A rapid and affordable point of care test for antibodies against SARS-CoV-2 based on hemagglutination and artificial intelligence interpretation

Diagnostic tests that detect antibodies (AB) against SARS-CoV-2 for evaluation of seroprevalence and guidance of health care measures are important tools for managing the COVID-19 pandemic. Current tests have certain limitations with regard to turnaround time, costs and availability, particularly in point-of-care (POC) settings. We established a hemagglutination-based AB test that is based on bi-specific proteins which contain a dromedary-derived antibody (nanobody) binding red blood cells (RBD) and a SARS-CoV-2-derived antigen, such as the receptor-binding domain of the Spike protein (Spike-RBD). While the nanobody mediates swift binding to RBC, the antigen moiety directs instantaneous, visually apparent hemagglutination in the presence of SARS-CoV-2-specific AB generated in COVID-19 patients or vaccinated individuals. Method comparison studies with assays cleared by emergency use authorization demonstrate high specificity and sensitivity. To further increase objectivity of test interpretation, we developed an image analysis tool based on digital image acquisition (via a cell phone) and a machine learning algorithm based on defined sample-training and -validation datasets. Preliminary data, including a small clinical study, provides proof of principle for test performance in a POC setting. Together, the data support the interpretation that this AB test format, which we refer to as 'NanoSpot.ai', is suitable for POC testing, can be manufactured at very low costs and, based on its generic mode of action, can likely be adapted to a variety of other pathogens.

Is the Second Treponemal Test Necessary in the Reverse Algorithm for the Diagnosis of Syphilis?

BACKGROUND

This study was performed to investigate the necessity of the second treponemal test and to evaluate the diagnostic performance of the first treponemal test in the reverse algorithm of syphilis diagnosis.

METHODS

Abbott Architect Syphilis TP assay, a chemiluminescence immunoassay (CIA), was used as the first step treponemal test. Treponema pallidum haemagglutination assay (TPHA) test results of reactive samples from the first test were recorded. TPHA test result was considered as confirmatory. TPHA test results were grouped according to their Abbott Architect Syphilis TP assay results and they were compared with Mann-Whitney U test. For Abbott Architect Syphilis TP assay, a cutoff value with 100% specificity was determined via a ROC curve analysis which would render TPHA test unnecessary.

RESULTS

Out of 146,800 samples 2,646 were reactive in the first step. Of those, 2,002 had a TPHA test result. Of the 2,002 TPHA tests, 1,706 were positive and 296 were negative. TPHA positive and negative groups have significantly different CIA signal/cutoff values. Using a ROC curve built for evaluation of the first-step test, the maximum Youden's index value was found as 5.26. If this value would be accepted as cutoff, it would have a specificity of 85%. The specificity of 100% can be reached if a new cutoff value is set to 27.83.

CONCLUSIONS

Calculated cutoff value with 100% specificity is not practically applicable. It achieves saving of TPHA test in only six percent of reactive samples. Architect Syphilis TP assay is advantageous in large laboratories but is not enough to lead diagnosis without a second treponemal assay. Therefore it was decided to continue the reverse algorithm with dual treponemal assays.

Red Blood Cell Alloantibody Titration - Does the Titration Method Matter?

BACKGROUND

Red blood cell (RBC) alloantibody titration is a quasi-quantitative method to assess antibody concentration and is considered a useful means of estimating maternal alloimmunization during pregnancy. Traditionally, titration is performed using conventional tube test (CTT). The gel microcolumn agglutination-based method (GMA) has been proven reliable for many immunohematology tests. Our study compared CTT with GMA of two different, commercially available GMA systems for RBC alloantibody titration.

METHODS

Serum samples with significant RBC-alloantibodies were evaluated in our study. Each sample was titrated concurrently with CTT, with ID-DiaMed-GmbH, Cressier, Switzerland (GMA1), and with DG Gel Coombs Diagnostic Grifols, Passeig Fluvial, Spain (GMA2).

RESULTS

One hundred thirty-seven titration tests including 50 anti-D, 25 anti-Kell, 10 anti-E, 9 anti-Jka, 8 anti-c, 5 anti-Cw, 5 anti-Fya, 7 anti-M, 6 anti-Kpa, 3 anti-Lua, 1 anti-e, 3 anti-G, and 2 anti-Cha were performed and evaluated. Samples tested by CTT versus GMA1 and GMA2 generated mostly equal or higher titers by GMAs. The results of both comparisons were in good agreement (W = 0.91, p < 0.0001, and W = 0.92, p < 0.0001, respectively). For all antibody specificities, the mean absolute difference in titers ranged from 1 - 3 for both GMA1 and GMA2 versus CTT. Samples tested by GMA1 vs. GMA2 were in almost perfect agreement (W = 0.95, p < 0.0001).

CONCLUSIONS

Although both GMAs were found slightly more sensitive than CTT for alloantibody titration, the differences were not significant and the agreement between all methods was very good, possibly indicating GMA as a suitable alternative to CTT in RBC antibody titration.

