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[Epidemiological evaluation of the serological grouping of meningococci].

Use of the precipitation and hemagglutination inhibition tests to determine the serological group of 114 meningococcus strains which cannot be grouped by agglutination slide permitted to establish the serological group of 56% of the strains, this pointing to the greater diagnostic value of these tests. Nevertheless, 70% of 307 strains isolated from carriers could not be referred to any of the determinable groups (A, C, X, Y, and Z). Strains (417) isolated from the cerebrospinal fluid of patients with meningitis were grouped depending on the epidemic curve: only half of the cultures could be classified in sporadic cases, but from 80 to 100% of the strains were classified at the "peak" of the meningitis incidence rise. This rise was connected with increase of the incidence of cases caused by meningococcus, group A; at the decline these strains were eliminated, and cases due to the rarely encountered serological groups and nongrouping strains occurred. Marking meningococc by serological groups proved to be of no use for detection of epidemiological relations between the infected persons.

Agglutination Tests↗

Helicobacter pylori serology and the diagnosis of H. pylori infection in children.

Serological screening accuracy rate may be dependent on clinical and pathological determinants. The aim of this study was to evaluate the accuracy of Hp serology test (Roche Biomedical Lab., Labcorp), in the diagnosis of Hp infection in 121 children who were seen in the Pediatric Gastoenterology Clinic at the Marshall University Joan C. Edwards School of Medicine in Huntington. Positive serology detected children with Hp-associated gastritis with a sensitivity of 51.6%. Positive serology significantly correlated with the degree of gastric inflammation and density of Hp organisms in the gastric mucosa (ANOVA p < 0.001). The Labcorp. Hp-ELISA test had a poor accuracy rate for the detection of Hp-gastritis in children. Gastric biopsies should always be performed to establish the diagnosis of Hp infection in children.

Adolescent↗

Serologic Testing for Chagas' Disease and HIV in Counseling Programs and Blood Banks in Midwest Brazil.

For many years it has been the practice in Brazil to question donors and to test blood to be used in blood banks for HIV, Chagas' disease, hepatitis B and C, and syphilis. Counseling and blood testing programs have recently been established to assist in identifying and treating those with HIV. In a blood bank center in Campo Grande, Mato Grosso do Sul State (MS), we evaluated the frequency and age of patients with positive tests for T.cruzi in order to determine whether the frequency and age distribution indicated that this infection should be added to the counseling and testing programs. A group of 476 first time blood donors were enrolled to answer a questionnaire and to be tested serologically for Chagas' disease, HIV, hepatitis B and C, and syphilis. A standard ELISA and an IFA test were used for Chagas' disease patients. Five patients (1.1%) were serologically positive for T.cruzi infection. All five were male between 22 and 35 years of age. None of the five had been born in Mato Grosso do Sul State. Four donors donated blood in order to obtain serologic test results, only one donated blood as a social responsibility. One was HIV positive and related previous STD, and one had received a blood transfusion between 1980 and 1986. Each had had only one sexual partner in the last six months. The age range and the frequency of 1.1% suggest that it would be beneficial to include this disease in counseling and testing program in Brazil. The limitations of this approach are the relatively low attendance at such centers in Mato Grosso do Sul (1.7 people/day compared to a national average of 2.9 people/day), the slow reporting time for results (1 week compared to 1 day for the blood bank reporting), and the absence of a standard disease-specific testing procedure. We recommend increasing the use of serologic tests for T.cruzi and designing appropriate questionnaires in counseling and testing programs now used primarily for HIV, assuming the existing limitations can be overcome.

Journal Article↗

[Data on the biological characteristics of serological group O4 Escherichia isolated in acute intestinal diseases].

