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PubMed1983

Invasive fungal infections. The use of serologic tests in diagnosis and management.

Serologic tests are useful in providing a presumptive diagnosis of invasive fungal infection, allowing early institution of specific therapy. The judicious use of these serologic tests for circulating antibodies or antigens also may aid in analyzing response to treatment and in assessing prognosis. This review summarizes the currently available serologic tests for common invasive mycoses and discusses their relative usefulness and reliability.

Aspergillosis↗
PubMed1997

Respiratory syncytial virus specific serum antibodies in infants under six months of age: limited serological response upon infection.

The decline of maternal respiratory syncytial virus (RSV) specific serum antibodies was studied in 45 children during the first 6 months of life, using a virus neutralization assay and competition ELISAs measuring fusion protein and glycoprotein specific antibodies. In all children RSV neutralizing antibodies were demonstrated at birth, with titers ranging from 33 to 1382. The calculated mean half life of these antibodies was 26 days. Furthermore, in a group of 38 children with suspected RSV infection, all younger than 6 months of age on admission, the diagnostic value of serological assays was evaluated. In 32 children RSV infection was confirmed by virus isolation, direct immune fluorescence and RT-PCR. In 7 patients of this group a significant titer rise in virus neutralization assay was demonstrated. Six additional RSV infected children could be identified by showing the presence of RSV-specific IgM or IgA serum antibodies or by showing an increase in fusion protein or glycoprotein specific antibodies. All serological tests together identified 13 (41%) of the 32 RSV infected patients. It is concluded that in children of this age group, which represent the majority of patients hospitalized with RSV infections, serological assays not only have a limited diagnostic value but are of limited value for sero-epidemiological studies.

Antibodies, Viral↗
PubMed1993

Significance of reactive Lyme serology in multiple sclerosis.

Nineteen of 283 consecutive patients evaluated in the Multiple Sclerosis (MS) Comprehensive Care Center had a borderline or positive B. burgdorferi serology. In 8 patients a repeat serology was nonconfirmatory. Cerebrospinal fluid was examined in 10 seropositive patients and showed anti-B. burgdorferi antibodies without intrathecal production in 5 patients. Antibiotic treatment did not prevent subsequent neurological relapses. The finding of reactive Lyme serology in an MS patient with no suggestive features of the infection is unlikely to indicate neurological Lyme disease.

Adult↗
PubMed1994

Avidities of IgG directed against viral capsid antigen or early antigen: useful markers for significant Epstein-Barr virus serology.

Classical Epstein-Barr virus (EBV) serology can be misleading in some cases due to the variability of the viral capsid antigen (VCA)-IgM response, persistent or reactivated VCA-IgM, or loss of anti-EBNA-1 during suppression of the cellular immune system. Therefore, we studied the usefulness and significance of avidity determinations of VCA-IgG and EA-IgG to achieve unequivocal interpretation of serological results. Avidities of EBV capsid antigen-specific IgG (VCA-IgG) and early antigen-specific IgG (EA-IgG) were determined by indirect immunofluorescence during and after acute EBV infection. Low-avidity antibodies were removed from antigen-antibody complexes by incubation with 6 M urea for 3 minutes. The analysis of 105 sera taken at defined time spans with regard to the onset of clinical symptoms allowed us to determine the kinetics of maturation of avidity of VCA-IgG. All sera had low-avidity antibodies at the onset of disease. More than 90% of the sera showed an avidity index below 0.25 during the first 10 days after the onset of disease. Fifty percent of the sera exhibited an avidity index of 0.25 or above 20-30 days after the onset of clinical symptoms. Sera from past infections uniformly exhibited avidity indices of 0.5 or 1. Avidity of EA-IgG may still be low when avidity of VCA-IgG is already borderline or high, thus allowing further differentiation of acute and recent infections. Avidity determination represents an important additional marker of serology in classical cases and allows diagnosis in aberrant cases, such as acute infections with low or undetectable VCA-IgM.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

Simian virus 40 (SV40) and human cancer: a review of the serological data.