A haemagglutination test for rapid detection of antibodies to SARS-CoV-2

Serological detection of antibodies to SARS-CoV-2 is essential for establishing rates of seroconversion in populations, and for seeking evidence for a level of antibody that may be protective against COVID-19 disease. Several high-performance commercial tests have been described, but these require centralised laboratory facilities that are comparatively expensive, and therefore not available universally. Red cell agglutination tests do not require special equipment, are read by eye, have short development times, low cost and can be applied at the Point of Care. Here we describe a quantitative Haemagglutination test (HAT) for the detection of antibodies to the receptor binding domain of the SARS-CoV-2 spike protein. The HAT has a sensitivity of 90% and specificity of 99% for detection of antibodies after a PCR diagnosed infection. We will supply aliquots of the test reagent sufficient for ten thousand test wells free of charge to qualified research groups anywhere in the world.

Role of a schistosoma haematobium specific microRNA as a predictive and prognostic tool for bilharzial bladder cancer in Egypt

Urinary bladder cancer is a common malignancy in Egypt, thus reliable methodologies are required for screening and early detection. In this study, we analyzed the gene expression of a Schistosoma hematobium specific microRNA "Sha-miR-71a" and mitogen-associated protein kinase-3 (MAPK-3) in the urine samples of 50 bladder cancer patients and 50 patients with benign bilharzial cystitis. Fifty control subjects were also tested. Indirect hemagglutination test (IHA) diagnosed 70% of studied cancer cases as bilharzial associated bladder cancer (BBC), while histopathological examination detected only 18%. Urinary Sha-miR-71a & MAPK-3 revealed enhanced expression in BBC (p-value = 0.001) compared to non-bilharzial bladder cancer (NBBC) cases. Patients with chronic bilharzial cystitis exhibited a significant increase in gene expression compared to those with acute infection (p-value = 0.001). Sha-miR-71a and MAPK-3 showed good sensitivity and specificity in the diagnosis of BBC when analyzed by the receiver operating characteristic (ROC) curve. They were also prognostic regarding malignancy grade. Both biomarkers showed a positive correlation. Our results revealed that IHA is a reliable test in the diagnosis of bilharziasis associated with bladder cancer, and that Sha-miR-71a and MAPK-3 provide non-invasive specific biomarkers to diagnose BBC, as well as a potential role in testing bilharzial patients for risk to develop cancer.

Antibodies in Melioidosis: The Role of the Indirect Hemagglutination Assay in Evaluating Patients and Exposed Populations

Melioidosis is a major neglected tropical disease with high mortality, caused by the Gram-negative bacterium Burkholderia pseudomallei (Bp). Microbiological culture remains the gold standard for diagnosis, but a simpler and more readily available test such as an antibody assay is highly desirable. In this study, we conducted a serological survey of blood donors (n = 1,060) and adult melioidosis patients (n = 200) in northeast Thailand to measure the antibody response to Bp using the indirect hemagglutination assay (IHA). We found that 38% of healthy adults (aged 17-59 years) have seropositivity (IHA titer ≥ 1:80). The seropositivity in healthy blood donors was associated with having a declared occupation of rice farmer and with residence in a nonurban area, but not with gender or age. In the melioidosis cohort, the seropositivity rate was higher in adult patients aged between 18 and 45 years (90%, 37/41) compared with those aged ≥ 45 years (68%, 108/159, P = 0.004). The seropositivity rate was significantly higher in people with diabetes (P = 0.008). Seropositivity was associated with decreased mortality on univariable analysis (P = 0.005), but not on multivariable analysis when adjusted for age, diabetes status, preexisting renal disease, and neutrophil count. This study confirms the presence of high background antibodies in an endemic region and demonstrates the limitations of using IHA during acute melioidosis in this population.

Association between Haemagglutination inhibiting antibodies and protection against clade 6B viruses in 2013 and 2015

BACKGROUND

The epidemiology of the pandemic A(H1N1) virus has been changing as population immunity continues to co-evolve with the virus. The impact of genetic changes in the virus on human's susceptibility is an outstanding important question in vaccine design. In a community-based study, we aim to (1) determine the genetic characteristics of 2009-2015 pandemic H1N1 viruses, (2) assess antibody response following natural infections and (3) assess the correlation of A/California/07/09 antibody titers to protection in the 2013 and 2015 epidemics.

METHODS

In a household transmission study, serum specimens from 253 individuals in Managua, Nicaragua were analyzed. Combined nose and throat swabs were collected to detect RT-PCR confirmed influenza infection and virus sequencing. Hemagglutination inhibition assays were performed and the protective titer for circulating H1N1pdm was determined.

RESULTS

Clade 6B pandemic H1N1 viruses predominated in Nicaragua during the 2013 and 2015 seasons. Our household transmission study detected a household secondary attack rate of 17% in 2013 and 33% in 2015. Infected individuals, including vaccinees, showed an apparent antibody response to A/California/07/09. Baseline titers of A/California/07/09 antibodies were found to associate with protection in both seasons. A titer of ≥1:40 correlated to a 44% protection in children, a 29% protection in adults 15-49years old and a 51% protection in adults 50-85years old.

