Interpretation Of Serology Tests In Selected Infections

Prof. Abdulkarim AlAska
Interpretation Of Serology Tests In Selected Infections 1

Antibodies (ABs)

IgM Acute infection IgM cannot cross the placenta


IgG previous infection or exposure IgG can cross the placenta. IgG titre acute phase + Convalescence phase (usually 2 weeks) is needed to confirm diagnosis Sero – conversion >2 to 3 weeks but may be delayed.
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Interpretation Of Serology Tests In Selected Infections

False Negative Serologic Test
1. 2.

3.

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Immune system not intact Delay in Antibody response (Lyme disease - Legionnaire’s Disease) Competition for Antigen binding site of antibody) IgM binds to the Antigen IgG site IgG binds to the Antigen IgM site Prozone Phenomena
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Interpretation Of Serology Tests In Selected Infections

2. Cross reacting antibody Cross reactivation of latent organism (Influenza Virus A infection activate CMV IgM – production Presence of Rheumatoid factors RF = IgM RF + IgG = Complexed = False positive organismspecific IgM Antibody 4 Interpretation Of Serology Tests In Selected Infections .False Positive 1. 3.

treponemal Antibody Anti – treponemal Antibody Reagin Antibody (BFP) Interpretation Of Serology Tests In Selected Infections 5 . Specific Anti.Serological Diagnosis Of Syphilis I. II. III.

6 Interpretation Of Serology Tests In Selected Infections . C. Absorbed fluorescent treponemal antibody (FTA . Expensive Potentially hazardous.ABs) 2.treponemal Antibody 1.Serological Diagnosis Of Syphilis Test for specific Anti . D. Treponema Pallidum Immobilization Test (TPI) A. Most sensitive Utilize living Treponema maintained by passage in rabbits testes. B.

D. B. chicken or turkey RBCs. Sensitized by attaching killed Treponema pallidum. A. C. Sheep. E. Sometimes false positive Interpretation Of Serology Tests In Selected Infections 7 .Serological Diagnosis Of Syphilis 3. Agglutinate by presence ofantibody Less sensitive than FTA – Abs Less reliable in the diagnosis of primary syphilis. Treponema pallidum haemagglutination (TPHA) test.

Appears later than specific ABs Some syphilis patient do not produce the form of ABs Used is limited.Serological Tests Of Syphilis   Anti – treponemal Antibody Anti-treponemal ABs group detected by Reiter Protein Complement Fixation Test (RPCFT) A. 8 Interpretation Of Serology Tests In Selected Infections . C. B.

Malaria Pregnancy Leprosy – the only infection B.  Chronic:  Reagin titre falls rapidly with treatment 9 Interpretation Of Serology Tests In Selected Infections .Tests For Reagin Antibody  A. Biological False Positive Antibody (BFP) Reagin Antibody: associated with other diseases (BFP) Acute:     Pneumonia Vaccination with live attenuated viruses.

Interpretation Of Serology Tests In Selected Infections 10 .  RPR (Rapid Plasma Reagin)  ART (Automated Reagin Test) Good sensitive screening  Titre falls rapidly with treatment   Reagin titre falls with treatment.Tests For Reagin Antibody  A large numbers of tests for Reagin:  VDRL (Venereal Diseases Reference Laboratory).

Interpretation Of Serology Tests In Selected Infections 11 .Active Treponema Pallidum Infection 1.g. • • • Positive Specific Tests e. 2. TPHA Positive ( ≥1/ 32) of non-specific test (VDRL) TPI-T (Treponema Pallidum Immobilization Test) FTA –T (Fluorescent Treponema Test) Sometimes needed for confirmation.

most typically dry cough.  Non respiratory:       Meningitis Encephalitis Pancreatitis Steven Johnson’s Syndrome Sensori neural hearing loss Interpretation Of Serology Tests In Selected Infections 12 . fever.Mycoplasma Pneumonia Gradual onset. malaria. headache.