Serum antibodies are widely utilised as specific and sensitive markers of virus infections but they have been employed relatively infrequently in the investigation of simian virus 40 (SV40) as a human carcinogen. In the past few years, serological data have become available which allow an examination of whether SV40 is currently circulating in human communities and if SV40 infection is associated with human cancer. The development of EIA with virus-like particles (VLPs) of SV40, BKV and JCV has facilitated serological studies. Sera from macaques naturally infected with SV40 cross-react unambiguously with BKV and JCV VLPs. Tests of over 9000 human sera with different immunological assays reveal a common pattern of SV40 reactivity. A small proportion of sera react at low titers and this reactivity is unrelated to age or the geographic location of the donor, but correlates with the presence and titers of BKV and JCV antibodies. Absorption with BKV and JCV VLPs decreases or abolishes the SV40 reactivity of human sera. The SV40 reactivity of sera from patients with mesothelioma, osteosarcoma or lymphomas, cancers which are reported to be associated with SV40, was similar to that in their controls or other comparison groups. The SV40 reactivity of human sera appears to be almost entirely a result of cross-reactivity with BKV and JCV antibodies. Serological data thus do not support the possibility that SV40 is circulating in human communities or that it is associated with human cancer.

Adolescent↗
PubMed2002

Laboratory diagnosis of influenza--virology or serology?

Although classical influenza is a clinically typical illness ("unchanging disease due to a changing agent"), laboratory investigations are essential at the beginning of each influenza epidemic. They should confirm suspected influenza cases and exclude "flu-like illnesses" which may be caused by numerous other viral and bacterial agents. Different virological as well as serological methods are available. For early diagnosis of acute influenza virus infections, virus detection using rapid procedures for virus isolation or antigen staining and molecular biological techniques have been developed. The determination of specific antibodies (IgG, IgM) has traditionally been widely used diagnostically. Conventional serological diagnosis is possible by means of the complement fixation and hemagglutination inhibition tests and allows the detection of type- and subtype-specific antibodies, respectively. As part of an automated serology, immunofluorescence test and enzyme-linked immunosorbent assay are the mostly widely available methods. In comparison, virus detection is clearly superior to antibody determination for diagnosis of influenza virus infections. However, antibody testing may be useful as a complementary tool to confirm the diagnosis retrospectively.

Antibodies, Viral↗
PubMedDate not supplied

Epstein-Barr virus polymerase chain reaction and serology in pediatric post-transplant lymphoproliferative disorder: three-year experience.

To assess whether the semiquantitative peripheral blood Epstein-Barr virus (EBV) polymerase chain reaction (PCR) test correlates with post-transplant lymphoproliferative disorder (LPD), we compiled the results of the test done over a 3-year period ending July 1997. Six hundred seventy-six tests were done on 185 patients. Four hundred-thirty tests (63%) were negative, 167 (25%) were weak positive, 67 (10%) were moderate positive, and 12 (2%) were strong positive. Twelve of the patients developed a lymphoproliferative disorder (LPD) during this time. The EBV PCR tests proximate to the diagnosis of LPD in the 12 patients with EBV-positive LPD were 6 strong positive, 5 moderate positive, 1 weak positive. No patient with LPD had a negative result at diagnosis. Stated another way, 6/12 (50%) of strong-positive PCR tests, 5/67 (7%) moderate-positive tests, and 1/167 (.6%) of weak-positive tests correlated with LPD. Serologic evaluation for EBV done on 7 patients at the time of LPD showed low serologic responses in 5 of the 7 patients. The EBV PCR temporally associated with the serology indicated moderate to large viral burdens. In each patient evaluated serially, the EBV PCR test rose before the diagnosis of LPD and fell with treatment for the disorder. In conclusion, the EBV PCR test may be used as an adjunct to the diagnosis of patients with LPD and may be used to monitor response to therapy for the disorder.

Antibodies, Viral↗
PubMed2001

Serologic diagnosis of Helicobacter pylori infection in outpatients aged 45 years or less.

The diagnostic accuracy of serological tests for Helicobacter pylori was studied in 145 consecutive outpatients aged 45 years or less referred for gastroscopy. Helicobacter pylori infection can be detected by serological tests, including rapid whole-blood tests. The low prevalence of the disease in young people may have a negative effect on the positive predictive value of a test. In this study, the presence of Helicobacter pylori was assessed by a biopsy urease test and histological examination, and by several serological tests: a rapid whole-blood test on fingerstick blood, a latex agglutination serum test, a commercial enzyme immunoassay (EIA) test, and an in-house EIA for detection of antibodies of both the IgG and IgA classes. Helicobacter pylori infection was diagnosed with invasive tests in 21 (14.5%) patients. The sensitivity, specificity, and positive and negative predictive values of the EIA-based tests, compared to histological examination, were 100%, 96-97%, 81-84%, and 100%, respectively. The positive predictive value of the latex agglutination test was 78%, whereas it was only 47% for the whole-blood rapid test used. Although the results of the whole-blood rapid test were unsatisfactory, the quantitative EIA-based tests could reliably detect Helicobacter pylori among young patients, in whom the prevalence of the infection is low.

