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Avidity as a criterion for diagnosis of human strongyloidiasis increases specificity of IgG ELISA. Diagn Microbiol Infect Dis 2017; 89:262-264. [DOI: 10.1016/j.diagmicrobio.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
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Mancuso R, Baglio F, Agostini S, Cabinio M, Laganà MM, Hernis A, Margaritella N, Guerini FR, Zanzottera M, Nemni R, Clerici M. Relationship between herpes simplex virus-1-specific antibody titers and cortical brain damage in Alzheimer's disease and amnestic mild cognitive impairment. Front Aging Neurosci 2014; 6:285. [PMID: 25360113 PMCID: PMC4197651 DOI: 10.3389/fnagi.2014.00285] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/26/2014] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) is a multifactorial disease with a still barely understood etiology. Herpes simplex virus 1 (HSV-1) has long been suspected to play a role in the pathogenesis of AD because of its neurotropism, high rate of infection in the general population, and life-long persistence in neuronal cells, particularly in the same brain regions that are usually altered in AD. The goal of this study was to evaluate HSV-1-specific humoral immune responses in patients with a diagnosis of either AD or amnestic mild cognitive impairment (aMCI), and to verify the possible relation between HSV-1-specific antibody (Ab) titers and cortical damage; results were compared to those obtained in a group of healthy controls (HC). HSV-1 serum IgG titers were measured in 225 subjects (83 AD, 68 aMCI, and 74 HC). HSV-specific Ab avidity and cortical gray matter volumes analyzed by magnetic resonance imaging (MRI) were evaluated as well in a subgroup of these individuals (44 AD, 23 aMCI, and 26 HC). Results showed that, whereas HSV-1 seroprevalence and IgG avidity were comparable in the three groups, increased Ab titers (p < 0.001) were detected in AD and aMCI compared to HC. Positive significant correlations were detected in AD patients alone between HSV-1 IgG titers and cortical volumes in orbitofrontal (region of interest, ROI1 RSp0.56; p = 0.0001) and bilateral temporal cortices (ROI2 RSp0.57; p < 0.0001; ROI3 RSp0.48; p = 0.001); no correlations could be detected between IgG avidity and MRI parameters. Results herein suggest that a strong HSV-1-specific humoral response could be protective toward AD-associated cortical damage.
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Affiliation(s)
| | | | | | - Monia Cabinio
- IRCCS, Don C. Gnocchi Foundation - ONLUS Milan, Italy
| | | | - Ambra Hernis
- IRCCS, Don C. Gnocchi Foundation - ONLUS Milan, Italy
| | | | | | | | - Raffaello Nemni
- IRCCS, Don C. Gnocchi Foundation - ONLUS Milan, Italy ; Università degli Studi di Milano Milan, Italy
| | - Mario Clerici
- IRCCS, Don C. Gnocchi Foundation - ONLUS Milan, Italy ; Università degli Studi di Milano Milan, Italy
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de Ory F, Guisasola E, Tarragó D, Sanz JC. Application of a commercial immunoblot to define EBV IgG seroprofiles. J Clin Lab Anal 2014; 29:47-51. [PMID: 24687237 DOI: 10.1002/jcla.21726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/12/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immunoblot (IB) techniques using different Epstein-Barr virus (EBV) antigens have been applied for detecting specific antibodies, making possible to obtain EBV seroprofiles in a single determination. The aim of this study was to evaluate a commercial IB for the detection of EBV-specific IgG (Euroimmun, Lübeck, Germany). METHODS A total of 117 samples classified as EBV primary recent infections (n = 70), past infections (n = 29), or not infected (n = 18) have been used. The samples were characterized by immunofluorescence, by testing EBV capsid antigens IgM and IgG (using indirect approaches) and EBV nuclear antigen (by anticomplement technique; Meridian Bioscience Inc.). RESULTS Using the cut-off value as defined by the IB manufacturer, the concordance, relative sensitivity, and relative specificity were 85.5 (100/117), 94.3% (66/70), and 72.3% (34/47), respectively. If a corrected cut-off value was considered to classify the samples, the corresponding corrected figures were 89.7, 88.6, and 91.5%, respectively. CONCLUSION Being a useful serological diagnostic tool, IB for testing EBV IgG seems to be an adequate approach to define EBV seroprofiles. However, efforts to better define the cut-off value should be made in order to improve the performance of the assay in evaluation.