A study was made of 155 strains of E. coli of the O4 serological group isolated from sick children and adults during group and sporadic acute intestinal diseases), from persons who came in contact with them, and also from healthy persons during prophylactic examination; three standard cultures were examined as well. Along with strains with a typical enzymatic activity there were strains which produced retarded lactose fermentation and also gas-free, immobile and lysin-negative strains resembling Shigellae. Eight biochemical types were determined among E. coli 04. A study of the antigenic structure by cross agglutinin adsorption indicated identicity of the strains by O-antigen and their difference by the K- and H-antigens. Circulation of E. coli of serological types O4: K12(L): H1,O4: K3(L): H5,O4: K3(L): H12,04: K12(L): H40,04: K52(L): H4, and O4: K12(L) HII was revealed; the first two serological types prevailed. Serological types of O4: K3(L):H12, O4: K12(L): HI and O4: K12(L): H40, isolated in cases of group and sporadic acute intestinal diseases were described for the first time.

Acute Disease↗

[Serologic screening for neurosyphilis].

BACKGROUND: Syphilis serology is analysed in all patients admitted as in-patients to the Department of Neurology in Tromsø. In this study we examined the utility of performing routine laboratory testing for syphilis in neurological patients. MATERIAL AND METHODS: We registered all in-patients in the Department of Neurology with a confirmed diagnosis of syphilis during a ten-year period (1990-1999). Additionally, we calculated the cost of performing laboratory tests of all hospitalised patients in this period. RESULTS: From a total of 8,637 patients, we identified five patients with syphilis, one of them with neurosyphilis. This patient had impaired cognitive functions at the time of admittance and a broad spectrum of neurological deficits suggesting a serious neurological disease. A positive syphilis serology confirmed the diagnosis and treatment was initiated. The mean cost for Treponema pallidum serological screening in neurological patients during 10 years was calculated to be about NOK 17,000 per year. INTERPRETATION: Tertiary syphilis is a serious disease with symptoms often mimicking other diseases. Although the laboratory tests for syphilis have been performed in every in-patient admitted to the neurological ward, a speedier diagnosis of neurosyphilis could not be detected in any patient in a ten-year hospital material. Routine serological examination for syphilis in neurological patients is therefore not recommended in this geographical area.

Cost-Benefit Analysis↗

[Secondary serologic responses to dengue epidemic in 1998 in Salta, Argentina, where other flavivirus co-circulate].

In 1998, a dengue outbreak (serotype 2) occurred in Salta province in Northern Argentina, following the first detection of dengue in the same area in 1997. We classified the serologic response of cases from 1998 as primary or secondary, since the risk of severe disease is greater for secondary cases. We studied 154 cases by plaque reduction neutralization and hemagglutination inhibition tests. Thirty-eight cases (25%) were classified as primary serologic responses and 84 cases (54%) as secondary responses. Thirty-two cases (21%) with borderline IgG titers could not be classified. Previous exposure to potentially cross-reacting flaviviruses (Saint Louis Encephalitis [SLE] and Yellow Fever [YF] viruses) was analyzed, as a possible cause of the secondary response pattern. Our results indicated that among cases classified as dengue secondary response, 83% could be attributed to previous SLE or YF exposure or serologic cross-reactivity. Vaccination against YF virus was at most a minor contributor to the secondary response pattern. The finding of a positive YF serologic result among persons not vaccinated may indicate silent circulation of YF in a region that can support both urban and jungle cycles. Other cases showing dengue secondary responses remained unexplained, suggesting the unrecognized occurrence of a previous infection with other dengue serotypes or of flaviviruses other than SLE or YF.

Antibodies, Viral↗

Simplicity through complexity: immunoblot with recombinant antigens as the new gold standard in Epstein-Barr virus serology.

Immunofluorescence tests have been the gold standard in Epstein-Barr virus (EBV) serology during the past decades. Despite their high quality they cannot resolve significant problems with i) anticellular reactivity of some sera, ii) missing anti-EBNA-1 response in 5% of healthy individuals, and iii) loss of anti-EBNA-1 during immunosuppression. Immunoblots with recombinant EBV antigens (either in the Blot or the Line assay version) allow unequivocal serological diagnosis also in those cases that are problematic for immunofluorescence testing, 1) since due to the use of purified recombinant antigens, anticellular reactivities are no problem, and 2) since a combination of two late markers is tested (p72 and p18). Positive p18-IgG thereby defines those cases of past infections in which p72-IgG (anti-EBNA-1) is missing or has been lost. In nearly all cases, a single IgG test is sufficient for a definitive serological diagnosis. Whenever required, the immunoblot technique allows precise quantitation and avidity determination. The immunoblot with recombinant antigens represents the most sensitive, unequivocal and simple test system available at present, with the highest complexity of information obtained. Therefore, the immunoblot with recombinant antigens should be regarded as the new gold standard in EBV serology.