Adult↗
PubMed2004

Relevance of serologic studies in inflammatory bowel disease.

The serologic panel for inflammatory bowel disease (IBD) is rapidly expanding. Antineutrophil cytoplasmic antibodies (ANCA) and anti-Saccharomyces cerevisiae mannan antibodies (ASCA) have remained the most widely studied markers, but immune reactivity against a new group of bacterial antigens such as I2, OmpC (outer membrane porin C), and flagellin, has been described in Crohn's disease. Several clinical avenues have been explored, such as the usefulness of serologic markers as screening tools for IBD and in accelerating a diagnosis in patients with indeterminate colitis. Another area of interest is disease stratification. Emerging data suggest there is a diversity of qualitative and quantitative responses to environmental antigens that differs among groups of IBD patients and may be associated with different clinical behaviors. As a result, it may be possible to tailor therapy on the basis of serologic responses. Prospective studies are needed before translating this concept into clinical practice. Clustering of IBD patients into more homogeneous subgroups based on antibody responses may help to unravel the pathophysiology of subsets of IBD.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1994

Treatment of chronic Chagas' disease with benznidazole: clinical and serologic evolution of patients with long-term follow-up.

Prescribing etiologic treatment for chronic Chagas' disease is highly controversial because of the difficulties involved in assessing its therapeutic efficacy--the low degree of parasitemia, the persistence of positive immunologic reactions, the lack of clinical findings to support each type of treatment, and the necessarily prolonged follow-up of the patient. An 8-year average follow-up was performed on 131 patients treated with benznidazole (5 mg/kg/day for 30 days) (TP) and 70 untreated patients (UTP) by serial electrocardiograms and analysis of the cardiomyopathic progress of the clinical groups, and by immunologic tests at both the beginning and end of the study. TPs presented less electrocardiographic changes during the follow-up period (4.2% vs 30%) and a lower frequency of deterioration in their clinical condition (2.1% vs 17%). The percentage of TPs who were serologically negative was 19.1% whereas 6% of the UTPs became serologically negative, a result that correlated with a lack of progress in the cardiomyopathy. Benznidazole treatment significantly decreased serologic titers, signifying parasitologic cure in two patients.

Adult↗
PubMed1986

Further studies on genital mycoplasmas in intra-amniotic infection: blood cultures and serologic response.

Mycoplasma hominis is recovered significantly more often in amniotic fluid of women with intra-amniotic infection than in matched control women, but Ureaplasma urealyticum is found in 50% of amniotic fluid samples of both groups. To gain further understanding, we performed blood cultures for genital mycoplasmas and measured serologic responses by a micro enzyme-linked immunosorbent assay method in women with intra-amniotic infection and in control subjects. In blood cultures of 81 women with intra-amniotic infection, M. hominis was isolated in two (2.5%) and U. urealyticum in 11 (13.6%). In 44 control blood cultures, M. hominis was not isolated, and U. urealyticum was recovered in eight (18.2%). These differences were not significant. Serologic response was determined in 86 patients. Rise in antibody to M. hominis was significantly more common in women with intra-amniotic infection and M. hominis in the amniotic fluid than in either women with intra-amniotic infection or control patients without M. hominis. For U. urealyticum antibody response was significantly more common in the intra-amniotic infection group than in control subjects, but there was no association between antibody response and isolation of this organism in amniotic fluid. When M. hominis was found in amniotic fluid or maternal blood, patients were nearly always symptomatic. The high likelihood of serologic response in these cases supports a pathogenic role of M. hominis in intra-amniotic infection. The role of U. urealyticum remains unclear.

Adult↗
PubMed1990

Serological interpretation--theoretical limits to information from blocking.

Contemporary immunogenetics uses a symbolism that tacitly assumes a one-to-one correspondence between genes, antigens, and antibody reagents that identify these. Thus a particular gene will be symbolized by an identifier, say X, and the reagent that supposedly uniquely identifies X is called anti-X. Ultimately, the precise relation between genes and antibody reagents will be determined by molecular techniques. Previous mathematical work has shown that by allowing a general relation (not constrained by symbolic conventions), alternative genetic descriptions can be found for some systems. This work predicts that when the relation is identified for these systems by molecular means, there will be an unresolved cross-reactivity, that is, there will not be a simple one-to-one correspondence between genes and the reagents used to identify them. This will contradict the notation in which the immunogenetic systems are described. Serology will have to be reinterpreted in terms of a more general notation that will allow for cross-reactivity. The focus of a mathematical model will switch from making inferences about genes, antigens, and antibodies in some system to analyzing genetics and serology as described by the notation. This paper investigates the information theoretically available from the serological operations of blocking, absorption, and elution. We show that, except for antigens (called undetectable) that mimic combinations of other antigens (in all cells in the system), blocking can theoretically reveal the relationship between antigens and antibodies in a system.