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Affiliation(s)
- Fernando de Ory
- Laboratory of Serology, National Center of Microbiology, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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De Ory F, Guisasola ME, Sanz JC, García-Bermejo I. Evaluación del sistema VIDAS para estudio de marcadores serológicos de infección por el virus Epstein Barr. Enferm Infecc Microbiol Clin 2012; 30:618-20. [DOI: 10.1016/j.eimc.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 03/08/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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De Paschale M, Clerici P. Serological diagnosis of Epstein-Barr virus infection: Problems and solutions. World J Virol 2012; 1:31-43. [PMID: 24175209 PMCID: PMC3782265 DOI: 10.5501/wjv.v1.i1.31] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/19/2011] [Accepted: 10/28/2011] [Indexed: 02/05/2023] Open
Abstract
Serological tests for antibodies specific for Epstein-Barr virus (EBV) antigens are frequently used to define infection status and for the differential diagnosis of other pathogens responsible for mononucleosis syndrome. Using only three parameters [viral capsid antigen (VCA) IgG, VCA IgM and EBV nuclear antigen (EBNA)-1 IgG],it is normally possible to distinguish acute from past infection: the presence of VCA IgM and VCA IgG without EBNA-1 IgG indicates acute infection, whereas the presence of VCA IgG and EBNA-1 IgG without VCA IgM is typical of past infection. However, serological findings may sometimes be difficult to interpret as VCA IgG can be present without VCA IgM or EBNA-1 IgG in cases of acute or past infection, or all the three parameters may be detected simultaneously in the case of recent infection or during the course of reactivation. A profile of isolated EBNA-1 IgG may also create some doubts. In order to interpret these patterns correctly, it is necessary to determine IgG avidity, identify anti-EBV IgG and IgM antibodies by immunoblotting, and look for heterophile antibodies, anti-EA (D) antibodies or viral genome using molecular biology methods. These tests make it possible to define the status of the infection and solve any problems that may arise in routine laboratory practice.
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Affiliation(s)
- Massimo De Paschale
- Massimo De Paschale, Pierangelo Clerici, Microbiology Unit, Hospital of Legnano, 20025 Legnano (MI), Italy
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6
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Vilibic-Cavlek T, Ljubin-Sternak S, Kos L, Mlinaric-Galinovic G. The role of IgG avidity determination in diagnosis of Epstein-Barr virus infection in immunocompetent and immunocompromised patients. Acta Microbiol Immunol Hung 2011; 58:351-7. [PMID: 22207292 DOI: 10.1556/amicr.58.2011.4.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is a high degree of variability in the serologic response to Epstein-Barr virus (EBV) infection, especially in viral capsid antigen (VCA)-IgM antibodies. Therefore, additional tests are needed to confirm primary infection. We evaluated the value of IgG avidity determination in diagnosis of EBV infection in immunocompetent and immunocompromised patients. A total of 236 serum samples from immunocompetent patients with symptoms suggestive of EBV infection were tested for the presence of VCA-IgM/IgG antibodies and IgG avidity. Using IgG avidity, acute primary infection was confirmed in 56.7% of the immunocompetent patients with positive and in 1.8% of patients with negative VCA-IgM. Recent primary infection was documented in 8.9% of the IgM positive and 3.5% of the IgM negative patients. In patients with indeterminate serology (equivocal IgM), 6.7% were classified by avidity index (AI) as acute primary infection, 10.0% as post-acute and 83.3% as past infection cases. Concerning the 32 immunocompromised patients, recent primary infection was documented in 3 of the 14 IgM positive patients. High AI was detected in 11 of these patients, indicating an IgM response due to reactivation. Determination of IgG avidity in combination with classical serologic markers seems to be a reliable method to confirm primary infection both in immunocompetent and immunocompromised patients. It may be especially useful to differentiate cases of primary infection in patients with undetectable VCA-IgM antibodies or indeterminate routine EBV serology.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- 1 Croatian National Institute of Public Health and School of Medicine University of Zagreb Department of Virology Zagreb Croatia
| | - Suncanica Ljubin-Sternak
- 1 Croatian National Institute of Public Health and School of Medicine University of Zagreb Department of Virology Zagreb Croatia
| | - Ljiljana Kos
- 2 University of Applied Health Studies Ljiljana Kos, BSc Zagreb Croatia
| | - Gordana Mlinaric-Galinovic
- 1 Croatian National Institute of Public Health and School of Medicine University of Zagreb Department of Virology Zagreb Croatia
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Fogeda M, de Ory F, Avellón A, Echevarría JM. Differential diagnosis of hepatitis E virus, cytomegalovirus and Epstein-Barr virus infection in patients with suspected hepatitis E. J Clin Virol 2009; 45:259-61. [PMID: 19505848 DOI: 10.1016/j.jcv.2009.05.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/11/2009] [Indexed: 01/24/2023]
Abstract
BACKGROUND The accuracy of the diagnosis of hepatitis E in the clinical setting relies mainly on the performance of assays for hepatitis E virus (HEV)-specific IgM (anti-HEV IgM) testing in serum. OBJECTIVES Identification of factors influencing the specificity of the results obtained with these assays is an important issue in regard to the accuracy of the diagnosis. STUDY DESIGN Anti-HEV IgM and HEV RNA were studied in samples from 153 patients with acute hepatitis of unknown aetiology received during a two-year period. Fifteen patients were positive for anti-HEV IgM, and eight of them were also positive for HEV RNA. Investigation of CMV and Epstein-Barr virus (EBV) infection markers among the remaining seven patients, and of HEV infection markers among 18 patients with infectious mononucleosis, was performed. RESULTS The results obtained showed that acute infection by CMV or EBV may cause false reactivity for anti-HEV IgM, likely because of polyclonal B-cell stimulation. CONCLUSIONS Since infection by these herpesviruses may produce acute hepatitis, such event can cause diagnostic mistakes and should be investigated in patients positive for anti-HEV IgM and negative for HEV RNA.