Antibodies, Viral↗

Poor serologic response to upper respiratory infection with Mycoplasma synoviae in turkeys.

Mycoplasma synoviae (MS) was isolated from a flock of commercial tom turkeys in which a small percentage of the birds exhibited clinical signs and lesions typical of MS synovitis. However, serologic testing of such flocks revealed poor to inconsistent reactivity by agglutination, enzyme-linked immunosorbent assay (ELISA) or hemagglutination inhibition; isolation of MS from such flocks proved to be very difficult. Turkeys were challenged with one of the isolates (K4463B) either by aerosol or systemically by a combination of intravenous, foot pad, and eyedrop routes. Turkeys challenged by the systemic route responded normally to all serologic tests, whereas those challenged by aerosol either responded very poorly on all serologic tests or were seronegative up to 6 wk postchallenge even though they were positive for MS by tracheal culture. These results suggest that turkeys may harbor an upper respiratory infection with MS while remaining serologically negative.

Agglutination Tests↗

Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus.

OBJECTIVE: A Multiple-Indicator Cluster Survey (MICS) was conducted at mid-decade in more than 60 developing countries to measure progress towards the year 2000 World Summit for Children goals. These goals included the protection of at least 90% of children against neonatal tetanus through the immunization of their mothers, as measured by tetanus toxoid (TT) coverage. In the Central African Republic (CAR), serological testing was added to the MICS to understand better the relationship between survey estimates of TT coverage and the prevalence of serological protection. METHODS: In the CAR MICS, mothers of children younger than one year of age gave verbal histories of the TT vaccinations they had received, using the MICS TT questionnaire. A subsample of mothers was tested for tetanus antitoxin, using a double-antigen enzyme-linked immunoadsorbent assay (ELISA). Seropositivity was defined as a titre of > or =0.01 IU/ml, and TT coverage was defined as the proportion of mothers protected at delivery, according to their history of TT vaccinations. FINDINGS: Among the 222 mothers in the subsample, weighted TT coverage was 74.4% (95% Confidence Interval (CI); 67.0% - 81.7%) and tetanus antitoxin seroprevalence was 88.7% (95% CI; 83.2% - 94.2%). The weighted median antitoxin titre was 0.35 IU/ml. CONCLUSIONS: Tetanus toxoid coverage in the CAR was lower than the prevalence of serological protection against neonatal tetanus. If this relationship holds for other countries, TT coverage estimates from the MICS may underestimate the extent to which the year 2000 goal for protecting children against neonatal tetanus was reached. We also showed that a high level of serological protection had been achieved in a country facing major public health challenges and resource constraints.

Central African Republic↗

[Application of the HLA system to forensic medicine--from serology to DNA polymorphism].