CONCLUSION

In 2013 and 2015, antibody titers to A/California/07/09 associated with an infection risk reduction amongst exposed household contacts. This is consistent with a detectable vaccine effectiveness reported in a number of studies. Genetic changes in clade 6B viruses might have led to a reduced immunity in some whereas others might have been less affected. The use of human serologic data is important in virus characterization and if performed in a timely manner, could assist in vaccine strain selection.

Evaluation of the Ph. Eur. anti-A and anti-B assay on a pipetting robot in combination with a camera guided reading mode

The main objective of this study was the standardization of the direct anti-A, anti-B haemagglutination assay for immunoglobulin products in microtitre plates and gelcards by automation on a liquid handling robot. In addition, the evaluation of the pipetted microtitre plates with a computer-controlled camera was investigated and these results were related to titres from visual live reading. The titres obtained with the automated and the manual assay in microtitre plates and gelcards were compared. They were in excellent agreement: the titres of samples processed with the automated method varied maximally one titre step relative to the median titres of the same sample analysed with the manual method. The implementation of a camera guided test plate reading further increased the repeatability of the reported titres. In summary, the automated haemagglutination assay combined with a camera improved the consistency plus the traceability of the results and reduced the required hands-on time.

Distinct susceptibility and applicability of MDCK derivatives for influenza virus research

Madin-Darby Canine Kidney (MDCK) cells are widely utilized as a substrate for influenza virus isolation and propagation due to the high yields of virus. Here we compared the conventional MDCK cell line, MDCK-SIAT1 and MDCK-London for viral production, cell survival, and suitability in testing antivirals using six influenza strains including two H1N1 (pandemic and epidemic strains), three H3N2 and one influenza B strain. Overall our results suggest that MDCK-London cell line is superior for virus culturing and quantification, and hence an ideal platform to evaluate antiviral drug efficacy against multiple strains of influenza. Our data also suggests that while virus titers determined by the hemagglutination assay (HA) and neuraminidase activity (NA) are widely used to indicate viral load, there is a poor correlation between these measurements and the infectious titer obtained by plaque assay.

The development of laboratory tests for cancer in Japan with special reference to carcinoembryonic proteins

The present paper describes the present status of clinical tests for cancer in Japan. Since no cancer-specific substance has been found so far the clinical tests for cancer at present are always quantitative but not qualitative. Among these substances, alpha-fetoprotein is one of the most specific substances for cancer and its test is essential for diagnosis of hepatoma beins used worldwide. AFP is a specific product of liver cancer cells. The measurement of carcinoembryonic antigen in patient blood is a hopeful method for cancer diagnosis. This substance is not specifically produced by cancer cells, but the phenomenon of appearance in bloodstream appears to be cancer-specific. This may reflect the invasion of blood vessels in tissues such as colorectum, lung, etc., by infiltration of cancer cell. This is the reason for the appearance of CEA in a wide variety of cancers. There are many other clinical tests at present but these are only secondary aids for the diagnosis of cancer. This is the reason why the description concentrates mostly on AFP and CEA. The companies manufacturing the kits for these tests in Japan are also listed in this paper.

[Establishment of archives of Schistosoma japonicum antibody indirect hemagglutination tests]

OBJECTIVE

To establish written and electronic archives of Schistosoma japonicum antibody indirect hemagglutination (IHA) tests.

METHODS

In the process of schistosomiasis screening by IHA, the written records, electronic records, and serum sample bank were combined to make comprehensive archives.

RESULTS

The S. japonicum antibody IHA test archives can preserve the schistosomiasis screening data in the long term and even can trace the source of experiments, and the operation was simple.

CONCLUSION

The archives of S. japonicum antibody IHA tests are simple and useful, and worth of popularization.

Hemagglutination assay for influenza virus

The hemagglutination assay (HA) is a tool used to screen cell culture isolates or amnioallantoic fluid harvested from embryonated chicken eggs for hemagglutinating agents, such as type A influenza. The HA assay is not an identification assay, as other agents also have hemagglutinating properties. Live and inactivated viruses are detected by the HA test. Amplification by virus isolation in embryonated chicken eggs or cell culture is typically required before HA activity can be detected from a clinical sample. The test is, to some extent, quantitative as 1 hemagglutinating unit (HAU) is equal to approximately 5-6 logs of virus. It is inexpensive and relatively simple to conduct. Several factors (quality of chicken erythrocytes, laboratory temperature, laboratory equipment, technical expertise of the user) may contribute to slight differences in the interpretation of the test each time it is run. This chapter describes the methods validated and used by the US National Veterinary Services Laboratories for screening and identification of hemagglutinating viruses.

[Evaluation of specific antibodies of blood receiver sera to Treponema pallidum by chemiluminescence immunoassay]

OBJECTIVE

The purpose of this study was to evaluate the diagnostic performance of chemiluminescence immunoassay (CLIA ) , in comparison with that of the following currently used treponemal tests: hemagglutination test (TPHA), and Western Blot (WB).

METHODS

First, a retrospective study was performed with a panel of 18 494 blood receiver sera by CLIA and TPHA, the specific antibody against T. pallidum in 177 were positive sera by CLIA and/or TPHA, 81 clinical and serologically characterized syphilitic sera, 55 sera obtained from subjects with potentially interfering diseases, and 250 healthy sera were negative were detected by CLIA, TPHA and WB.

