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INDIRECT HEMAGGLUTINATION ASSAY IN PATIENTS WITH MELIOIDOSIS IN NORTHERN AUSTRALIA

Melioidosis is caused by the saprophytic organism Burkholderia pseudomallei. The use of the indirect hemagglutination assay (IHA) has found widespread use in areas endemic for this disease. Using this assay, we explored the serologic profile of 275 patients with culture-confirmed melioidosis in the Northern Territory of Australia. Based on a threshold titer of 1:40, the sensitivity of the IHA on admission was 56%. Female patients, those with positive blood cultures, and those with pneumonia independently predicted a negative IHA result. Most patients (68%) with negative admission IHA titers subsequently seroconverted. Most patients (92%) with positive admission IHA titers had persistently positive IHA titers. Relapses were not observed in 36 patients who had a negative IHA at least 1 month after admission, irrespective of initial admission IHA. The IHA has limited utility as a diagnostic test for acute disease, and most patients subsequently have persistently positive titers after recovery from illness.

Received July 26, 2005. Accepted for publication September 9, 2005.

Acknowledgments: We thank Susan Jacups and Linda Ward for data management, Mark Mayo and Daniel Gal for laboratory support, the medical and nursing staff at the Royal Darwin Hospital for clinical support, and the Royal Darwin Hospital microbiology laboratory staff for expertise in isolate identification and for determining IHA titers.

Financial support: This study was supported by a project grant to Bart J. Currie from the Australian National Health and Medical Research Council Allen C. Cheng was supported by an Australian National Health and Medical Research Council Training Scholarship.

Disclosure: None of the authors have any conflicts of interest.

^* Address correspondence to Bart J. Currie, Menzies School of Health Research, P.O. Box 41096, Casuarina 0811, Darwin, Northern Territory, Australia. E-mail: bart{at}menzies.edu.au

Authors’ addresses: Allen C. Cheng, Geelong Hospital, Barwon Health, Geelong, Victoria, Australia, Telephone: 61-3-5229-0378, Fax: 61-3-5222-5003, E-mail: allenc{at}menzies.edu.au. Mathew O’Brien, University of Melbourne, Parkville, Melbourne, Victoria 3052, Australia, E-mail: mattyobrien{at}hotmail.com. Kevin Freeman, Microbiology Laboratory, Northern Territory Government Pathology Service, Royal Darwin Hospital, Darwin, Northern Territory, Australia, Telephone: 61-8-8922-8888, E-mail: kevin.freeman{at}nt.gov.au. Gary Lum, Microbiology Laboratory, Northern Territory Government Pathology Service, Royal Darwin Hospital, Darwin, Northern Territory, Australia, Telephone: 61-8-8922-8304, Fax: 61-8-8980-0714, E-mail: gary.lum{at}nt.gov.au. Bart J. Currie, Menzies School of Health Research, P.O. Box 41096, Casuarina 0811, Darwin, Northern Territory, Australia; Flinders University, Darwin, Northern Territory, Australia; Telephone: 61-8-8922-8196, Fax: 61-8-8927-5187, E-mail: bart{at}menzies.edu.au.

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