Clinical Features That Affect Indirect-Hemagglutination-Assay Responses to Burkholderia pseudomallei
Clinical Features That Affect Indirect-Hemagglutination-Assay Responses to Burkholderia pseudomallei
复制标题
DOI：
10.1128/cvi.00026-09
复制
发表时间：
2009-06-01
影响因子：
--
通讯作者：
Norton, Robert E.
中科院分区：
文献类型：
--
作者：
Harris, Patrick N. A.;Ketheesan, Natkunam;Norton, Robert E.
类鼻疽是澳大利亚北方和东南亚的一种地方性疾病，由土壤中的嗜盐菌类鼻疽伯克霍尔德氏菌引起。间接血凝试验（IHA）是最常用的血清学试验，以帮助确认暴露于致病微生物。然而，尽管培养证实的疾病，患者往往有一个阴性的IHA结果在介绍，偶尔未能血清转化系列测试。我们回顾性地检查了1996年1月至2008年8月间我们实验室所有经培养确诊的类鼻疽患者的结果。140例患者在就诊时记录了IHA滴度，其中71例为阳性，滴度为1：40或更高。53例患者在就诊后1个月或更长时间继续进行IHA。检查IHA反应与临床特征之间的关系。菌血症的存在与就诊时IHA阴性显著相关。合并糖尿病与就诊时IHA阳性相关。总共有14名患者（26%）在系列检测中表现出持续阴性IHA滴度。没有发现临床因素与这种现象显著相关。通过EIA使用类鼻疽特异性免疫球蛋白G进行的补充检测显示了不同的效果，只有土著或托雷斯海峡岛民种族与呈现的阳性EIA显著相关。这些研究结果的原因进行了检查，并讨论了未来的研究方向。
Melioidosis, a disease endemic to northern Australia and Southeast Asia, is caused by the soil saprophyte Burkholderia pseudomallei. The indirect hemagglutination assay (IHA) is the most frequently used serological test to help confirm exposure to the causative organism. However, despite culture-confirmed disease, patients often have a negative IHA result at presentation and occasionally fail to seroconvert in serial testing. We retrospectively examined results for all patients with culture-confirmed melioidosis from our laboratory between January 1996 and August 2008. One hundred forty patients had a recorded IHA titer at presentation, 71 of which were positive at a titer of 1: 40 or greater. Fifty-three patients went on to have subsequent IHAs 1 month or more after presentation. The relationships between IHA responses and clinical features were examined. The presence of bacteremia was significantly associated with a negative IHA at presentation. The coexistence of diabetes was associated with the presence of a positive IHA at presentation. In total, 14 patients (26%) demonstrated persistently negative IHA titers upon serial testing. No clinical factors were found to be significantly associated with this phenomenon. Supplementary testing using melioidosis-specific immunoglobulin G by EIA demonstrated different effects, with only Aboriginal or Torres Straits Islander ethnicity being significantly associated with a positive EIA at presentation. Reasons for these findings are examined, and directions for future research are discussed.