Mycoplasma Pneumonia  ELISA: More sensitive and specific  Detect IgM. IgA  IgM rise early after onset  Peak is 1 – 4 weeks  Decline in 2 – 4 months  IgM rise in young patient (Good for diagnosis in young patient)  Interpretation Of Serology Tests In Selected Infections 13 .

 Interpretation Of Serology Tests In Selected Infections 14 .IgG and IgA  IgG: Rise slower.  Remain elevated for long time.  Rising titre diagnosis  (2 samples at least 2 weeks apart indicate current infection)   IgA: High level in elderly  May be more useful than IgM in old patient.

Legionella Sensitivity Specificity Technique Description Processing Time Disadvantages Culture Growing of bacterium from clinical sample. such as sputum. on specialized culture media Screening of urine sample for the presence of specific legionella antigen (cell markers) 80 % 100 % 3 – 5 days Requires that laboratory technicians have specialized training and expertise. Will only diagnose infections with L. pneumophila serogroup 1 Urinary Antigen Test 80 % 95 % Within hours Interpretation Of Serology Tests In Selected Infections 15 .

16 . (serology) one collected during acute illness and the other 2-8 weeks later Interpretation Of Serology Tests In Selected Infections 95 – 100 % 2-8 weeks Sensitivity is low. screening is done under a UV microscope. Clinical Diagnosis Sensitivity Specificity Technique Description Processing Time Disadvantages Direct fluorescent antibody (DFA) stain of sputum or other sample from lung Visual screening of sputum or other sample from lung for legionella bacteria.Cont. requires collection of second blood sample. for optimal results. using fluorescently – tagged antibodies to “light up” bacteria 33 – 70 % 95 – 100 % Within hours Easy to miss bacterium on microscope slide. results difficult to interpret. requires that laboratory technicians have specialized training and expertise Screening of blood sample for antibodies to legionella. generally 40 – Antibody requires comparison of 60% testing results from two samples.

needs machine Paper Chromatography  (No instrument . rapid) (70 – 80 % sensitive) ( 80 – 100 % specific) ELISA. (Simple.Legionella Urinary Antigen Tests    I. II.30 minutes) Interpretation Of Serology Tests In Selected Infections 17 .

5. 2.  Serum Agglutination Test (SAT) 2-Mercaptoethanol Coomb’s Test Microplate Agglutination Test ELISA Test OTHERS:    Complement Fixation Test Rose Bengal Test Gel Precipitation 18 Interpretation Of Serology Tests In Selected Infections .Serological Tests Used In The Diagnosis Of Human Brucellosis 1. 3. 4.

IgG. 1 / 160 ?.  Interpretation Of Serology Tests In Selected Infections 19 .1. IgA  Prozone  End – Point Agglutination (1 / 80 ?. SAT = STAT (Standard Tube Agglutination Test) IgM. 1 / 320)  Persisting Antibody up to 24 months.

 Decrease IgG is prognostic of successful outcome  Interpretation Of Serology Tests In Selected Infections 20 .2. ME (Mercaptoethanol) Remove IgM  Persisting IgG + IgA is diagnostic for persistent – relapsing of Brucellosis.

MICROPLATE AGGLUTINATION (Antigen + NaCl + AHG)   Highly sensitive End – Point agglutination not defined Interpretation Of Serology Tests In Selected Infections 21 . COOMB’S TEST  Detect non-agglutinating antibody (Adding AHG) B.Brucellosis A.

≥ 1 / 80  Interpretation Of Serology Tests In Selected Infections 22 . Typhi  H Antibody  Non specific O Antibody  Most lab.S.

 Previous antibiotic treatment  Variability in the preparation of commercial antigens.  Interpretation Of Serology Tests In Selected Infections 23 .Causes of Negative Widal Agglutination Test The carrier state  An inadequate inoculum of bacterial antigen in the host to induce antibody production  Technical difficulty or errors in the performance of the test.

Causes Of False-positive Widal Agglutination Tests Previous immunization with Salmonella antigen.  Cross-reaction with non – typhoidal Salmonella.  Infection with malaria  other enterobacteriaceae charring the same s-LPS .  Interpretation Of Serology Tests In Selected Infections 24 .  Variability and poorly standardized commercial antigen preparation.

