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Counterimmunoelectrophoresis of blood cultures. Temporal Relationship of positive Gram stain to positive counterimmunoelectrophoresis.

Counterimmunoelectrophoresis (CIE), Gram staining, and quantitative measurements were performed on simulated blood cultures at hourly intervals after inoculation with Streptococcus pneumoniae, Klebsiella pneumoniae, or Haemophilus influenzae. The CIE became positive either at the same time as the Gram stain or within the ensuing five hours. In no case was CIE positive when the Gram stain was negative. The numbers of colony-forming units milliliter necessary for a positive CIE result varied with the types of microorganisms. The procedure of CIE appears useful as a rapid screening technic for identification of bacteria in blood cultures when microorganisms are seen in Gram-stained smears.

Antigens, Bacterial↗

Counterimmunoelectrophoresis employing coccidioidin in serologic testing for coccidioidomycosis.

Counterimmunoelectrophoresis, was performed for serologic testing for coccidioidomycosis, employing coccidioidin and spherulin as antigens. Results obtained by counterimmunoelectrophoresis were compared with results obtained by complement-fixation and radial immunodiffusion. Of the 37 sera positive by complement-fixation, 28 were positive by counter-immunoelectrophoresis utilizing coccidioidin, whereas only 11 were positive by counterimmunoelectrophoresis utilizing spherulin (although an additional 14 were positive with counterimmunoelectrophoresis employing spherulin when the quantity of spherulin was increased by 50 to 100%). Thirty-three of these complement-fixation-positive sera were positive by immunodiffusion. Counterimmunoelectrophoresis performed with coccidioidin detected antibodies to C. immitis in all patients who had complement-fixation titers greater than 1:4. When combined with latex agglutination, counterimmunoelectrophoresis utilizing coccidiodin had an 86% correlation with complement-fixation for the detection of positive sera.

Antigens, Fungal↗

Evaluation of counterimmunoelectrophoresis for serotyping Actinobacillus pleuropneumoniae isolates and detection of type-specific antigens in lungs of infected pigs.

A rapid, simple, and accurate counterimmunoelectrophoresis technique was developed for serotyping cultures of Actinobacillus pleuropneumoniae as well as for detection of their type-specific antigens in the lung tissues of infected pigs. The counterimmunoelectrophoresis test correctly identified all of the reference antigens and more than 99% of 1,200 field isolates of A. pleuropneumoniae representing the 12 established serotypes within 1 h. Counterimmunoelectrophoresis and coagglutination tests did not differ broadly in sensitivity from each other. Both procedures were more rapid and more sensitive than immunodiffusion and indirect hemagglutination tests. A total of 355 lung tissue samples (130 lungs of pigs that died because of acute respiratory problems, 125 lungs of pigs from herds with chronically infected pleuropneumonia, and 100 lungs from apparently healthy pigs at the slaughterhouse) were examined for the presence of A. pleuropneumoniae type-specific antigens by counterimmunoelectrophoresis, coagglutination, and immunodiffusion tests. A. pleuropneumoniae type-specific antigen was found in all 55 samples from which the bacteria had earlier been isolated and in 27 specimens in which they had not been found. Detection of antigen in the lung tissues by coagglutination and counterimmunoelectrophoresis tests was found to be much simpler and much more rapid than conventional culture isolation. Both counterimmunoelectrophoresis and coagglutination tests were found extremely useful in the diagnosis of acute cases of porcine pleuropneumonia. However, these techniques were able to detect only some of the chronically infected carrier pigs.

Actinobacillus Infections↗

Diagnosis of pneumococcal pneumonia by coagglutination and counterimmunoelectrophoresis of sputum samples.

A comparison was made of the methods of coagglutination (using sensitized staphylococci) and counterimmunoelectrophoresis with regard to (i) sensitivity in detecting capsular polysaccharides from 14 different types of pneumococci, and (ii) sensitivity and specificity in detecting pneumococcal antigen in sputum samples from patients with pneumonia. Counterimmunoelectrophoresis was 20-150 times less sensitive than coagglutination in detecting purified type 7F and 14 polysaccharide preparations, and was as sensitive as or slightly more sensitive than coagglutination in detecting the other 12 polysaccharide types. Of 331 sputum samples examined, 94 were antigen positive, 87 by coagglutination and 76 by counterimmunoelectrophoresis; strong reactions were obtained with 85 and 63 samples, respectively. Moreover, with counterimmunoelectrophoresis 24 samples gave rise to probably non-specific precipitates, while with coagglutination either a strong positive or an unequivocally negative result was obtained in all but six samples. It is concluded that coagglutination is not only simpler and faster than counterimmunoelectrophoresis, but also appears to be more specific and sensitive for the detection of pneumococcal antigen in sputum samples.