Antibodies↗
PubMed1994

Diagnostic value of recombinant Aspergillus fumigatus allergen I/a for skin testing and serology.

BACKGROUND: We report a clinical study comparing the recombinant Aspergillus fumigatus allergen I/a (rAsp f I/a) to two commercial A. fumigatus extracts in skin prick tests, intradermal tests, and serologic assays. METHODS: Patients with allergic bronchopulmonary aspergillosis and A. fumigatus-allergic patients with asthma, and control subjects, including allergic patients with asthma without allergy to A. fumigatus and healthy subjects, were investigated. RESULTS: All patients with allergic bronchopulmonary aspergillosis (n = 15) reacted to skin prick tests with the commercial extracts, and eight were sensitized to rAsp f I/a. Of 10 patients with well-characterized A. fumigatus-allergic asthma nine showed positive skin prick test results to at least one of the commercial extracts, and five reacted to rAsp f I/a. There was a strong correlation between skin test reactivity to rAsp f I/a and rAsp f I/a-specific serum IgE as determined by an antigen-specific ELISA. The healthy control subjects (n = 7) and allergic patients with asthma without A. fumigatus allergy (n = 6) did not react in skin prick and intradermal tests to rAsp f I/a, nor did they have detectable amounts of rAsp f I/a-specific IgE. In addition, patients with allergic bronchopulmonary aspergillosis showed significant elevated levels of rAsp f I/a-specific IgG4 and IgG1 but no significant differences in rAsp f I/a-specific serum IgA levels when compared with the healthy control subjects. CONCLUSIONS: The data show that rAsp f I/a is a major allergen with biologic relevance in some A. fumigatus-allergic individuals as evaluated by skin prick tests, intradermal tests, or serologic methods. Furthermore, no discrepancies were observed between skin test results and rAsp f I/a-specific IgE. Hence the correlation between rAsp f I/a skin test results and serologic data indicates the potential of recombinant allergens for clinical applications and diagnosis of allergies.

Adult↗
PubMed1995

Evaluation of different serological tests for detection of antibodies against Serpulina hyodysenteriae in pig sera.

Swine dysentery is a mucohemorrhagic diarrheal disease caused by S. hyodysenteriae. The detection of asymptomatic carriers in herds is possible by serological tests. However, cross-reactions between S. hyodysenteriae and S. innocens pose a major problem in serological diagnosis. Several serological tests were evaluated for detection of antibodies to S. hyodysenteriae such as: indirect hemagglutination, passive hemolysis, conglutination and microagglutination tests. Among the tests used, only the microagglutination test was able to detect antibodies to S. hyodysenteriae. 70 to 95% of the pigs were invariably seropositive in a single dilution of 1:10 in actively infected herds whereas the number of seropositives did not exceed 10% in presumably non-infected herds. The test was found to be simple, and reliable to be used with confidence for detection of herd infection using boiled cell suspension as an antigen.

Animals↗
PubMed2004

Cost-effectiveness of herpes simplex virus type 2 serologic testing and antiviral therapy in pregnancy.

OBJECTIVE: The purpose of this study was to determine whether serologic testing for herpes simplex virus type 2 (HSV-2) in pregnant women and their partners is cost-effective. STUDY DESIGN: A decision analysis model was developed to investigate the cost-effectiveness of providing type-specific serologic testing at week 15 of pregnancy for all women unaware of their HSV-2 status, and offering antiviral suppressive therapy from week 36 until delivery to all seropositive women. This scenario was compared with current care, in which only a minority of women diagnosed with genital herpes (GH) receives antiviral suppressive therapy (AST). In a third scenario, testing is offered to partners of pregnant women who test seronegative, and antiviral suppressive therapy is offered to the partners who test seropositive. RESULTS: Compared with current care, offering testing and antiviral suppressive therapy to 100,000 pregnant women resulted in an incremental cost of $3.1 million, 15.7 fewer cases of neonatal herpes, 186 fewer cesarean deliveries, and an incremental cost per quality-adjusted life- year gained (QALY) of $18,680. Offering testing and suppressive therapy to both the pregnant women and their partners resulted in an increased cost of $8.6 million, 16.8 fewer cases of neonatal herpes, 192 fewer cesarean deliveries, and an incremental cost per QALY of $48,946 compared with no testing. CONCLUSION: Compared with commonly accepted benchmarks for cost-effectiveness (<$50,000/QALY), type-specific HSV-2 serologic testing of pregnant women may be a cost-effective strategy.