H Pylori TEST EFFECT OF H2 ↓ DRUGS ANTI -BIOTIC REMARKS Antibody IgM. IgG. IgA NO NO Population study Past or current infection Active Infection Active Infection 25 Urea Breath Test Fecal Antigen YES + YES YES Interpretation Of Serology Tests In Selected Infections .

C.Toxoplasmosis IHA Test    APPLICATION: To detect Toxoplasma antibodies by indirect haemagglutination test. 26 Interpretation Of Serology Tests In Selected Infections . INTERPRETATION OF RESULTS: Results will be reported as: A. B. Positive Doubtful Negative  Doubtful results should be retested within 2 weeks.

not necessarily of a still active infection. 2. Titres of 1:256 are usually indicative of a recent infection. Titres of 1:512 and greater indicative of Toxoplasmosis.Comments  There is evidence that very early infectious and those of infants under 1 year of age may not be detected by TOXO IHA Test. 3. titres of antibodies may be very low. 27 Interpretation Of Serology Tests In Selected Infections . and can be the result of an asymptomatic infection.  In ocular Toxoplasmosis. Titres of 1:64 to 1:128 are usually indicative of past exposure. 1.

0.599 ≥ 0. 28 Interpretation Of Serology Tests In Selected Infections . INTERPRETATION OF RESULTS: A.Toxoplasma IgM Elisa   APPLICATION: For measurement of the IgM antibodies to toxoplasma gondii in human serum and plasma to aid in the diagnosis of primary infection. Negative : Equivocal : Positive : < 0. C. B.600.500 (arbitrary units) 0.500 .

The risk of fetal infection is a function of the time at which acute maternal infection occurs during gestation. if any. risk to the fetus 29 Interpretation Of Serology Tests In Selected Infections .Comments  Transplacental transmission of the parasite resulting in Congenital Toxoplasmosis can occur during acute acquired maternal infection. Maternal infections acquired before conceptions present very little.

Comments (2)  Prospective studies of pregnancies have shown that prenatal diagnosis if infection followed by prenatal therapy reduces the frequency and Severity of Congenital Toxoplasmosis. Interpretation Of Serology Tests In Selected Infections 30 .

Comments (3)  Since persisting IgM levels may be detected long after the onset of acquired infection. the use of a single serological test result must be used with caution in those cases when it is critical to establish the time of infection. gondii infection acquired during pregnancy Interpretation Of Serology Tests In Selected Infections 31 . This applies to the diagnosis of Acute T.

 Comments: Low positive titres of 1:32 or more are a sign of Leishmania infection (but does not indicate the status of infection whether active or inactive). send another sample after 2 weeks for re-testing. Significant titres range from 1:256 to 1:12048. 32 Interpretation Of Serology Tests In Selected Infections .Leishmaniasis IHA   Application: For detection of anti-leishmania antibodies in serum. Interpretation of Results:  1. The result is reported as follows: If the reported titre is 1:128. 2.

Titres of 1:512 or higher are considered significant for Echinococcosis. Interpretation of Results: Positive agglutination is given by titres ranging from 1:32 to 1:128.Echinococcus IHA   1. Application: For detection of anti Echinococcus antibodies in human serum. Interpretation Of Serology Tests In Selected Infections 33 . 2.

2. Specimen: Serum Interpretation of Result: The result is reported as follows: 1. 34 Interpretation Of Serology Tests In Selected Infections .Schistosomiasis IHA    Application: For detection of Schistosomia antibodies in serum. Titre of patients suffering from schistosomiasis range between 1:256 and 1:1024. If the reported titre is 1:128. may indicate exposure.

ABDULKARIM AL-ASKA. FACHARTZ PROFESSOR & CONSULTANT IN INFECTIOUS DISEASES INFECTIOUS DISEASES UNIT DEPARTMENT OF MEDICINE KING KHALID UNIVERSITY HOSPITAL Interpretation Of Serology Tests In Selected Infections 35 . PROF.Thank you ..

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