RESULTS

The results of WB as the gold standard, the sensitivity of CLIA (98. 4%) was significantly higher than that of TPHA (94. 4%) (Chi2 = 5.76,P <0. 05), the specificity of CLIA (100%) was similar to that of TPHA (99.7%) (Chi2 =1. 0, P >0. 05).

CONCLUSION

CLIA is characterized with higher sensitivity and specificity, It is suitable for screening Syphilis in clinical laboratory.

[Field application of antibody detection in a low transmission area of Schistosoma japonicum]

OBJECTIVE

To evaluate the field application of IHA and ELISA for schistosomiasis japonica detection at low transmission status.

METHODS

728 and 799 persons were examined by Kato-Katz's method, IHA and ELISA for schistosomiasis in an endemic village in the year of 2008 and 2010, respectively. The results of IHA and ELISA was evaluated in comparison to that of Kato-Katz (27 slides with 3 stool specimens) used as gold standard.

RESULTS

The positive rate of Kato-Katz's method, IHA and ELISA were 10.3% (75/728), 40.0% (291/728) and 40.1% (292/728) in 2008, and 3.8% (30/799), 31.5% (252/799) and 40.1% (320/799) in 2010 respectively, in which significant difference was observed for the result between Kato-katz's method (chi2 = 26.92, P < 0.05) and IHA (chi2 = 11.82, P < 0.05). The consistency between the result of antibody detection and that of Kato-Katz's method was poor, lower than 0.2 (P < 0.01). If routine screening diagnosis mode was adopted, namely, population screened with IHA or ELISA first and confirmed with Kato-Katz's method, correlation analysis showed that the positive rate of Kato-Katz's method increased with the number of stool specimens and slides (rIHA2008 = 0.922, rELISA2008 = 0.908, rIHA2010 = 0.749, rELISA = 0.798; P < 0.05) . Those with egg positive but missed by IHA or ELISA mainly were cases with low infection intensity. When EPG < or = 40, the rate of detection ranged from 66.1% (39/59) to 87.0% (20/23) with IHA, and 62.7% (37/59) to 100% (23/23) with ELISA. When EPG > 40, however, all cases could be detected with ELISA, but some missed with IHA.

CONCLUSION

In low transmission areas, the determination of target population for chemotherapy should be based on the examination of nine slides per stool specimen by Kato-Katz's method after serological screening.

High molecular weight constituents of cranberry interfere with influenza virus neuraminidase activity in vitro

Cranberry juice contains high molecular weight non-dialyzable material (NDM) which was found to inhibit hemagglutination induced by the influenza virus (IV) as well as to neutralize the cytotoxicity of IV in cell cultures. Because influenza virus surface glycoproteins hemagglutinin (HA) and neuraminidase (NA) are involved in viral replication and in the infectious process, we sought in the present study to examine the effect of NDM on neuraminidases which are the target of most anti-influenza drugs today. NDM inhibited the NA enzymatic activity of influenza A and B strains as well as that of Streptococcus pneumoniae. This finding is of importance considering the emergence of influenza isolates resistant to antiviral drugs, reaching 90 % in some places. The anti-NA activity of NDM, evaluated by the MUNANA method and expressed as the concentration required for 50 % inhibition (IC₅₀), was most potent against N1 (IC₅₀, 192 µg/mL), less active against BN and N2 (IC₅₀, 509 µg/mL and 1128 µg/mL, respectively), and moderately active against Streptococcus pneumoniae NA (IC₅₀, 594 µg/mL). The in vitro findings of the present study suggest that cranberry constituents may have a therapeutic potential against both A and B influenza virus infections and might also interfere with the development of secondary bacterial complications.

Diagnostic dilemma of the single screening test used in the diagnosis of syphilis in Nepal

Syphilis screening by the nontreponemal rapid plasma reagin (RPR) test is not usually followed up by specific treponemal tests in most of the resource poor healthcare settings of Nepal. We analyzed serum specimens of 504 suspected syphilis cases at the immunology department of the national reference laboratory in Nepal during 2007-2009 using RPR test and Treponema pallidum hemagglutination assay (TPHA). In overall, 35.7% were positive by both methods (combination) while 13.1% were RPR positive and TPHA negative, 8.7% were positive by TPHA only and 42.5% were negative by both methods. Among the RPR reactive (n = 246), 73.2% were positive by TPHA. Non-specific agglutination in RPR testing was relatively higher (26.8%) compared to TPHA (19.6%). Although TPHA was found more specific than RPR test, either of the single tests produced inaccurate diagnosis. Since the single RPR testing for syphilis may yield false positive results, specific treponemal test should be routinely used as confirmatory test to rule out false RPR positive cases. More attention needs to be paid on formulation of strict policy on the implementation of the existing guidelines throughout the country to prevent misdiagnosis in syphilis with the use of single RPR test.

[Diagnostic efficiency of Indirect Hemagglutination Assay Kit for antibody detection of schistosomiasis japonica]

OBJECTIVE

To evaluate the clinical diagnostic efficiency of Indirect Hemagglutination Assay Kit (IHA kit) for antibody detection of schistosomiasis japonica.

