Diagnosis and clinical virology of Lassa fever as evaluated by enzyme-linked immunosorbent assay, indirect fluorescent-antibody test, and virus isolation
Diagnosis and clinical virology of Lassa fever as evaluated by enzyme-linked immunosorbent assay, indirect fluorescent-antibody test, and virus isolation
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DOI：
10.1128/jcm.38.7.2670-2677.2000
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发表时间：
2000-07-01
影响因子：
9.4
通讯作者：
Ksiazek, TG
中科院分区：
文献类型：
--
作者：
Bausch, DG;Rollin, PE;Ksiazek, TG
拉沙病毒（一种沙粒病毒）在西非发现，有时会导致严重的出血性疾病，称为拉沙热。实验室诊断传统上是通过间接荧光抗体（IFA）测试。然而，已经开发了用于拉沙病毒抗原和免疫球蛋白M（IgM）和G（IgG）抗体的酶联免疫吸附测定（ELISA），其被认为更敏感和特异。我们对305例拉沙热疑似病例的血清进行了ELISA和IFA检测，以病毒分离和阳性逆转录-PCR（RT-PCR）检测作为“金标准”。“在三百零五宗怀疑个案中，五十宗（百分之十六）的病毒分离及逆转录聚合酶链反应呈阳性反应。总之，拉沙病毒抗原和IgM ELISA对急性感染的敏感性为88%（95%置信区间[CI]，77 - 95%），特异性为99%（95% CI，88 - 91%）。由于采用严格的黄金标准，这些可能代表低估。诊断往往可以在一个单一的血清标本。抗原检测在提供早期诊断和预后信息方面特别有用。抗原血症水平与生存率呈负相关，早期检测IgG抗体有助于排除急性拉沙病毒感染。在感染的急性期和恢复期都存在IFA，以及观察者之间在阅读载玻片时存在显著差异，这使得解释困难。然而，该测定提供了有用的预后信息，IFA的存在与死亡相关的疾病过程中的早期，ELISA的高灵敏度和特异性，早期诊断能力和预后价值使它们成为检测拉沙热的诊断测试的选择。
The Lassa virus (an arenavirus) is found in West Africa, where it sometimes causes a severe hemorrhagic illness called Lassa fever. Laboratory diagnosis has traditionally been by the indirect fluorescent-antibody (IFA) test. However, enzyme linked immunosorbent assays (ELISAs) for Lassa virus antigen and immunoglobulin M (IgM) and G (IgG) antibodies have been developed that are thought to be more sensitive and specific. We compared ELISA and IFA testing on sera from 305 suspected cases of Lassa fever by using virus isolation with a positive reverse transcription-PCR (RT-PCR) test as the "gold standard." Virus isolation and RT-PCR were positive on 50 (16%) of the 305 suspected cases. Taken together, Lassa virus antigen and IgM ELISAs were 88% (95% confidence interval [CI], 77 to 95%) sensitive and 99% (95% CI, 88 to 91%) specific for acute infection. Due to the stringent gold standard used, these likely represent underestimates. Diagnosis could often be made on a single serum specimen. Antigen detection was particularly useful in providing early diagnosis as well as prognostic information. Level of antigenemia varied inversely with survival, Detection by ELISA of IgG antibody early in the course of illness helped rule out acute Lassa virus infection. The presence of IFA during both acute and convalescent stages of infection, as well as significant interobserver variation in reading the slides, made interpretation difficult. However, the assay provided useful prognostic information, the presence of IFA early in the course of illness correlating with death, The high sensitivity and specificity, capability for early diagnosis, and prognostic value of the ELISAs make them the diagnostic tests of choice for the detection of Lassa fever.