Agglutination Tests↗

Detection of cryptococcal polysaccharide using counterimmunoelectrophoresis.

Counterimmunoelectrophoresis was used to detect Cryptococcus neoformans capsular polysaccharide in the body fluids of infected patients. Using rabbit anti-C. neoformans A15 globulin, counterimmunoelectrophoresis detected 1.25 microgram of purified cryptococcal polysaccharide per ml of cerebrospinal fluid (CSF) or urine and 2.5 microgram per ml of serum. When the body fluids were subjected to a hundredfold concentration prior to testing, as little as 25 ng of purified cryptococcal polysaccharide/ml CSF or urine and 80 ng/ml serum was detected. Among patients with cryptococcal meningitis, counterimmunoelectrophoresis detected polysaccharide in the CSF when the India-ink examination was negative. Using counterimmunoelectrophoresis, the concentrations of polysaccharide antigen in the body fluids of these patients could be estimated. Specificity of the rabbit anti-C. neoformans A15 globulin was evaluated. There was no crossreaction that detracted from its diagnostic usefulness. Rheumatoid factor was not a source of false-positive tests. Counterimmunoelectrophoresis is a useful technic for establishing a rapid, specific serologic diagnosis of cryptococcosis.

Antigens, Fungal↗

Comparison of latex agglutination and counterimmunoelectrophoresis in the diagnosis of acute Streptococcus pneumoniae infections.

The ability of latex agglutination (Slidex Pneumokit) and counterimmunoelectrophoresis to detect Streptococcus pneumoniae antigen in body fluids was evaluated. The patients were classified as having proven Streptococcus pneumoniae infection, suspected Streptococcus pneumoniae infection, acute superinfection of chronic bronchitis or non-pneumococcal respiratory infection. Sixty-two non-pneumococcal meningitis patients were also included in the study. Latex agglutination and counterimmunoelectrophoresis tests were performed on serum, urine and cerebrospinal fluid specimens when indicated and repeated each week until the patient was discharged. Latex agglutination was done on samples boiled for 10 min. In vitro sensitivity of counterimmuno-electrophoresis and latex agglutination were 10 and 1 ng/ml respectively for type three antigen. In pulmonary disease (proven and suspected Streptococcus pneumoniae infection) counterimmunoelectrophoresis and latex agglutination had a clinical sensitivity of 72.9 and 87.5% respectively, a specificity of 96.3 and 92.6%, a predictive value for a positive test of 97.2 and 95.4% and for a negative test of 66.6 and 80.6%. Latex agglutination may offer an alternative to counterimmunoelectrophoresis in the rapid diagnosis of Streptococcus pneumoniae infections since it is easier to perform and gives a reliable result within 15 min.

Acute Disease↗

Comparison of Phadebact coagglutination, Bactogen latex agglutination, and counterimmunoelectrophoresis for detection of Haemophilus influenzae type b antigens in cerebrospinal fluid.

Cerebrospinal fluid specimens from patients with suspected meningitis were screened with the Phadebact Haemophilus Test (Pharmacia Diagnostics), with Bactogen (Wampole Laboratories), and by counterimmunoelectrophoresis. With culture-positive fluids, Phadebact coagglutination detected 95%, Bactogen latex agglutination detected 91%, and counterimmunoelectrophoresis detected only 79%. Both agglutination techniques were 25-fold more sensitive than counterimmunoelectrophoresis when tested with dilutions of positive fluids. To obtain specific reactions with the Phadebact reagents it was necessary to heat treat (95 degrees C, 5 min) the fluid; with Bactogen and counterimmunoelectrophoresis this was not necessary.

Agglutination Tests↗

Serological diagnosis of typhoid fever by counterimmunoelectrophoresis.

The sensitivity and specificity of counterimmunoelectrophoresis using three antigenic preparations obtained from Salmonella typhi were compared with those of the Widal test in the serological diagnosis of typhoid fever. A veronal buffer extract yielded precipitation lines against 50 (96%) out of 52 sera collected from patients with typhoid but against none out of 62 sera obtained from control subjects who did not have typhoid. Less satisfactory results were obtained by counterimmunoelectrophoresis when two other preparations, a protein extract (Barber antigen) and an ultrasonic lysate, were used as the antigens. By Widal test the rate of detection in patients' sera was 73% and the false-positive rate for control sera 16%. It is concluded that in an area where typhoid is endemic counterimmunoelectrophoresis using veronal buffer extract as the antigen is superior to the Widal test for serological diagnosis of typhoid fever. An additional advantage of counterimmunoelectrophoresis is that results may be obtained on the same day that the serum specimens are received.

