Comparison of the Diagnostic Value of the Standard Tube Agglutination Test and the ELISA IgG and IgM in Patients with Brucellosis

Background and Aims: Brucellosis is endemic in Turkey. Since it affects many organs and the symptoms are non-specific, the diagnosis by clinical findings is difficult and may be easily missed. Many serological tests have been used for the diagnosis of human brucellosis. This study compared the diagnostic value of the Brucella standard tube agglutination test (SAT) with that of ELISA (Brucella specific IgG and IgM) tests in patients with Brucella bacteremia. Patients and Methods: Thirty-two patients with brucellosis who had positive blood and/or bone-marrow cultures for Brucella species, and 20 healthy individuals as controls were included in the study. Results: At the end of the study SAT was positive in 30 of the 32 patients, ELISA IgG was positive in 26 and ELISA IgM was positive in 32. Of the 20 control sera, all were negative in SAT, 1 was positive in ELISA IgG, and 3 were positive in ELISA IgM. The positive predictive value of SAT was 100.0% and the negative value was 90.9%. The positive and negative predictive values for ELISA IgG were 96.3% and 76.0%, and for ELISA IgM were 90.9% and 89.5%, respectively. Conclusions: SAT may be preferred to ELISA in acute brucellosis because it is cheap and easily applicable.

Anahtar Kelimeler:

Brucellosis, ELISA, Standard tube agglutination test

Comparison of the Diagnostic Value of the Standard Tube Agglutination Test and the ELISA IgG and IgM in Patients with Brucellosis

Keywords:

Brucellosis, ELISA, Standard tube agglutination test,

PDF

___

1. Young EJ. Brucella species. Principles and Practice of Infectious Diseases 5th edn. (Eds. Mandell GL, Bennett JE, Dolin R) Philadelphia, Churchill Livingstone 2000, pp: 2386-2393.
2. Altuglu I, Zeytinoglu A, Bilgic A et al. Evaluation of Brucella dipstick assay for the diagnosis of acute brucellosis. Diagn Microbiol Infect Dis 2002; 44: 241-243.
3. Ruiz J, Lorente I, Perez J et al. Diagnosis of brucellosis by using blood cultures. J Clin Microbiol 1997; 35: 2417-2418.
4. Ozturk R, Mert A, Kocak F et al. The diagnosis of brucellosis by use of BACTEC 9240 blood culture System. Diagn Microbiol Infect Dis 2002; 44: 133–135.
5. Memish ZA, Almuneef M, Mah MW et al. Comparison of the Brucella Standard Agglutination Test with the ELISA IgG and IgM in patients with Brucella bacteremia. Diagn Microbiol Infect Dis 2002; 44: 129-132.
6. Young EJ. Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature. Rev Infect Dis 1991; 13: 359-372.
7. Weynants V, Gilson D, Cloeckaert A et al. Characterization of a monoclonal antibody specific for brucella smooth lipopolysaccharide and development of a competitive enzymelinked immunosorbent assay to improve the serological diagnosis of brucellosis. Clin Diagn Lab Immunol 1996; 3: 309–314.
8. Gazapo E, Lahoz GJ, Subiza J. et al. Changes in IgM and IgG antibody concentrations in brucellosis over time: Importance for diagnosis and follow up. J Infect Dis 1989; 159: 219-225.
9. Kostoula A, Bobogianni H, Virioni G et al. Detection of Brucella Ig G, IgM and IgA antibodies with ELISA method in patients with Brucellosis. Clin Microbiol Infect 2001; 7 (suppl 1): 108.
10. Jagannath C, Shegal S. Enhancement of the antigen binding capacity of incomplete IgG antibodies to Brucella melitensis through Fc region interactions with staphylococcal protein A. J Immunol Methods 1989; 124: 251-257.
11. Colak H, Usluer G, Ozgunes I et al. Comparison of the Wright, indirect Coombs and enzyme immunoassay IgG methods for the diagnosis of chronic brucellosis. Mikrobiyol Bul 1992; 26: 56-60. 12. Araj GF. Evaluation of ELISA in the diagnosis of acut and chronic brucellosis in human beings. J Hyg (Lond) 1986; 97: 457-469.
13. Ariza J, Pellicer T, Pallares R. et al. Specific antibody profile in human brucellosis. Clin Infect Dis 1992; 14: 131-139.
14. Osoba AO, Balkhy H, Memish Z et al. Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis. J Chemother 2001; 13 (Suppl 1): 54-59.
15. Gad El-Rab MO, Kambal AM. Evaluation of a Brucella enzyme immunoassay test (ELISA) in comparison with bacteriological culture and agglutination. J Infect 1998; 36(2): 197-201.
16. Guneri H, Ogutman R. Comparison of the different serological tests, used in Diagnosing Brucellosis, with ELISA. Brucella and Brucellosis in Man and Animals. (Eds. Tumbay E, Hilmi S, Ang O.) Ege University Press Izmir, Turkey 1991. pp.161.
17. Sirmatel F, Turker M, Bozkurt AI. Evaluation of the methods used fort he serological diagnosis of Brucellosis. Mikrobiyol Bul 2002; 36: 161-167.
18. Araj GF, Lulu AR, Mustafa MY et al. Evaluation of ELISA in the diagnosis of acute and chronic brucellosis in human beings. J Hyg (Lond) 1986; 97: 457-469.
19. Prado A, Gutierres P, Duenas A et al. Serological Follow-up of brucella patients using an immunocapture-agglutination test (Brucellacapt), Coombs anti-Brucella and LPS- ELISA tests. Clin Microbiol Infect 2001; 7 (suppl 1): 109-110.
20. Gilbert GL, Hawes LA. The antibody response to Brucella: immunoglobulin response measured by enzyme-linked immunosorbent assay and conventional tests. Aust N Z J Med 1981; 11: 40–45.
21. Hunter SB, Bibb WF, Shih CN et al. Enzyme-linked immunosorbent assay with major outer membrane proteins of Brucella melitensis to measure immune response to Brucella species. J Clin Microbiol 1986; 24: 566–572.