty patients (10 diagnosed with acute and 10 with endocarditis Q fever) were studied. Those diagnosed with acute infection were followed up from 2.5 to 88 months (mean 35.8 months). Serological variables included indirect immunofluorescence against phase I and II of Coxiella burnetii (IgM, IgG, and IgA), complement fixation and rheumatoid factor (RF). RESULTS: All patients with titres of IgA against phase I, after IgG removal, equal to or above 320 and a complement fixation value equal to or above 128 had endocarditis. No patient with acute Q fever had such a serological profile. CONCLUSIONS: The combination of IgA against phase I and complement fixation values may be sufficient to differentiate the serological profile of chronic (endocarditis) Q fever from the late follow up of acute cases.

Acute Disease↗

PubMed1994

Predictive value of serology in diagnosing Lyme borreliosis.

AIMS: To compare the predictive value of immunoblotting and enzyme linked immunosorbent assay (ELISA) in diagnosing Lyme borreliosis. METHODS: An ELISA using a whole cell sonicate of the B31 strain of Borrelia burgdorferi was used to screen samples submitted for Lyme borreliosis serology. A total of 1222 serum samples reactive in the ELISA were tested by immunoblotting also using the B31 strain. Patients with other spirochaetal diseases were tested by both methods to assess specificity, while those with erythema migrans were used to evaluate sensitivity. Subjects with different clinical conditions, which may have been associated with Lyme borreliosis, were tested using both techniques. RESULTS: Only 16.3% of serum samples from patients submitted for Lyme borreliosis serology which were reactive by ELISA were confirmed as positive by immunoblotting. This is unlikely to represent a sensitivity problem as 51% of samples from 53 patients with erythema migrans were detected by immunoblotting compared with only 28% by ELISA. Patients whose samples were negative by ELISA were also negative by immunoblotting. Serum samples from patients with relapsing fever were reactive in both ELISA and by immunoblotting, but for other test groups immunoblotting offered increased specificity. CONCLUSIONS: Not all ELISA results could be confirmed by immunoblotting. Yet immunoblotting was both more sensitive and specific than ELISA techniques. As a result of these observations all ELISA results should be serologically confirmed by immunoblotting. Though immunoblotting is not suited to large scale screening of samples, it can be used satisfactorily in conjunction with ELISA methods to improve the predictive value of serological tests for Lyme borreliosis.

Cross Reactions↗

PubMed1996

Accuracy of serology for the diagnosis of Helicobacter pylori infection--a comparison of eight kits.

AIMS: To determine the accuracy of eight commercially available kits for the serological diagnosis of Helicobacter pylori infection, and hence whether a serology service could be introduced to reduce endoscopy workload. METHODS: Eighty four patients newly presenting to their general practitioners with dyspepsia were recruited. Gold standard diagnosis of H pylori infection was obtained both by a histological examination of gastroduodenal biopsy specimens and by the 14C-urea breath test (UBT). The performance of six quantitative and two qualitative enzyme linked immunosorbent assays for H pylori IgG, used according to the manufacturers' instructions, with serum samples obtained during the endoscopy visit, were compared. RESULTS: The study population had a median age of 45 years, and the prevalence of H pylori infection was 35%. With one exception, where the patient had received a course of anti-H pylori treatment between endoscopy and UBT, there was 100% concordance in the results of the two gold standard techniques. Discordant serology results were more common in patients aged > 50 years (42% of the total) than in younger patients (21%), and this was most noticeable in uninfected patients. The sensitivity of the kits was good (90-100%), but specificity was more variable (76-96%), and the rate of equivocal results was unacceptably high in some cases (0-12%). The overall accuracy of the kits ranged from 83 to 98%. Two kits in particular performed well (Pylori-Elisa II, Bio-Whitaker and Premier, Launch; qualitative) with 98% and 100% accuracy, respectively. CONCLUSIONS: In a symptomatic population with a prevalence of H pylori infection of 35%, particularly in patients aged < 50 years, some but not all serology kits may be used as a highly accurate and inexpensive alternative to the gold standard techniques.

Adult↗

PubMed1988

Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus?

To assess the value of serological tests in diagnosing and monitoring the response to treatment of syphilis in patients infected with the human immunodeficiency virus (HIV), case notes of eight homosexual men with a history of treated syphilis, positive reactions to serological tests for syphilis, and documented subsequent conversion to HIV seropositivity were studied. No change was noted in serological markers of syphilis after HIV infection. The case notes of one man with primary syphilis, four men with secondary syphilis, and three men with latent syphilis, of whom all were HIV seropositive, were also studied. In seven of these patients the serological responses to infection and after treatment were consistent with the experience of syphilis in HIV seronegative patients. In one man treated for secondary syphilis, and confirmed as HIV seropositive eight months after treatment, the rapid plasma reagin (RPR) test result continued to be positive at a high titre for up to 20 months after treatment.

Acquired Immunodeficiency Syndrome↗