Serology of typhoid fever in an area of endemicity and its relevance to diagnosis
Serology of typhoid fever in an area of endemicity and its relevance to diagnosis
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DOI：
10.1128/jcm.39.3.1002-1007.2001
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发表时间：
2001-03-01
影响因子：
9.4
通讯作者：
Farrar, JJ
中科院分区：
文献类型：
--
作者：
House, D;Wain, J;Farrar, JJ
目前，伤寒的实验室诊断取决于肠沙门氏菌亚种的分离。从临床样本中检测肠杆菌血清型伤寒，或检测针对伤寒血清型脂多糖 (LPS) (O) 或鞭毛 CH) 抗原的凝集血清抗体滴度升高（Widal 试验）。在本研究中，对来自伤寒流行地区的个体进行了对伤寒血清型 LPS 和鞭毛抗原的血清抗体反应进行了调查，并评估了它们在伤寒诊断中的有用性。在感染伤寒血清型的个体中，对两种抗原的抗体反应差异很大，并且在高比例的伤寒患者中也检测到抗体滴度升高。 来自社区健康受试者的血清样本。将用于检测特定类别的抗 LPS 和抗鞭毛抗体的内部酶联免疫吸附测定 (ELISA) 与其他基于血清学的伤寒诊断测试（Widal TO 和 TB、抗血清型伤寒免疫球蛋白 M [IgM] 试纸和 IDeaL TUBEX）进行比较。在特异性大于或等于0.93时，抗LPS IgM、IgG和IgA ELISA的不同测试的灵敏度分别为0.75、0.55和0.52；抗鞭毛 IgG ELISA 为 0.28； Widal TO 和 TH 测试分别为 0.47 和 0.32；抗血清型伤寒 IgM;I 试纸检测为 0.77，IDeaL TUBEX 的特异性低于 0.90（灵敏度为 0.87；特异性为 0.76），基于针对血清型伤寒 LPS (ELISA) 或全细菌（试纸）检测 IgM 抗体的血清学检测的灵敏度明显高于 Widal TO 测试 当与单一急性期血清样本一起使用时（P小于或等于0.007），这些测试可用于临床伤寒但培养阴性的患者或在没有细菌培养设施的地区诊断伤寒。
Currently, the laboratory diagnosis of typhoid fever is dependent upon either the isolation of Salmonella enterica subsp. enterica serotype Typhi from a clinical sample or the detection of raised titers of agglutinating serum antibodies against the lipopolysaccharide (LPS) (O) or flagellum CH) antigens of serotype Typhi (the Widal test). In this study, the serum antibody responses to the LPS and flagellum antigens of serotype Typhi were investigated with individuals from a region of Vietnam in which typhoid is endemic, and their usefulness for the diagnosis of typhoid fever was evaluated, The antibody responses to both antigens were highly variable among individuals infected with serotype Typhi, and elevated antibody titers were also detected in a high proportion of serum samples from healthy subjects from the community. In-house enzyme-linked immunosorbent assays (ELISAs) for the defection of specific classes of anti-LPS and antiflagellum antibodies were compared with other serologically based tests for the diagnosis of typhoid fever (Widal TO and TB, anti-serotype Typhi immunoglobulin M [IgM] dipstick, and IDeaL TUBEX). At a specificity of greater than or equal to0.93, the sensitivities of the different tests were 0.75, 0.55, and 0.52 for the anti-LPS IgM, IgG, and IgA ELISAs, respectively; 0.28 for the antiflagellum IgG ELISA; 0.47 and 0.32 for the Widal TO and TH tests, respectively; and 0.77 for the anti-serotype Typhi IgM;I dipstick assay, The specificity of the IDeaL TUBEX was below 0.90 (sensitivity, 0.87; specificity, 0.76), The serological assays based on the detection of IgM antibodies against either serotype Typhi LPS (ELISA) or whole bacteria (dipstick) had a significantly higher sensitivity than the Widal TO test when used with a single acute-phase serum sample (P less than or equal to 0.007), These tests could be of use for the diagnosis of typhoid fever in patients who have clinical typhoid fever but are culture negative or in regions where bacterial culturing facilities are not available.