METHODS

Schistosomiasis examinations by parasitological method were conducted in the schistosomiasis endemic areas in Jiangxi, Anhui and Hubei provinces, respectively. A total of 371 serum samples of schistosomiasis patients and 761 serum samples of non-patients without history of schistosome infection and infested water contact were collected. All the sera were detected by using IHA Kit. The diagnostic efficiency indicators of the kit, including sensitivity, specificity, positive predicted value, negative predicted value etc. were calculated.

RESULTS

The sensitivity and specificity of the kit were 95.1% (95% confidence interval was between 92.9% and 97.3%) and 97.8% (95% confidence interval was between 96.8% and 98.8%), respectively; the positive and negative predicted values were 95.4% and 97.6%, respectively. No statistically significant difference was found in the prevalence of IHA positive detecting by the kit among the groups with different EPG levels (< or = 40, 41-100, > 100). Also, no significant difference was observed in sensitivity and specificity among the different age groups.

CONCLUSIONS

The IHA kit shows a relative high efficiency for diagnosis and can be used for mass screening of schistosomiasis in field sites.

Yaws in Polynesia's Wallis and Futuna Islands: a seroprevalence survey

We carried out a serological and clinical survey to determine the prevalence and clinical presentation of yaws on two twin islands in Polynesia: Wallis and Futuna. A total of 264 serum samples were tested for specific Treponema pallidum haemagglutinations assay and non-specific rapid plasma reagin: 52 were positive for one or both tests; only one young adult had skin lesion consistent with yaws; and there were no observed cases of secondary or tertiary yaws. Our results contrast with findings in neighbouring islands, such as Vanuatu, where yaws has been reported to resurge. This difference might be explained by better availability and accessibility of healthcare on Wallis and Futuna, thus allowing widespread use of antibiotics for other bacterial diseases.

Evaluation of ELISA and IHAT in serological diagnosis of proven cases of human hydatidosis

Cystic hydatid disease (Hydatidosis) is the most serious tape-worm infection prevalent in the cattle and sheep raising area of the world. Hydatidosis in man (as an accidental host) is caused by infection with the ova containing larval stage of Echinococcus granulosus. In the last decade, different techniques have been employed for sero-diagnosis of hydatidosis; as IHA, IFA, ELISA, CCLE (Counter Current Immuno-electrophoresis). This paper evaluated the validity of ELISA and IHA. Since whole hydatid cyst fluid was used as a source of antigen for serodiagnosis. Thirty surgical and pathological hydatidosis proven patients were examined. The sensitivity and specificity of ELISA were 96.7% & 97.5% respectively, and that of IHA were 86.7%, &95% respectively.

In vivo functional tests for assessing immunotoxicity in birds

Various methods have been adapted for assessing the effects of environmental contaminants on the structure and function of the immune system in wild and captive birds. This chapter describes two integrative functional assays that have been adapted to a variety of avian species and have proven to be sensitive biomarkers for immunotoxicological effects. The phytohemagglutinin (PHA) skin test measures T cell-mediated immunity. PHA is injected intra- or sub-dermally into the wing web of the elbow joint (or interdigitary skin or wattle). The PHA stimulates T lymphocytes to release cytokines that cause an inflammatory influx of leukocytes and fluid. The thickness of the wing web is measured before and 24 h after injection. A stimulation index, which reflects T cell function, is calculated as the increase in skin thickness caused by the PHA minus the increase caused by an injection of phosphate buffered saline (PBS) in the other wing web. In addition to its sensitivity to contaminants, ecological studies have shown that the PHA skin response is positively associated with rates of survival and colonization of new areas (i.e., ability to found new local populations) in wild birds.The sheep red blood cell (SRBC) hemagglutination assay measures the antibody response to immunization with SRBC antigens, integrating the functions of B lymphocytes, helper T lymphocytes, and macrophages. A SRBC suspension is injected i.v., and a blood sample is collected approximately 6 days later. Plasma (or serum) from the blood sample is serially diluted in a microtiter plate, and SRBCs are added. The magnitude of the antibody response is defined as the titer - the highest dilution of plasma in which the concentration of antibody is sufficient to agglutinate the SRBCs. Both IgM and IgG titers can be measured. This avian test is very similar in principle to the anti-SRBC ELISA and splenic plaque forming assays used for immunotoxicological testing in rodents. However, this avian hemagglutination assay does not require a species-specific secondary antibody (as does the ELISA), and this minimally invasive, nonlethal procedure is amenable to studies of protected species, as opposed to the splenic assay. The PHA and SRBC assays have been employed successfully in both the laboratory and field. In ecological studies birds must be recaptured 24 h or 6 days after the initial injections, limiting their use in some species. However, their sensitivity to a variety of contaminants and their ease of adaptability to a variety of species have made the PHA and SRBC tests some of the most commonly used assays for screening and monitoring immunotoxicity in birds.