Antibodies, Bacterial↗

Counterimmunoelectrophoresis using an arc 5 antigen for the rapid diagnosis of hydatidosis and comparison with the indirect hemagglutination test.

A modified counterimmunoelectrophoresis and a conventional indirect hemagglutination test were compared for routine diagnosis of human hydatid disease in an endemic area in the Middle East. Counterimmunoelectrophoresis was performed on a cellulose acetate membrane with dilutions of a commercially available antigen which interacts with sera of patients with confirmed hydatid disease to produce the arc 5 precipitin line. The test was performed with unconcentrated human sera and the lines stained in an aqueous solution of Ponceau red. Sensitivity (95.5% vs. 93.2%) and specificity (99.2% vs. 89.9%) were higher with counterimmunoelectrophoresis than with indirect hemagglutination. Cross-reactivity with sera of patients with other parasitic infections was noted with indirect hemagglutination but not with counterimmunoelectrophoresis. There was no cross-reactivity with sera of patients with autoimmune disorders by either test.

Antibodies↗

The role of counterimmunoelectrophoresis in the identification of antibodies to extractable nuclear antigens.

Antibodies to saline-extractable nuclear antigens are hallmarks of autoimmune diseases including systemic lupus erythematosus (SLE), mixed connective tissue disease, progressive systemic sclerosis and Sjogren's syndrome. In our laboratory, we use counterimmunoelectrophoresis as a screening test and immunodiffusion as a confirmatory test to identify these autoantibodies. This study examines the drawbacks of such an approach. Though 17 out of 19 sera that formed ribonuclease sensitive lines with rabbit thymus extract on counterimmunoelectrophoresis were confirmed to have anti-RNP by immunodiffusion, sera of several different autoantibody specificities were seen to form ribonuclease resistant precipitin lines with the thymus extract on counterimmunoelectrophoresis. Having screened sera to have autoantibodies by counterimmunoelectrophoresis, the identity of some of these autoantibodies were not confirmed because of the poor sensitivity of immunodiffusion or because inappropriate controls had been used for the confirmatory immunodiffusion test. To check these drawbacks and to obviate the need for a confirmatory test, a modification of the current approach is suggested.

Animals↗

[Etiologic diagnosis of pneumoccocal pneumonia by counterimmunoelectrophoresis (author's transl)].

The antigenic composition of the pneumoccocal capsule and its easy detection by counterimmunoelectrophoresis led us to carry out a comparative study of this method and the results obtained from cultures. A series of 159 patientes with suspected bacterial pneumonia were included in the study. Blood cultures were prepared for all of the patients; sputum cultures were practiced on 35 and cultures of pleural fluid on 32. Serum from all of the patients, urine from 104, sputum from 34, and pleural fluid from 16 were analyzed by counterimmunoelectrophoresis for pneumoccocal antigen. This method was particularly useful for detecting the germ in sputum and pleural fluid. Furthermore, a higher number of positive indexes in serum were obtained by counterimmunoelectrophoresis than by blood cultures (p less than 0.01). This was also true for tests with sputum and pleural fluid. Urine tests resulted in an even greater number of detections. Counterimmunoelectrophoresis is thus a simple, quick method for detecting pneumococcus and is especially useful when accompanied by cultures tests, since they are complementary. We were able to discover a positive indication of penumoccocus in bacterial pneumonia in 39.6 percent of cases with this technique, as opposed to 15 percent using cultures alone.

Antigens, Bacterial↗

Neonatal bovine enteritis: detection of rotavirus by counterimmunoelectrophoresis and enzyme-linked immunosorbent assay.

Counterimmunoelectrophoresis and enzyme-linked immunosorbent assay specific for rotavirus were performed on 253 calf gut and fecal specimens from eastern North Dakota. Rotavirus antigen was detected in 29 specimens by counterimmunoelectrophoresis and in 52 specimens by enzyme-linked immunosorbent assay. All of the counterimmunoelectrophoresis-positive specimens were positive by enzyme-linked immunosorbent assay. The counterimmunoelectrophoresis and the enzyme-linked immunosorbent assay, using a rabbit antirotavirus antibodies produced a golf ball-induced granuloma, were rapid and specific tests for the detection of rotavirus.

Animals↗

Diagnosis of bacterial meningitis and septicemia by serum counterimmunoelectrophoresis.

