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We developed and evaluated an enzyme-linked immunosorbent assay (ELISA) using monoclonal antibodies to capture somatic antigen 9 (O9), flagellar antigen d (Hd), and the Vi capsular polysaccharide antigen (Vi) from the urine of persons with and without typhoid fever. Sequential urine samples were collected from 44 patients with blood culture-confirmed typhoid fever and from two control groups. The first control group included patients with brucellosis (n = 12) and those with clinically diagnosed, non-typhoid, acute, febrile illness (n = 27). The second control group was a sample of healthy volunteer laboratory workers (n = 11). When assessed relative to date of fever onset, sensitivity was highest during the first week for all three antigens: Vi was detected in the urine of nine (100%) patients, O9 in 4 (44%) patients, and Hd in 4 (44%) patients. Sequential testing of two urine samples from the same patient improved test sensitivity. Combined testing for Vi with O9 and Hd produced a trend towards increased sensitivity without compromising specificity. The specificity for Vi exceeded 90% when assessed among both febrile and healthy control subjects, but was only 25% when assessed among patients with brucellosis. Detection of urinary Vi antigen with this ELISA shows promise for the diagnosis of typhoid fever, particularly when used within the first week after fever onset. However, positive reactions for Vi antigen in patients with brucellosis must be understood before urinary Vi antigen detection can be developed further as a useful rapid diagnostic test.
Received June 16, 2003. Accepted for publication November 5, 2003.
Acknowledgments: We thank Paul Duffey (California State Health Department Laboratory, Berkley, CA) for supplying Hd monoclonal antibody for use in this study. This work was presented in part at the 51st American Society of Tropical Medicine and Hygiene Annual Meeting, Denver, CO, November 10–14, 2002.
Financial support: This research was supported by the United States Department of Defense Global Emerging Infectious Disease Surveillance Program (GEIS) number 323987M906.
Disclaimer: The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Navy Department, the Department of Defense, the United States Government, or the Egyptian Ministry of Health and Population.
Authors’ addresses: Moustafa Abdel Fadeel, Serology/Chemistry Section, Laboratory Unit, Disease Surveillance Program, Naval Medical Research Unit Number 3, PSC 452, Box 5000 (Attn: Coe 304A), FPO AE 09835-0007, Cairo, Egypt, Fax: 20-2-684-1375, E-mail: fadeelm{at}namru3.org. John A. Crump, Eric D. Mintz, and William F. Bibb, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road, Atlanta, GA 30333. Frank J. Mahoney, Disease Surveillance Program, Naval Medical Research Unit Number 3, Cairo, Egypt. Isabelle A. Nakhla and Adel M. Mansour, Enteric Research Program, Naval Medical Research Unit Number 3, Cairo, Egypt. Baheia Reyad, Faculty of Science, Cairo University, Cairo, Egypt. Dawlat El Melegi, Faculty of Medicine, Cairo University, Cairo, Egypt. Yehia Sultan, Abbasia Fever Hospital, Cairo, Egypt.
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