The evaluation of a user-friendly lateral flow assay for the serodiagnosis of human brucellosis in Kazakhstan

Serum samples from all patients with culture-confirmed brucellosis including those with chronic disease from Kazakhstan tested positive in the serum agglutination test for titers > or = 1:25 and reacted in the Brucella immunoglobulin M/immunoglobulin G lateral flow assay (LFA) confirming the high sensitivity of these assays. The strong reactivity in the LFA observed for the majority (92.1%) of the samples from the patients with culture-confirmed brucellosis together with the user-friendliness of the assay procedure makes the LFA ideal for the confirmation of brucellosis in endemic areas in Kazakhstan. The Rose Bengal test lacked sensitivity in particular for patients with chronic brucellosis therefore limiting its value as a quick screening assay. The study emphasizes the importance of the LFA as a useful, rapid, and easy-to-perform tool in the diagnostic testing of brucellosis.

Screening and identification of unexpected red cell antibodies by simultaneous LISS/Coombs and NaCl/Enzyme gel methods

We evaluated the clinical usefulness of simultaneous LISS/Coombs and NaCl/Enzyme testing using the gel method for screening and identification of unexpected antibodies in 15,014 samples. When unexpected antibodies were detected by either screening test, those antibodies were identified using both the LISS/Coombs and the NaCl/Enzyme gel test. The positive screening rates of the LISS/Coombs, NaCl/Enzyme, and combined tests (excluding 25 autoantibody cases) were 0.48%, 1.29%, and 1.39%, respectively. Among the 57 samples positive by both screening methods, the antibodies in 19.3% could be identified only by the NaCl/Enzyme method. Among the 137 samples positive only by NaCl/Enzyme screening, 74.5% showed positive results in antibody identification only by the NaCl/Enzyme test, although 7.3% were also positive in the LISS/Coombs test. The NaCl/Enzyme method thus showed about threefold higher detection rates than the LISS/Coombs method, especially in screening for Rh antibodies, and higher exact identification rates and discriminatory power for identifying mixed antibodies. Addition of the NaCl/Enzyme method to routine laboratory procedures may detect and identify considerable numbers of significant antibodies that might be missed if only the LISS/Coombs method is used.

[Single-stage detection of A and B antigens in the hair by absorption-elution and mixed agglutination techniques]

The proposed method is intended for single-stage detection of A and B antigens in ultrafine hair fragments by means of absorption-elution and mixed agglutination techniques with the use of a mixture of anti-A and anti-B sera.

[Combination of absorption-elution and gel-filtration methods for group identification of blood spot specimens]

It is proposed to combine the traditional method of microscopic assessment of the results of absorption-elution reaction and the gel-filtration technique with the use of the ScanGel immunohematology system (Bio-Rad Laboratories, USA) in blood grouping tests. The study was designed to select monoclonal antibodies suitable for the purpose and optimize conditions of gel filtration. It is concluded that the combined method allows for rapid differential grouping of the large number of blood spots, promotes objectivization of assay results, and lightens the work of the operator carrying out serial analyses.

Is pretest probability assessment on emergency department patients with suspected venous thromboembolism documented before SimpliRED D-dimer testing?

BACKGROUND

The SimpliRED D-dimer assay is commonly ordered by emergency physicians for suspected pulmonary embolus or deep venous thrombosis. A pretest probability (PTP) assessment is required for the results of this diagnostic test to be interpreted correctly and applied appropriately. Without this assessment, the physician may misinterpret the test results and proceed to unnecessary diagnostic imaging (DI) or inappropriate discharge. Our objectives were to measure the documentation rate of PTP for emergency department (ED) patients on whom a SimpliRED D-dimer assay was performed for suspected venous thromboembolism (VTE) and to determine if the clinical management decisions that followed were in keeping with current recommendations.

METHODS

In this medical record review, we used a random number generator to select 100 charts from all 760 patients who had a SimpliRED D-dimer performed during a 3-month period at an academic tertiary care centre with 3 EDs. Trained data abstractors, blinded to the study hypothesis, abstracted explicitly defined data from each chart. An independent abstractor assessed the reliability of 15 of the charts that were randomly chosen.

RESULTS

Suspicion of VTE was documented in 97 of the 100 charts. There was no documentation of PTP assessment for 62 of the 97 cases. Ten had a positive D-dimer but 5 of these had no evidence of subsequent DI. Of the 97 charts reviewed, 24 documented decisions were in discordance with published clinical management recommendations for VTE.

CONCLUSION

In the majority of ED cases of suspected VTE, PTP assessment was not documented and approximately one-quarter of these documented decisions were in discordance with established recommendations for the given test results. This suggests that PTP assessments are not being conducted in a significant proportion of cases and the diagnostic test results are misinterpreted, applied incorrectly or both.

A longitudinal study of comparison of the Kato-Katz technique and indirect hemagglutination assay (IHA) for the detection of schistosomiasis japonica in China, 2001-2006

From 2001 to 2006, about one-third of the residents aged 5-65 years were selected as the subjects in a schistosome-endemic village located in Jiangxi Province, China. Every 1 year, all participants were analyzed by the Kato-Katz parasitologic examination and indirect hemagglutination assay (IHA). Statistical analysis of the results showed the k indices ranged from 0.250 to 0.347 between the two methods. Assuming the Kato-Katz results as the gold standard reference, the specificity of the IHA was from 60% to 77%, the positive predictive value of this method was from 19% to 30%, and its sensitivity and negative predictive value were more than 97%. The IHA method is unsuitable for individual screening in endemic community with relatively high prevalence (e.g. with >10% or more prevalence). A search for a better diagnostic test that can be applied in field situations in China is essential and should be given high priority.