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Affiliation(s)
- M Fogeda
- Service of Diagnostic Microbiology, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Evaluation of an immunofiltration assay that detects immunoglobulin M antibodies against the ZEBRA protein for the diagnosis of Epstein-Barr virus infectious mononucleosis in immunocompetent patients. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2009; 16:885-8. [PMID: 19403783 DOI: 10.1128/cvi.00123-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The performance of an immunofiltration assay (IMFA) that detects immunoglobulin M (IgM) antibodies to the Epstein-Barr virus (EBV) ZEBRA (BamHI Z EBV replication activator) protein was evaluated for the diagnosis of EBV infectious mononucleosis (IM) in immunocompetent patients. The test panel consisted of 47 sera displaying an EBV-specific antibody profile compatible with an acute primary EBV infection from patients with clinical and biological features of EBV IM, 20 sera from healthy individuals either with a past EBV infection or who were EBV seronegative, 20 sera displaying an equivocal EBV antibody pattern (viral capsid antigen IgG positive [VCA IgG+], VCA IgM+, and EBV nuclear antigen-1 IgG+), and 15 sera obtained from patients with a mononucleosis-like syndrome owing to cytomegalovirus, human herpesvirus 6, or parvovirus B19. Overall, the sensitivity and the specificity of the assay were found to be 92.5%, and 97.3%, respectively. The sensitivity of the assay for the diagnosis of heterophile antibody-negative EBV IM was 86.2%. The IMFA is rapid, easy to perform, and, thus, suitable for point-of-care testing, and it may be used as a first-line test for the diagnosis of acute EBV IM in immunocompetent patients.
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. SE, . EES, . MAEH, . AI. Morphological and Ultrastructural Studies for the Biological Action of Penicillic Acid on Some Bacterial Species. ACTA ACUST UNITED AC 2007. [DOI: 10.3923/jm.2007.303.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Prevalence of primary versus reactivated Epstein-Barr virus infection in patients with VCA IgG-, VCA IgM- and EBNA-1-antibodies and suspected infectious mononucleosis. J Clin Virol 2007; 38:292-7. [PMID: 17336144 DOI: 10.1016/j.jcv.2007.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 01/15/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND In Epstein-Barr virus (EBV) infection, IgG- and IgM-antibodies to viral capsid antigen (VCA) and IgG-antibodies to Epstein-Barr nuclear antigen 1 (EBNA-1) can occur simultaneously both in late primary infection and during subclinical viral reactivation in immunocompetent persons, and the differential diagnosis is of importance. OBJECTIVES To study the prevalence of primary infection and serological reactivation in patients with suspected primary EBV infection and with all three parameters present. STUDY DESIGN Fifty serum samples from 43 consecutive patients referred for suspected infectious mononucleosis and positive for VCA IgG-, VCA IgM- and EBNA-1-antibodies by EIA, were tested for IgG-antibody avidity with an EBV IgG immunoblot. Sera were also tested for heterophile antibodies (HA). To verify the presence of IgM-antibodies an EBV IgM immunoblot was performed when high-avidity IgG-antibodies were found. RESULTS AND CONCLUSIONS Of 43 patients with suspected primary EBV infection and VCA IgG-, VCA IgM- and EBNA-1-antibodies present, only 18 patients (42%) had a late primary infection. Twenty-one patients (49%) had high-avidity IgG-antibodies, indicating an IgM response due to reactivation, thus suggesting other causes for their symptoms. In 10 of these 21 patients the presence of IgM-antibodies was confirmed by immunoblot, indicating reactivation as a cause of IgM-antibodies in at least 23% of the 43 patients studied. Of 18 patients with primary infection, HA were detected in 16 (94%) of 17 patients tested. Only one (5%) of the patients with high-avidity antibodies had HA. Absence of HA in patients with this serological pattern is therefore a good indicator of reactivation, and conversely, the presence of HA is a good indicator of primary infection. In HA negative patients, avidity testing could be used for differential diagnosis.