We compare the results obtained by counterimmunoelectrophoresis in samples of serum and cerebrospinal fluid with microbiologic methods for 3,298 patients suspected of bacterial meningitis and/or septicemia at Instituto Adolfo Lutz, São Paulo, in a retrospective study of the period from July 1998 to July 1994. Of the 415 patients (12.6% of the total cases studied) who were positive by the serum test, only 249 (7.6% of the total cases studied) were also positive when cerebrospinal fluid was assayed. Thus, 40% of the positives (5.6% of the total) were identifiable by analysis of serum but not of cerebrospinal fluid. Neisseria meningitidis accounted for 77.7% (129) and Haemophilus influenzae for 22.3% (37) of the positive results obtained only when serum was examined. These data show that although sensitivity and specificity of serum counterimmunoelectrophoresis are relatively low compared to cerebrospinal fluid counterimmunoelectrophoresis, the serum test is necessary to complement cerebrospinal fluid counterimmunoelectrophoresis data.

Antigens, Bacterial↗

Diagnosis of systemic candidiasis: development of co-counterimmunoelectrophoresis.

To improve the results of counterimmunoelectrophoresis for serological diagnosis of candidiasis, a new method was devised to characterize human sera precipitins: co-counterimmunoelectrophoresis. Cellulose acetate was chosen as the support in order to observe identity reactions between precipitin lines from serum systems run conjointly (thus, co-counterimmunoelectrophoresis). Different experimental antisera (anti-somatic and anti-cytoplasmic antigens and anti-whole fixed germ tube antisera) were tested for reactions of identity with sera from selected patients with systemic candidiasis caused by Candida albicans. The reaction of patient sera and anti-germ tube antiserum with a selected somatic antigen always resulted in an identity reaction as proven by the continuity of major precipitin lines. The precipitating system, named the co-specific precipitin line, involved polysaccharide antigens; it was not present in human control sera.

Adult↗

Application of counterimmunoelectrophoresis in rapid detection of cytomegalovirus antibodies.

Determination of cytomegalovirus antibodies by counterimmune-electrophoresis correlated well with results of complement-fixation antibody studies. The sensitivity and specificity of the counterimmunoelectrophoresis method (vs. complement fixation) was 88.9%. Fourfold antibody increases detected by complement fixation were also detected by counterimmunoelectrophoresis. In addition, no cross-reaction was observed in the counterimmunoelectrophoresis assay between other DNA viral antisera and cytomegalovirus antigen (Ad-169).

Antibodies, Viral↗

Detection of streptococcal antigen by counterimmunoelectrophoresis.

Rapid detection systems for identifying antibody or bacterial antigen have been used for two to three years. The analysis for the presence of bacterial antigen by counterimmunoelectrophoresis has been used in the detection of neonatal and pediatric infections. In the present report, the previous data concerning the detection of group B streptococcal antigen in cerebrospinal fluid, sera, and urine of infected newborns was reinforced. Counterimmunoelectrophoresis was also established as a method for detecting group B streptococcal antigen in amniotic fluid and group D streptococcal antigen in body fluids, and for verifying group A streptococcal antigen from 24-hour culture plates. This is a further extension of the use by the clinical laboratory of counterimmunoelectrophoresis in the detection of bacterial antigen.

Amniotic Fluid↗

Minimum number of bacteria needed for antigen detection by counterimmunoelectrophoresis: in vivo and in vitro studies.

Threshold concentrations of Streptococcus pneumoniae type 3, Haemophilus influenzae type b, and Streptococcus sp. group B type Ib required for positive counterimmunoelectrophoresis reactions were determined in vivo and in vitro. Animals were infected intraperitoneally with various concentrations of microorganisms: adult mice with S. pneumoniae, suckling rats with H. influenzae, and 3-week-old mice with Streptococcus sp. group B. At 24 h after infection a minimum blood concentration of 10(3) colony-forming units (CFU)/ml was needed for S. pneumoniae or H. influenzae before antigen was detected in the serum. A minimum concentration of 10(6) CFU/ml was needed for Streptococcus sp. group B at 10 h after infection. Larger threshold concentrations (10(4) CFU/ml for S. pneumoniae, 10(5) CFU/ml for H. influenzae, and 10(7) CFU/ml for Streptococcus) were required in broth-grown cultures before cell-free antigens could be demonstrated by counterimmunoelectrophoresis in the medium. Marked levels of antigen release by group B streptococci were observed as the cultures entered early stationary phase. This study provides evidence of a long-accepted, though poorly substantiated, hypothesis that a threshold concentration of microorganism is necessary before counterimmunoelectrophoresis reactions become positive. Counterimmunoelecrophoresis results for clinical specimens should be interpreted cautiously in light of this evidence.

Animals↗