HLA antigens are highly polymorphic and therefore considered useful for personal identification in forensic medicine. The HLA system was first applied to forensic medicine for serological typing and is currently being applied to DNA typing. We first applied the HLA system to serological typing for paternity testing. Exclusion of paternity was confirmed in 39 of 93 cases. While serological HLA typing and other testing yielded consistent results in 37 of these 39 cases, exclusion of paternity could be confirmed only by serological HLA typing in 1 case and only by other testing in 1 case. Even in cases where exclusion could not be confirmed, it was possible to increase the probability of paternity. Bloodstains with known HLA types were then subjected to lymphocytotoxic inhibition tests to detect HLA antigens using one of the following methods: a two-stage method using an antibody and a bloodstain extract; a one-stage method where a bloodstain was allowed to react directly with an antiserum; or a washing method where washing was combined with one of the two above methods. Although HLA antigen detection was possible using any of these methods, some antisera yielded false-positive reactions, which limited the range of usable antisera. With the exception of cross-reactions, the washing method eliminated false-positive reactions. Antigens were detectable in bloodstains that were left to stand for up to 42 days. DNA typing based on the HLA system was investigated by determining DR and DQB1 types using the Hot Start PCR-SSP method with various samples of known HLA types and tissue samples collected from unidentified corpses. With bloodstains, DR typing was possible in all 61 cases, while DQB1 typing was possible in 31 of 33 cases. DR typing was possible even when bloodstains had been stored for 10 to 20 years. With saliva stains, typing was possible in all cases by purifying DNA using a Microcon 100 microconcentrator. With hair samples, typing was possible with all hair root samples and about half of hair shaft samples. With mixed stains, the detection of minor components was possible even at a low mixing ratio of 10:1. With cigarette butts, as was the case with saliva stains, typing was possible using purified DNA. Lipstick did not affect the results of DNA typing. Although DNA typing was possible in many cases using tissue samples collected from unidentified corpses, the results were affected by factors such as status of corpse, postmortem interval, postmortem change and tissue type. With some aorta samples, for example, typing was possible up to one year after death. The results of typing were also fairly favorable using bone samples.

DNA↗

[Serological tests for detection of fungal infection connected with prolonged antibiotic treatment after valve replacement].

UNLABELLED: In recent years substantial progress has been seen in the development of approaches and methods for serological diagnosis of the mycosis. The aim of our study was to assess the clinical usefulness of serological tests for fungal infection in pts who underwent prolonged antibiotic therapy after valve replacement. MATERIAL AND METHODS: The group consisted of 27 pts after valve replacement with prolonged antibiotic therapy (6-12 weeks) due to infective endocarditis (22 pts) or sternal infection (5 pts). The samples of blood were taken 10 days after antibiotics were started and next every 10 days. Serological techniques for the diagnosis of Candidiasis consisted of antibody detection to: the cell wall polysaccharide antigen (test A), cytoplasmic protein antigen (test B) and the germ tube antigens (test C). RESULTS: Patients were divided in 3 groups due to the kinetics of the antibody responses to the Candida antigen: 1. pts with normal level of antibody during antibiotic treatment--they didn't required antifungal therapy, 2. pts with increasing level of antibody needed antifungal treatment, 3. pts with increasing kinetics of antibody responses during antibiotic and antifungal treatment needed the change of antifungal therapy, 4. Control group (pts before cardiac surgery without any sign of fungal infection). Antibody to the cytoplasmic antigen was detected infrequently. The presence of antibody to the cytoplasmic antigen was correlated with the patient clinical outcome and prognosis and necessity for change of antifungal therapy. One pt died after valve replacement due to valve dysfunction because of fungal endocarditis. CONCLUSIONS: Serological tests for Candidiasis can be a useful marker of fungal infection, prognosis and treatment in pts required prolonged antibiotic therapy after valve replacement.

Aged↗

[Evaluation of the methods used for the serologic diagnosis of brucellosis].

Serological tests are the most widely used methods for the diagnosis of Brucella infections, since bacterial isolation techniques are time consuming. The conventional serological methods are the tube and slide agglutination tests, however enzyme immunoassays (ELISA) have gained importance recently as rapid diagnostic techniques. The aim of this study was to evaluate the performances of standard tube agglutination (STA, Wright test), slide agglutination (Rose-Bengal, RB) and ELISA-IgG and -IgM methods, in the serological diagnosis of brucellosis. For this purpose, Brucella antibodies have been searched in the serum samples of 184 patients (92 acute and 92 chronic brucellosis cases, of these 21 had positive blood cultures) and 20 healthy blood donors, who inhabit in the same region, as the control group. The positivity rates of STA (titers > or = 1/160), ELISA-IgG and -IgM in the patient group were found 83.7%, 61.9% and 49.5% respectively, while RB positivities for Brucella abortus and B. melitensis were 61.9% and 67.9%, respectively. In the control group STA and ELISA tests showed negative results, but RB for B. abortus and B. melitensis were positive in 25% and 30% of controls, respectively. Since ELISA and RB were found less sensitive than STA, it was concluded that STA is still the most reliable method for the serological diagnosis of brucellosis.