Adolescent↗
PubMed2005

[Rational use of viral serology in the child].

Very sensitive and allowing discrimination between IgG and IgM, the enzyme immunoassays are the most commonly used to carry out viral serologies. The presence of IgG corresponding to a natural or postvaccination immune status or to a latent or occult infection is a reliable information to assess the protection against some opportunistic or teratogenic infections respectively in children or pregnant women. The search of IgM by immunocapture is suitable to early diagnose the majority of common viral diseases in childhood, specially when presenting in an atypical form, and to attest a congenital rubella infection. Moreover, IgG avidity proved to be useful in dating an infection and confirming positive IgM results. However, viral infections localized at an entry site of the host, such as respiratory and enteric diseases, as well as syndromes of herpes simplex and enteroviral origin, do not represent indications of serological diagnosis. Provided its use with discernment, the serological diagnosis of viral infections have to be considered as a high performance and of low cost biological tool.

Child↗
PubMed2006

Evaluation of new-generation serologic tests for the diagnosis of typhoid fever: data from a community-based surveillance in Calcutta, India.

Although typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi, rapid and simple diagnostic serologic tests would be useful in developing countries. We examined the performance of Widal test in a community field site and compared it with Typhidot and Tubex tests for diagnosis of typhoid fever. Blood samples were collected from 6697 patients with fever for > or =3 days for microscopy, culture, and serologic testing and from randomly selected 172 consenting healthy individuals to assess the baseline Widal anti-Typhi O lipopolysaccharide antibody (anti-TO) and anti-Typhi H flagellar antibody (anti-TH) titers. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 3 serologic tests were calculated using culture-confirmed typhoid fever cases as "true positives" and paratyphoid fever and malaria cases as "true negatives". Comparing cutoff values for the Widal test, an anti-TO titer of 1/80 was optimal with 58% sensitivity, 85% specificity, 69% PPV, and 77% NPV. Sensitivity was increased to 67% when the Widal test was done on the 5th day of illness and thereafter. The sensitivity, specificity, PPV, and NPV of Typhidot and Tubex were not better than Widal test. There is a need for more efficient rapid diagnostic test for typhoid fever especially during the acute stage of the disease. Until then, culture remains the method of choice.

Antibodies, Bacterial↗
PubMed2006

Serological and virological profile of chronic HBV infected women at reproductive age in Greece. A two-year single center study.

OBJECTIVE: Seroprevalence of HBsAg in 26,746 women at reproductive age in Greece and evaluation of HBeAg/anti-HBe serological status as well as serum HBV-DNA levels in a subgroup of HBsAg(+) women at labor. STUDY DESIGN: Serological markers were detected using enzyme immunoassays. Serum HBV-DNA was calculated using a sensitive quantitative PCR assay, with a lower limit of quantification of 200 copies/ml. RESULTS: Overall, 1.53% of women were HBsAg(+) and the majority of them (64.96%) were Albanian. Among Albanian women the mean prevalence of HBsAg was 4.9%, 5.57% among Asian women, and 1.29% among women from Eastern European countries. The prevalence of HBsAg among African (0.29%) and Greek women (0.57%) was very low and significantly lower in comparison with the mean value of the studied population. Only 2.67% of HBsAg(+) women were HBeAg(+). Of a subgroup of women in labor with available serum samples 28.6% had undetectable levels of viremia (<200 copies/ml) and 15.9% had extremely low levels of viral replication (<400 copies/ml). Only 12.7% of pregnant women evaluated at labor exhibited extremely high serum HBV-DNA levels (>10,000,000 copies/ml) whereas 42.8% of them exhibited HBV-DNA levels between 1500 and 40,000 copies/ml. CONCLUSIONS: The overall prevalence of HBsAg is relatively low among women at reproductive age in Greece but is higher among specific ethnic populations (Asian, Albanian). The HBeAg(-)/antiHBe(+) serological status is a finding observed in the vast majority of HBsAg(+) women of our study population, and a significant percentage of them (approximately 44.5%) exhibit extremely low or even undetectable levels of viral replication at labor, suggesting possibly that only a proportion of HBsAg(+) women in Greece exhibit an extremely high risk of vertical transmission of the infection.

Adolescent↗