Simplified spectraphotometric method for the detection of red blood cell agglutination

Human error is the most significant factor attributed to incompatible blood transfusions. A spectrophotometric approach to blood typing has been developed by examining the spectral slopes of dilute red blood cell (RBC) suspensions in saline, in the presence and absence of various antibodies, offering a technique for the quantitative determination of agglutination intensity [Transfusion39, 1051, 1999TRANAT0041-113210.1046/j.1537-2995.1999.39101051.x]. We offer direct theoretical prediction of the observed change in slope in the 660-1000 nm range through the use of the T-matrix approach and Lorenz-Mie theory for light scattering by dilute RBC suspensions. Following a numerical simulation using the T-matrix code, we present a simplified sensing method for detecting agglutination. The sensor design has been prototyped, fully characterized, and evaluated through a complete set of tests with over 60 RBC samples and compared with the full spectrophotometric method. The LED and photodiode pairs are found to successfully reproduce the spectroscopic determination of red blood cell agglutination.

Serological evaluation of specific-antibody levels in patients treated for chronic Chagas' disease

Serological tests are the main laboratory procedures used for diagnosis during the indeterminate and chronic stages of Chagas' disease. A serological regression to negativity is the main criterion used to define parasitological cure in treated patients. The aim of this work was to monitor the individual specificities of antibody levels for 3 years posttreatment in 18 adult patients. Conventional serological techniques (hemagglutination assays and enzyme-linked immunosorbent assay [ELISA]) were modified by using recombinant antigens to detect early markers of treatment effectiveness. For this purpose, serum samples were taken before and during treatment and every 6 months after treatment for at least 3 years. When hemagglutination assays were used, a decrease in antibody levels was observed in only one patient. When ELISA with serum dilutions was used, antibody clearance became much more apparent: in 77.7% (14/18) of the patients, antibody titers became negative with time. This was observed at serum dilutions of 1/320 and occurred between the 6th and the 30th months posttreatment. The immune response and the interval for a serological regression to negativity were different for each patient. For some of the recombinant antigens, only 50% (9/18) of the patients reached the serological regression to negativity. Recombinant antigen 13 might be a good marker of treatment effectiveness, since 66.6% (six of nine) of the patients presented with an early regression to negativity for specific antibodies to this antigen (P = 0.002).

Role of Glycoproteins Isolated from Epicoccum purpurascens in Host-Pathogen Interaction

OBJECTIVE

Attachment to host matrix is an important provisory step for the institution of any fungal infection. The present study investigates the role of glycoproteins of Epicoccum purpurascens in host-fungal adherence.

METHODS

Epicoccum spore-mycelial extract was fractionated on a concanavalin A-Sepharose column. Three glycoproteins of 12, 17 and 33 kDa (Epi p 1) were electroeluted and checked for hemagglutination and hemagglutination inhibition. The monosaccharide content of the highly potent protein Epi p 1 was determined by high-performance anion exchange chromatography and pulsed amperometric detection. The interaction of Epi p 1 with mannose-binding lectin (MBL) leading to the activation of the complement system was studied by immunoblot, ELISA and ELISA inhibition techniques. Immunoblot and immunoblot inhibition were carried out with culture filtrate to determine the nature of Epi p 1.

RESULTS

33 (Epi p 1)-, 17- and 12-kDa proteins were 58, 46 and 38 times more potent than crude extract in hemagglutination activity (HA). The HA of Epi p 1 was inhibited by N-acetyl glucosamine, glucose and laminin. Epi p 1 had a high mannose content, showed MBL binding in ion-dependent manner and caused complement activation. The protein was detected in culture filtrate and thus seems to play a significant role in fungal invasion.

CONCLUSION

Epi p 1, an allergenic glycoprotein of E. purpurascens, is involved in host-fungal interactions through MBL.

Comparative evaluation of 15 serological assays for the detection of syphilis infection

Fifteen commercial syphilis kits were assessed against the same moderately sized specimen panel that included 114 serum and plasma specimens from syphilis cases and 249 specimens from unselected blood donors. The 114 specimens from syphilis cases comprised 40 from cases of primary syphilis, 43 from cases of secondary syphilis, 19 from cases of early latent syphilis, and 12 from cases of late latent syphilis. Of the 15 kits, ten were enzyme immunoassays, four were Treponema pallidum haemagglutination assays, and one was a T. pallidum particle agglutination assay. Thirteen of the 15 kits gave final specificities of 100%; the other two kits were repeatedly reactive with one to two specimens. Initial sensitivities ranged from 93.9 to 99.1%. Most variation between kits was observed in results for the groups with untreated primary and treated late latent disease, although the differences were not statistically significant. The comparative data on kit performance derived from this study is useful for examining syphilis testing guidelines and for making informed purchasing decisions.