Acute Disease↗

Recombinant antigen expression on yeast surface (RAYS) for the detection of serological immune responses in cancer patients.

The serological analysis of antigens by recombinant expression cloning (SEREX) has identified a multitude of new tumor antigens in many different tumor entities. These antigens can be grouped into different classes according to their specificities, with cancer/testis antigens appearing to be the most attractive candidates for vaccine development. The observation that CD8 and CD4 T-cell responses against cancer/testis antigens such as NY-ESO-1 correlate with the presence of specific antibodies demonstrates the importance of serological monitoring patients participating in vaccine trials. However, all serological assays available (Western blot, phage display and ELISA) are hampered by the fact that the protein cannot be analyzed in its natural conformation. We have thus developed a yeast display system where the antigen is expressed on the yeast surface (RAYS), allowing for a more natural folding of the protein. To validate this approach we displayed the A33 colorectal cancer antigen on the yeast cell surface and demonstrated specific binding by an A33 monoclonal antibody recognizing a conformation-dependent epitope on the A33 antigen. We then compared RAYS with the more commonly used ELISA and Western blot serological monitoring methods by analyzing 50 sera from cancer patients with known NY-ESO-1 antibody status and 10 sera from patients with unknown SSX2 antibody status in a blind fashion. RAYS appears at least equivalent to both ELISA and Western blotting for the monitoring of antibodies against NY-ESO-1 as regards specificity and sensitivity, while antibodies against SSX2 were detected more frequently by RAYS than by ELISA or phage display.

Antibodies, Monoclonal↗

Serological titers to bovine herpesvirus 1, bovine viral diarrhea virus, parainfluenza 3 virus, bovine respiratory syncytial virus and Pasteurella haemolytica in feedlot calves with respiratory disease: associations with bacteriological and pulmonary cytological variables.

Acute and convalescent serum samples were taken from 59 calves with signs of respiratory disease (cases) and 60 clinically normal animals (controls) during their first month in the feedlot. Sera were analyzed for antibodies to bovine parainfluenza 3 (PI3) virus by hemagglutination inhibition, to bovine viral diarrhea (BVD) virus, bovine respiratory syncytial (BRS) virus and bovine herpesvirus 1 (BHV1) by virus neutralization, and to Pasteurella haemolytica by indirect agglutination (PhIA) and cytotoxin neutralization (PhCN) tests. There was minimal evidence of serological activity to BHV1. Serological activity to the other agents occurred commonly and the prevalence of acute titers and their mean values was similar in case and control groups. Mean convalescent PI3 and P. haemolytica (PhIA) titers were higher in controls than cases (p < 0.01) but, otherwise, convalescent titers did not differ between groups. The incidence of seroconversion was similar in both groups for all agents except for PI3 virus which was more frequent in controls than cases (p < 0.0001). There was a positive association between PhIA and CN seroconversion and isolation of P. haemolytica from bronchoalveolar lavage (BAL) fluid (p < 0.1). The measure of agreement (kappa) between seroconversion with the P. haemolytica PhIA and PhCN tests was 0.51. Bacteriological and cytological evaluations of the respiratory tract were made using BAL. No associations were evident between serological titers and pulmonary cytology. A multivariate logistic analysis was used to evaluate associations between disease status and serological, bacteriological and cytological data. Cases were positively associated with the presence of neutrophils and Pasteurella multocida in BAL fluid and negatively associated with PI3 virus and PhIA seroconversion.

Acute Disease↗

[Serologic pattern of meningococci in a focus of infection].

The authors present the results of typing of meningococci (isolated from the patients and carriers) by the sera of serological groups A, B, C, D, X, Y, and Z made at the Leningrad Institute of Vaccine and Sera. The causative agents of serological group A were most frequently isolated from the patients with the generalized forms of meningococcus infection. The percentage of detection of meningococci of serological group A was the greatest in the patients and much less in the carriers in and outside the foci of this infection. Many dissociated cultures were revealed among the strains isolated from the carriers. Sera of the Leningrad Institute of Vaccine and Sera have permitted typing of meningococci cultures belonging to various serological groups in accordance with the international classification.