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Vetter V, Kreutzer L, Bauer G. Differentiation of primary from secondary anti-EBNA-1-negative cases by determination of avidity of VCA-IgG. ACTA ACUST UNITED AC 2005; 2:29-39. [PMID: 15566751 DOI: 10.1016/0928-0197(94)90033-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/1993] [Revised: 10/19/1993] [Accepted: 10/20/1993] [Indexed: 12/11/2022]
Abstract
BACKGROUND Serological techniques are used to determine Epstein Barr virus (EBV) etiology of a constellation of signs or symptoms related to lymphadenopathy, fever, respiratory tract infection, mononucleosis, hepatitis, thrombocytopenia or neurological disorder. Anti-Epstein Barr Nuclear antigen (EBNA)-1 is regularly negative during the first 3-4 weeks after the onset of clinical symptoms indicating acute EBV infection (primary anti-EBNA-1-negative). It may, however, also be negative in immunocompromised convalescent individuals (secondary anti-EBNA-1-negative) such as tumor patients, HIV-positive patients and transplant recipients. OBJECTIVES The aim of this study was to determine the frequency of secondary anti-EBNA-1-negative cases and to find a way to distinguish them from primary anti-EBNA-1-negative cases using anticomplementary immunofluorescence (ACIF) and enzyme immunoassay (EIA). STUDY DESIGN All sera sent to our institute for EBV serology during one year were routinely tested for Viral Capsid antibody (VCA)-IgM, VCA-IgG and anti-EBNA-1. RESULTS VCA-IgG-positive/anti-EBNA-1-negative cases (13.5% of total VCA-IgG-positive) comprised 55% primary and 45% secondary anti-EBNA-1-negative cases. Detection of secondary anti-EBNA-1-negative cases was independent of the method used, i.e., ACIF or EIA. VCA-IgG retained its high avidity in secondary anti-EBNA-1-negative cases, whereas primary anti-EBNA-1-negative cases taken during the early phase of acute infection showed low avidity of VCA-IgG. CONCLUSION Determination of the avidity of VCA-IgG routinely and in concert with standard serodiagnosis (VCA-IgG, VCA-IgM, anti-EBNA-1) can enable the differentiation of primary and secondary anti-EBNA-1-negative cases.
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Affiliation(s)
- V Vetter
- Abteilung Virologie, Institut für Medizinische Mikrobiologie und Hygiene, Universitüt Freiburg, Hermann-Herder-Str. 11, D-79104 Freiburg, Germany
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Robertson P, Beynon S, Whybin R, Brennan C, Vollmer-Conna U, Hickie I, Lloyd A. Measurement of EBV-IgG anti-VCA avidity aids the early and reliable diagnosis of primary EBV infection. J Med Virol 2003; 70:617-23. [PMID: 12794726 DOI: 10.1002/jmv.10439] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Current serological methods for the diagnosis of Epstein-Barr virus (EBV) infection still differentiate poorly between primary infection and reactivation. This is particularly true when IgG and IgM antibodies are present simultaneously and only a single serum sample is provided for analysis. The demonstration of the IgG avidity state has the potential to distinguish recent from past or reactivated infection. An analysis of the kinetics of avidity maturation of anti-VCA antibodies in primary EBV infection was undertaken with longitudinally collected sets of sera from 28 well-characterised EBV cases and in sera from 35 cases with previous EBV infection and recent primary infection due to HIV, CMV, or hepatitis A. Antibodies directed against the viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA-1) were sought, using a commercial enzyme immunoassay (EIA). In parallel with standard IgG anti-VCA detection, serum was incubated with 8 M urea to disrupt low-avidity complexes to allow calculation of the percentage avidity. In cases with primary EBV infection, the mean avidity rose from 54% at 6 weeks to 82% by 28 weeks after the onset of symptoms, but remained lower than that of the control sera (96%). The addition of the avidity measurement improved the sensitivity of IgG and IgM anti-VCA testing in diagnosis of primary EBV infection from 93% to 100%. The specificity of IgM anti-VCA testing alone was poor, with 14 of 35 cases (49%) demonstrating false-positive results, but it improved to 97% by the demonstration of high-avidity IgG anti-VCA. The combination of negative IgG anti-EBNA and low-avidity IgG anti-VCA had a sensitivity and specificity of 100%. The routine addition of IgG anti-VCA avidity estimation to diagnostic EBV serology is recommended.
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Affiliation(s)
- Peter Robertson
- Serology Laboratory, SEALS, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Diagnóstico de laboratorio de parotiditis en la era posvacunal. Enferm Infecc Microbiol Clin 2003. [DOI: 10.1016/s0213-005x(03)72897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Odièvre MH, Cointe D, Thébaud B, Zupan V, Ingrand D, Lacaze-Masmonteil T, Grangeot-Keros L. The assessment of IgG avidity in the evaluation of perinatal herpes simplex virus infection. J Perinatol 2002; 22:669-71. [PMID: 12478453 DOI: 10.1038/sj.jp.7210781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Classical serologic assays are not useful for the diagnosis of perinatal herpes simplex virus (HSV) infection during the acute phase of the disease. We report two cases of neonatal HSV infection that highlight the diagnostic value of HSV-specific IgG avidity and its contribution for further characterization of neonatal HSV infection.