Comparison of several commercial serologic kits and Em18 serology for detection of human alveolar echinococcosis

The aim of this study was to design the best serologic strategy for diagnosing human alveolar echinococcosis (AE) cases in medical laboratory routine procedures. By combining 2 screening techniques, indirect hemagglutination with Em(2plus)-ELISA and/or recEm18-ELISA, 46 of 47 AE cases were detected. The necessary confirmation of results is then obtained by using immunoblot (LDBIO-IB and/or recEm18-IB).

[Isolation and characterization of lectin from the surface of Grifola frondosa (FR.) S.F. Gray mycelium]

For the first time, from the surface of the dikaryotic mycelium of the xylotrophic basidiomycete Grifola frondosa 0917 a lectin has been isolated with a molecular mass of 68 +/- 1 kDa, consisting of two subunits of 33-34 kDa each. The lectin is a hydrophilic glycoprotein with the protein : glycan ratio of 3 : 1. It exhibits high affinity to native rabbit erythrocytes and to human erythrocytes of the 0 blood group, but not to trypsin-treated ones. The hemagglutination (HA) caused by lectin was not blocked by any of the 25 tested mono-, di-, and amino sugars; it was also not blocked by some of glyco derivatives. Only 13.9 microg/ml of the homogeneous preparation of a polysaccharide, a linear D-rhamnan with the structure of the repetitive component --> 2)-beta-D-Rhap-(1 --> 3)-alpha-D-Rhap-(1 --> 3)-alpha-D-Rhap-(1 --> 2)-alpha-D-Rhap-(1 --> 2)-alpha-D-Rhap-(1 --> blocked hemagglutination completely. The analysis of the amino acid composition of the lectin showed the greatest percentage of amino acids with positively charged R groups, arginine, lysine, and histidine, as well as the complete absence of sulfur-containing amino acids, cysteine, and methionine. D-glucose and D-glucosamine were detected in the carbohydrate part.

[Potential risks for transmission of schistosomiasis caused by mobile population in Shanghai]

OBJECTIVE

To understand the potential risk for schistosomiasis transmission caused by introduction of infection source from mobile population in Shanghai.

METHODS

Field investigation was conducted in the suburb of Shanghai City by screening the mobile population living in Shanghai for more than 1 month and over 1 years old in a procedure of interviewing, serum indirect hemagglutination (IHA) test, and then fecal examination to detect the eggs with nylon sedimentation approach for those IHA positives.

RESULTS

Among 2,931 mobile people investigated, 1,575 were male (53.74%) and 1356 were female(46.26%); 138 out of 2931 were positive in IHA test (4.71%). 1938 (66.12%) out of 2 931 came from Schistosoma japonicum-endemic provinces and its positive rate in mobile population (5.99%) was significantly higher than those from the transmission-interrupted provinces (2.6%) (chi2=10.28, P<0.01), and those from non-endemic provinces (1.68%) (chi2=12.86, P<0.01). The 138 IHA positives all showed negative in fecal examination. In accordance with the serum positive rate and egg-infection rate in the national reporting system in 2004, it was estimated that there would be about 13 356 and 1 699 potential serum positive cases respectively from endemic area and transmission controlled area, and about 2,168 and 255 egg-positive cases from the two kind areas respectively, majority of the cases were from Anhui Province.

CONCLUSION

Schistosomiasis transmission risks potentially exist in Shanghai suburb due to the introduction of infected mobile people from other endemic provinces, and a surveillance system and quick response are needed for the possible re-emergence of the disease.

[Effectiveness of routinely used assays for the diagnosis of schistosomiasis japonica in the field]

OBJECTIVE

To evaluate the effectiveness of routinely used assays for schistosomiasis diagnosis in the field.

METHODS

From late November to early December 2005, 6-65 years old inhabitants from 3 endemic villages were examined by Kato-Katz technique (3 thick smears) and nylon bag sedimentation/hatching method. At the same time, dipstick dye immunoassay(DDIA), fast enzyme linked immunosorbent assay (F-ELISA), indirect haemagglutination test A (IHA-A) and B ( IHA-B) were carried out in parallel

RESULTS

1864 people were examined by stool examination with an average positive rate of 9.7%. The missing rate of DDIA was relatively stable in medium and heavily endemic areas of schistosomiasis. The missing rate of nylon bag sedimentation/hatching method was 25% and relatively stable when the number of eggs per gram of feces(EPG) was larger than 100. The average positive rate of DDIA, F-ELISA, IHA-A and IHA-B was 47.8%, 50.0%, 66.3% and 40.1% respectively. Using stool examination as the gold standard, the sensitivity of DDIA, F-ELISA, IHA-A and IHA-B was 75.3%, 65.8%, 85.6% and 76.0%; and the specificity was 55.1%, 51.7%, 35.7% and 63.6%, respectively. Among the four sero-diagnostics, the specificity, Youden index, positive likelihood rate and coincidence of IHA-B were the highest.

CONCLUSION

Kato-Katz method is more stable and effective than nylon bag sedimentation/hatching method in medium and heavily endemic areas of schistosomiasis japonica. The sensitivity and specificity of these four diagnosis kits are lower than 90%.