Humans↗

Effect of mismatching serologically defined residues on kidney transplant survival.

Amino acids within the HLA class I and II molecules were first examined individually for correlation with antibody reactions of over 50,000 antisera. The amino acids that correlated with the serologic reactions were classified as serologically defined: approximately half of the amino acids fell within that category, and the other half were employed as controls. The cadaver donor kidney transplant survival for patients who were mismatched for each of the sera-defined amino acids were compared to mismatches of the nonserologically defined amino acids. No differences were noted in the graft survivals of patients with mismatches for the serologically defined amino acids of HLA-A, -B, and -DR loci and for the nonserologically defined amino acids. Since many of the patients also had additional amino acids of mismatch, we cannot yet conclude that the serologically defined amino acids do not significantly influence graft outcome. In other words, the test may not have been sensitive enough to detect the degree of immunogenicity that may exist. However, we can conclude that mismatches for no single amino acid are strongly immunogenic.

Amino Acid Sequence↗

SEROLOGICAL activity of various fractions of culture filtrates of the tubercle bacillus.

As culture filtrates of Mycobacterium tuberculosis have been shown by numerous workers to be antigenically heterogeneous, a series of experiments has been started to identify some of the different antigens likely to be useful in laboratory tests for measuring the antibodies in human blood. The work involves the fractionation of concentrated culture filtrates by various chemical procedures, the chemical analysis of the fractions, and their subsequent testing and cross-testing with various serological procedures.A number of fractions made from filtrates of heated and unheated cultures have been tested for activity in the Middlebrook-Dubos haemagglutination test. As might be expected, the fractions were found to vary in potency, some showing at least a thousand times more erythrocyte-sensitizing activity than others. Cross-inhibition tests made with the most active preparations indicated the existence of at least two different substances responsible for sensitizing erythrocytes to agglutination, one being demonstrable only in certain unheated fractions.Antibodies detected with the tannic acid haemagglutination test have a different serological specificity from those detected by the Middlebrook-Dubos test. Different heated fractions gave strong cross-reactions with each other in the tannic acid haemagglutination procedure, and little difference could be seen between them; in contrast, four active fractions from unheated filtrates were distinct from each other, showing very little cross-reaction.Results obtained with another haemagglutination procedure, consisting of agglutination of normal erythrocytes by antiserum-antigen mixtures, showed that this method detected another antigen, not measured in the tannic acid or Middlebrook-Dubos techniques under the conditions of the tests.The present experiments have shown that the culture filtrates and fractions thereof contain a series of distinct antigens or at least characteristic combinations of antigens that differ in serological specificity and in their ability to react in the different tests. Further experiments are necessary to determine whether the serological differences are of any special significance in relation to tuberculous disease or bacterial type specificity.

Antibodies↗

Utilizing Chlamydia trachomatis IgG serology with HSG to diagnose tuboperitoneal-factor infertility.

To evaluate if Chlamydia trachomatis IgG serology combined with hysterosalpingography can make it easier to detect tuboperitoneal factor infertility, we conducted a chart review of 76 consecutive patients at an infertility practice at West Virginia University from 1999-2001. We checked the charts for results of Chlamydia trachomatis IgG serology, Hysterosalpingography (HSG) and laparoscopy. Results of these tests were reviewed along with age, parity, previous reproductive tract disease surgery and duration of infertility. Complete data was found on 32 of the 76 patients. Chlamydia serology in conjunction with the HSG had a sensitivity of 80% for tuboperitoneal factor (tubal obstruction or pelvic adhesions), and a specificity of 82.3%. The positive predictive value was 80% and the negative predictive value was 82%. Since Chlamdia trachomatis IgG serologic testing is non-invasive and relatively inexpensive, we recommend combining it with hysterosalpingography as an infertility work-up. More invasive testing such as laparoscopy may be postponed or completely eliminated.

Chlamydia trachomatis↗