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Affiliation(s)
- Marie-Hélène Odièvre
- Service de Pédiatrie et Réanimation Néonatales, Hôpital Antoine-Béclère, Assistance Publique/Hôpitaux de Paris, Clamart, France
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Abstract
Detection of Epstein-Barr Virus (EBV) DNA by PCR in serum had a sensitivity of 80%, a specificity of 94%, and positive and negative predictive values of 95 and 79%, respectively, for the diagnosis of primary EBV infection. We suggest that this is a useful addition to the panel of tests used for this purpose.
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Chan KH, Ng MH, Seto WH, Peiris JS. Epstein-Barr virus (EBV) DNA in sera of patients with primary EBV infection. J Clin Microbiol 2001; 39:4152-4. [PMID: 11682546 PMCID: PMC88503 DOI: 10.1128/jcm.39.11.4152-4154;2001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Detection of Epstein-Barr Virus (EBV) DNA by PCR in serum had a sensitivity of 80%, a specificity of 94%, and positive and negative predictive values of 95 and 79%, respectively, for the diagnosis of primary EBV infection. We suggest that this is a useful addition to the panel of tests used for this purpose.
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Affiliation(s)
- K H Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China.
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Nedeljkovic J, Jovanovic T, Oker-Blom C. Maturation of IgG avidity to individual rubella virus structural proteins. J Clin Virol 2001; 22:47-54. [PMID: 11418352 DOI: 10.1016/s1386-6532(01)00161-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND the structural proteins of rubella virus, the capsid protein C and the envelope glycoproteins E1 and E2 were produced in lepidopteran insect cells using baculovirus expression vectors. The C-terminal ends of the corresponding proteins were fused to a polyhistidine tag for easy and gentle purification by metal ion affinity chromatography. OBJECTIVES to investigate the maturation of natural and vaccinal IgG avidity against individual authentic and recombinant rubella virus (RV) structural proteins. STUDY DESIGN the analysis was carried out using a modified immunoblotting technique where the purified baculovirus-expressed proteins were compared with authentic rubella virus proteins. Altogether, 47 well-characterised serum samples from both naturally infected patients and vaccines were studied. RESULTS after natural RV infection, IgG antibodies specific for the E1 protein were predominant not only in terms of levels, but also in terms of rate and magnitude of avidity maturation. The avidity development of the IgG antibodies was much slower in vaccines than in patients after a natural RV infection. CONCLUSIONS together, our results indicate that IgG avidity determination in conjunction with immunoblot analysis is useful in the diagnosis of a RV infection. The recombinant proteins showed similar reactivity patterns in the immunoblot analyses as compared with the authentic viral structural proteins, suggesting suitability for serodiagnostics.
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Affiliation(s)
- J Nedeljkovic
- Institute of Immunology and Virology, Torlak, Belgrade, Yugoslavia
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Gutiérrez J, Rodríguez M, Maroto C, Piédrola G. Reliability of four methods for the diagnosis of acute infection by Epstein-Barr virus. J Clin Lab Anal 2000. [PMID: 9058240 DOI: 10.1002/(sici)1098-2825(1997)11:2<78::aid-jcla2>3.0.co;2-g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
We studied the reliability of new indirect tests in the diagnosis of acute infection by Epstein-Barr virus (EBV). Studied for all samples were method 1, the heterophil antibodies (Abs) (Monolatex, Biokit, Germany); method 2, the IgM Abs to EBV with ELISA tests (antigen pools, Enzygnost, Behring-werke, Germany); method 3, EA (Biotest Diagnostics, Germany); and method 4, the IgG avidity test. The reliability of the four tests for the detection of primary infection by EBV was: sensitivity (method 1: 89.1%; method 2: 100%; method 3: 79.7%; method 4: 99%); specificity (method 1: 98%; method 2: 100%; method 3: 84%; method 4: 100%); positive predictive value (method 1: 97.6%; method 2: 100%; method 3: 73.6%; method 4: 100%), and negative predictive value (method 1: 90.7%; method 2: 100%; method 3: 84%; method 4: 99%). The IgG avidity test (method 4) is simple and automated in the laboratory and is very useful for ascertaining, from a single sample, the time since infection. It is criteria of recent primoinfection higher levels than 55% of IgG with low avidity for the antigen. The investigation of the Abs to antigen pools (method 2) by ELISA of virus had a high reliability, but the investigation of heterophil Abs by latex (method 1) and the Abs IgM to EA (method 2) were lacking in sensibility regarding their use in the diagnosis of the primoinfection.
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Affiliation(s)
- J Gutiérrez
- Department of Microbiology, St. Cecil's Hospital, University of Granada, Spain
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Gutiérrez J, Vergara MJ, Piédrola G, Maroto MC. Clinical reliability of IgG, IgA, and IgM antibodies in detecting Epstein-Barr virus at different stages of infection with a commercial nonrecombinant polyantigenic ELISA. J Clin Lab Anal 1999; 13:65-8. [PMID: 10102134 PMCID: PMC6807699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
We studied the diagnostic reliability of a modification of the Enzygnost EBV test (Behringwerke, Germany) for the detection of IgG, IgA, and IgM antibodies (Abs) in the diagnosis of Epstein-Barr virus (EBV) disease. One hundred and twenty-three serum samples were studied: 14 asymptomatic subjects without EBV infection, 48 patients with primary infection, 46 subjects with past EBV infection (11 patients with other acute infections), 8 patients without EBV infection but with other viral infection, and 7 patients with probable acute clonal stimulation of B lymphocytes caused by different microorganisms. Enzygnost EBV is based on an ELISA test with a pool of viral antigens. In our series the reliability of IgM for the diagnosis of recent primary EBV infection was: sensitivity 100%, specificity 95%, positive predictive value 90.5%, and negative predictive value 100%. The IgG detection with Enzygnost was: sensitivity 98%, specificity 100%, positive predictive value 100%, and negative predictive value 91.7%. Only two subjects had positive IgA. The Enzygnost test is an efficient method for the diagnosis of EBV infection although a few IgM false positives can occur.
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Affiliation(s)
- J Gutiérrez
- Microbiology Department, University Hospital San Cecilio, Granada University, Spain.
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Gutiérrez J, Rodríguez MJ, De Ory F, Piédrola G, Maroto MC. Reliability of low-avidity IgG and of IgA in the diagnosis of primary infection by rubella virus with adaptation of a commercial test. J Clin Lab Anal 1999; 13:1-4. [PMID: 10025730 PMCID: PMC6807875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
The detection of IgA and low-avidity IgG and antibodies in serum is a potentially useful marker of recent infection by a microorganism. We studied the reliability of IgG avidity and presence of IgA for the diagnosis of recent acute infection by rubella virus. Low-avidity IgG (Avy-EIA test) was determined with a modified commercial test using 8 molar urea (indirect ELISA, DiaSorin, Italy) and IgA was determined with a homemade indirect ELISA test. Twenty-five patients with recent primary infection by rubella virus (group I) and 50 healthy subjects (group II) were studied. In group I low-avidity IgG varied between 100 and 0% (67.3+/-21.8%); IgA was present in 24 patients (96%). In group II low-avidity IgG varied from 50.4 to 0% (19.8+/-16.9%). IgA was present in 2 subjects (4%). The sensitivity of the Avi-EIA and the IgA test was 92 and 96%, respectively; specificity was 100 and 96%, respectively. We conclude that both low-avidity IgG and IgA tests are helpful and reliable for the diagnosis of recent primary infection.
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Affiliation(s)
- J Gutiérrez
- Microbiology Department, St. Cecil University Hospital, Granada University, Spain.
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21
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Guti�rrez J, Rodr�guez M, De Ory F, Pi�drola G, Maroto M. Reliability of low-avidity IgG and of IgA in the diagnosis of primary infection by rubella virus with adaptation of a commercial test. J Clin Lab Anal 1999. [DOI: 10.1002/(sici)1098-2825(1999)13:1<1::aid-jcla1>3.0.co;2-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Guti�rrez J, Vergara M, Pi�drola G, Maroto M. Clinical reliability of IgG, IgA, and IgM antibodies in detecting Epstein-Barr virus at different stages of infection with a commercial nonrecombinant polyantigenic ELISA. J Clin Lab Anal 1999. [DOI: 10.1002/(sici)1098-2825(1999)13:2<65::aid-jcla4>3.0.co;2-o] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Schubert J, Zens W, Weissbrich B. Comparative evaluation of the use of immunoblots and of IgG avidity assays as confirmatory tests for the diagnosis of acute EBV infections. J Clin Virol 1998; 11:161-72. [PMID: 9949952 DOI: 10.1016/s0928-0197(98)00061-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the availability of several different markers for Epstein--Barr virus (EBV) serology, the EBV status of some patients cannot be resolved from a single serum sample with routine testing. To avoid the requirement of follow-up samples, supplementary tests have to be used in these cases. OBJECTIVE To evaluate the usefulness of avidity and immunoblot assays as supplementary tests for the diagnosis of acute EBV infections. STUDY DESIGN Three groups of samples for which a definite diagnosis on the EBV status could not be obtained with the routine serological tests were further examined by an EBV IgG avidity assay, by an immunoblot based on a lysate of EBV infected cells, and by a second immunoblot based on recombinant EBV antigens. The three groups consisted of 38 samples with negative/borderline EB nuclear antigen 1 (EBNA-1) antibodies, negative/borderline EBV IgM and positive EBV IgG; 10 samples with indeterminate EBNA-1 and/or EBV IgM assays because of control antigen reactions; and 4 samples with positive EBV IgM results that were not plausible. RESULTS The avidity assay differentiated between acute and past infections for all samples. In contrast, some cases remained unresolved with both the recombinant and the lysate immunoblot. Two samples were incorrectly classified with the lysate immunoblot. Interpretation of the lysate immunoblot banding patterns was complicated when anticellular antibodies were present. CONCLUSION Avidity testing appears to be the confirmatory method of choice to differentiate between acute and past EBV infections.
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Affiliation(s)
- J Schubert
- Institute of Virology and Immunology, University of Würzburg, Germany
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Aalto SM, Linnavuori K, Peltola H, Vuori E, Weissbrich B, Schubert J, Hedman L, Hedman K. Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primary infection. J Med Virol 1998. [DOI: 10.1002/(sici)1096-9071(199811)56:3<186::aid-jmv2>3.0.co;2-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Abstract
The diagnosis of acute Epstein-Barr virus (EBV) infection is based frequently on the combination of positive viral capsid antigen (VCA) IgM antibodies and negative EB viral nuclear antigen 1 (EBNA-1) IgG antibodies. However, both VCA IgM and EBNA-1 IgG can provide false positive and false negative results. Therefore, situations in which the EBV serology remains unclear are not uncommon. Determination of EBV IgG avidity can clarify the EBV status in these patients. So far, mainly immunofluorescence assays have been used for this purpose. These tests are laborious, their evaluation is subjective, and automation is difficult. Therefore, two commercially available microtiter plate enzyme immunoassays (EIA) were compared for their usefulness for semi-automated EBV IgG avidity determination. One assay is based on a mixture of EBV antigens, the other assay uses a synthetic peptide of the VCA-complex. Patient sera of confirmed acute and past EBV infections were tested for avidity by both assays. The results with the antigen mixture assay proved to be highly sensitive (100%) and specific (100%). Avidity index calculations on the basis of one-point-quantification titers gave better results than calculations using OD values. Determination of EBV IgG avidity by the peptide assay was complicated by the fact that it was less sensitive than the antigen mixture assay for IgG detection in acute EBV infections. On the other hand, about 30% of the samples had to be retested with the peptide assay in a higher dilution because the IgG units in initial testing fell outside the range covered by the standard curve. Using OD values of the peptide EIA, the sensitivity was 99% but the specificity of detection of acute EBV infections was only 86%. Thus, while the peptide EBV avidity assay is unsuitable as a confirmatory assay, avidity testing with the antigen mixture assay is a useful tool to resolve equivocal EBV serologies. Avidity assays on the basis of EIA can be automated which should lead to wider use of this methodology.
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Affiliation(s)
- B Weissbrich
- Institute of Virology and Immunology, University of Würzburg, Germany.
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Hashido M, Inouye S, Kawana T. Differentiation of primary from nonprimary genital herpes infections by a herpes simplex virus-specific immunoglobulin G avidity assay. J Clin Microbiol 1997; 35:1766-8. [PMID: 9196189 PMCID: PMC229837 DOI: 10.1128/jcm.35.7.1766-1768.1997] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
An immunoglobulin G (IgG) antibody avidity assay which uses protein-denaturing agents and a modification of an enzyme-linked immunosorbent assay have been investigated for their usefulness in distinguishing primary genital herpes simplex virus (HSV) infections from nonprimary infections. Forty-nine serum specimens from patients with primary, recurrent, and nonprimary first-episode genital herpes were studied. The clearest separation was obtained with 6 M urea treatment, giving mean avidity indices of 0.398 for sera < or = 100 days after the infection and 0.879 for sera > 100 days after the infection (P < 0.001). No significant difference in avidity indices was observed between the recurrent and nonprimary first-episode infections. Determination of the avidity of HSV-specific IgG will improve the diagnostic potential of HSV serology.
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Affiliation(s)
- M Hashido
- Department of Epidemiology, National Institute of Health, Shinjuku-ku, Tokyo, Japan
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Gutiérrez J, Rodríguez M, Maroto MC, Piédrola G, Peirón J. Behaviour of IgG antibody avidity for the antigen and of IgA antibody in active cytomegalovirus, Epstein-Barr virus, herpes simplex virus and human herpes virus 6 infections. Adaptation of a commercial test. J Infect 1997; 35:25-30. [PMID: 9279720 DOI: 10.1016/s0163-4453(97)90881-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The clinical value of specific IgA and IgG antibody avidity to herpes simplex virus, cytomegalovirus, Epstein-Barr virus and human herpes virus 6 for the detection of active disease and primary infection, respectively, was evaluated. The IgG avidity test, with a break point of 55%, for the detection of primary infection, and of the IgA test for the detection of disease, were associated with a sensitivity of 97% and 64%, respectively; specificity of 100% and 82%; a positive predictive value of 100% and 76%; and a negative predictive value of 96% and 72%, respectively.
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Affiliation(s)
- J Gutiérrez
- Department of Microbiology, Universitary Hospital San Cecilio, University of Granada, Spain
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Gutiérrez J, Rodríguez M, Maroto C, Piédrola G. Reliability of four methods for the diagnosis of acute infection by Epstein-Barr virus. J Clin Lab Anal 1997. [DOI: 10.1002/(sici)1098-2825(1997)11:2<78::aid-jcla2>3.0.co;2-g] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Schubert J, ter Meulen V, Weißbrich B. Aviditätsbestimmung in der Epstein-Barr-Virus-Diagnostik - ein Vergleich von Immunfluoreszenztest und ELISA. ACTA ACUST UNITED AC 1996. [DOI: 10.1515/labm.1996.20.12.713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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30
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de Ory F, Casas I, Domingo CJ, Echevarría J. Application of fluoroimmunoassay to the identification of low avidity specific IgG against pathogenic human viruses and Toxoplasma gondii. ACTA ACUST UNITED AC 1995; 3:323-32. [PMID: 15566813 DOI: 10.1016/0928-0197(94)00045-v] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/1994] [Revised: 09/06/1994] [Accepted: 09/12/1994] [Indexed: 10/17/2022]
Abstract
BACKGROUND Serological diagnosis of primary viral infections is usually made by detection of specific IgM. In some cases, false positive results (mainly due to crossreactions between closely related viruses) can be obtained. Moreover, some primary infections occur without specific IgM response. Thus, alternative serological approaches are required for diagnosis. Detection of low avidity, specific IgG has been applied as a useful serological marker for diagnosing infections caused by several viruses and Toxoplasma gondii. OBJECTIVE The standardization and application of specific IgG avidity assays using a semiautomated solid phase immunoassay (fluoroimmunoassay (FIA)) on the basis of the urea elution principle, for the characterization of low avidity specific IgG against rubella virus, herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV) and T. gondii. STUDY DESIGN The method consists of two simultaneous determinations, one as recommended by the manufacturer and the other including a washing step with 8 M urea after the antigen-antibody reaction. A reduction in titer higher than, or equal to, 50% was considered indicative for presence of low avidity specific IgG. RESULTS When applied to the diagnosis of infections, this method showed sensitivity ranging from 81% to 100%, and absolute specificity. The detection of low avidity specific IgG allowed the differentiation between primary and recurrent infections caused by VZV. Furthermore, it helped in the identification of CMV as the etiological agent of congenital infection in the absence of specific IgM response, as well as in the elucidation of crossreactivity between antigenically related viruses, i.e., VZV and HSV, and Epstein-Barr virus and CMV. CONCLUSION FIA can be used for the characterization of the avidity of specific IgG antibody as a diagnostic test in clinical laboratories.
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Affiliation(s)
- F de Ory
- Departamento de Diagnóstico, Centro Nacional de Microbiología, Virología e Inmunología Sanitarias, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
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31
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Gray JJ. Avidity of EBV VCA-specific IgG antibodies: distinction between recent primary infection, past infection and reactivation. J Virol Methods 1995; 52:95-104. [PMID: 7769043 DOI: 10.1016/0166-0934(94)00147-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A commercial Epstein-Barr virus (EBV) antivirus capsid antigen (VCA) IgG antibody ELISA and an 'in-house' EBV VCA IgG immunofluorescence antibody assay (IFA) were used to detect EBV VCA IgG antibodies in 100 serum samples collected from organ transplant recipients and immunocompetent individuals. The avidity of EBV VCA IgG antibodies was determined in the IFA and ELISA using the mild reducing agent 8 M urea to remove low avidity antibodies. The samples were collected from patients who had previously been identified with a primary EBV infection, a reactivation of latent infection or evidence of a past EBV infection by means of EBV-specific serology. Using the ELISA, the antibody avidity was low in samples collected from patients with recent EBV infection and high in samples collected from patients with a past infection or a reactivation. There was a statistically significant difference of means (P < 0.001) of percentage reduction in optical density values, measured in the presence of 8 M urea, obtained with samples collected from patients with recent infection compared with samples from patients with a past infection or a reactivation of latent infection.
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Affiliation(s)
- J J Gray
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
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Andersson A, Vetter V, Kreutzer L, Bauer G. Avidities of IgG directed against viral capsid antigen or early antigen: useful markers for significant Epstein-Barr virus serology. J Med Virol 1994; 43:238-44. [PMID: 7931184 DOI: 10.1002/jmv.1890430308] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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)
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Affiliation(s)
- A Andersson
- Abteilung Virologie, Universität Freiburg, Germany
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