Epidemiology of toxoplasmosis in Chile. VI. Prevalence of human infection, investigated by means of an indirect hemagglutination test, in regions VII, VIII and IX

In presecuting the investigations on the epidemiology of toxoplasmosis in Chile, a new series of serological surveys has been performed during 1982-1989 in 10 urban and 25 periurban-rural localities from the regions VII, VIII and IX of the country (34 degrees 41'-39 degrees 38' South lat.). In 9,758, randomly selected apparently healthy persons, and indirect hemagglutination test (IHAT) for toxoplasmosis was carried out. The age of these individuals (4,203 males and 5,555 females) varied between 4 and 84 years. The examined persons represent a 0.33% of the total population of the three studied regions. IHAT titers of 1: > or = 16 were regarded as positive. The global prevalence for positive IHAT was 45.5% (50.5% in men and 41.7% in women). A higher proportion of positive tests was observed in urban areas (47.0%) than in periurban-rural sections (33.3%). An increasing prevalence with age was also observed. Only 5 (0.05%) persons had IHAT titers higher than 1:1000.     

Seroepidemiological survey of human toxoplasmosis in Osorno, Region X, Chile, 1998]

A serological survey was carried out in Osorno X Region, Chile (40 degrees 21'-40 degrees 46' South lat, and 73 degrees 26' -72 degrees-46' West long.). An indirect hemagglutination test (IHAT) for toxoplasmosis was performed to 305 persons--160 blood donors and 145 with sexually transmitted disease (STD). The age of the surveyed persons (167 males and 138 females) varied between 10 and 72 years. IHAT titers > 16 were considered as positive. The general prevalence was 20.3%--21.2% in blood donors and 19.3% in persons with some STD--with no differences between males and females. However, significant differences between males and females with STD were found (35.6% and 8.1% respectively). No differences between urban and rural inhabitants were found with a slight higher prevalence in the urban ones. No antibodies against Toxoplasma gondii were detected in six AIDS patients. The importance of performing toxoplasmosis immunodiagnosis and individual prophylaxis to avoid the infection in high risk group are recommended.     

Comparison of the yield of indirect hemagglutination reaction and complement fixation reaction in the diagnosis of neurocysticercosis

Two variations of an indirect hemagglutination test (IHAT) and a complement fixation test (CFT) for the diagnosis of human cysticercosis were compared and evaluated. For the IHAT, a cysticerci crude total saline extract (SE) and a cysticerci lyophylized and delipidized veronal bicarbonate saline buffer (VBS) extract were used, comparing their diagnosis yieldings with that of a CFT in 57 confirmed cysticercosis patients: 45 serum samples and 32 cerebrospinal fluid (CSF). Sera and CSF from 29 patients with other neurological diseases and 25 sera from healthy volunteers were also compared. Both types of methods presented an overall average concordance of 91.5% and 97.0% with CSF and sera respectively. With respect to the sensitivity observed with CFT was 85.2% and 93.3% for CSF and sera, whereas that of IHAT was 96.9% in CSF and 97.8% in sera, when SE antigen was used; with the VBS antigen for IHAT 96.9% and 95.6% were detected in CSF and sera respectively. In order to determine the specificity of the IHAT, besides the study in healthy volunteers, in patients with other neurological diseases and in 156 serum samples from individuals with other parasitoses, such as hydatidosis (43), trichinosis (56), fascioliasis (31) and Chagas' disease (26) were also tested. A high reactivity with the hydatidosis group was found. The specificity, using a titre > or = 1:16 as a diagnostic value and without considering hydatidic sera was 99.4% for RHAI (SE), 100.0% for RHAI (VBS). The use of IHAT and CFT in diagnosis of human cysticercosis is discussed.     

Electrocardiographic alterations in persons with a positive serology for toxoplasmosis]

To each of 11,161 randomly taken people from urban and peri-urban localities of the first seven regions of Chile (geographic area of distribution of Chagas' disease in the country), with negative serology for Chagas' disease, an indirect hemagglutination test (IHAT) for toxoplasmosis and an EKG were practiced. The IHAT for toxoplasmosis resulted positive in 3,519 individuals (31.5%). The EKG showed alterations in 10.9% of the IHAT positive individuals and in 7.9% of the IHAT negative ones. This difference between the proportion of altered EKG in IHAT positive people and altered EKG in those with negative IHAT is statistically significative with p < 0.001. These results suggest the convenience of considering toxoplasmosis as a cause of chronic myocardiopathy in epidemiological studies on Chagas' disease, since not discard the presence of Toxoplasma gondii infection should overvaluete the magnitude of the impact of Trypanosoma cruzi in the genesis of such a myocardiopathy.     

Epidemiology of toxoplasmosis in Chile. V. Prevalence of the infection in humans and domestic and wild animals, studied by indirect hemagglutination reaction, in the Juan Fernández Archipelago. V Region

A serological study utilizing an indirect hemagglutination test (IHAT) for toxoplasmosis was carried out in 222 humans and in 58 domestic animals (31 dogs, Canis familiaris; 27 cats, Felis catus), and in 62 wild mammals distributed into 50 rabbits, Oryctolagus cuniculus and 12 goats, Capra hircus. This survey was performed in the Juan Fernández Archipelago, formed by three islands: Robinson Crusoe, Santa Clara and Alejandro Selkirk (80 degrees 47'-78 degrees 47' west long., and 33 degrees 36'-33 degrees 47' south lat.). Blood samples were collected in filter paper and IHAT with titres greater than or equal to 1:16 were considered positive. This survey showed a prevalence of 42.3% in humans with no difference between men (43.0%) and women (41.5%). A high prevalence was found within groups of young individuals (0 to 19 years old), men and women. Regarding the domestic animal population, 44.8% resulted positive, distributed as follows: dogs 9.7% and cats 85.2%. Twenty one percent of wild animals were positive, distributed as follows: rabbits 8.0% and goats 75.0%. The global prevalence of toxoplasmosis in animals (domestic and wild) was 32.5%. All titres in humans and animals were less than or equal to 1:512. Toxoplasmosis is well extended among the human and animal population of the Juan Fernández Archipelago.     

Diagnostic significance of influenza subtype-specific IgG, IgA, and IgM antibodies

Up to now, the complement fixation test (CFT) has been the basis for the serological diagnosis of influenza virus infection in routine laboratories. Generally, low CF titers (1:20 or 1:40) are difficult to interpret. This means that the differentiation between recent and remote influenza infections is not possible by CFTs on single sera. Nonetheless this is generally possible by the subtype- and immunoglobulin class-specific immunofluorescence test (IFT) reported in this paper. Sera from 76 patients with confirmed influenza infection were tested and we obtained the following results: only 27.6% contained antibodies of all immunoglobulin classes, 51% contained IgG and IgA antibodies (without IgM) and 3.9% responded only with the IgG isotype. The IFT-positive and CFT-negative were 5.2% and the IFT-negative and CFT-positive 4%. In 7.9% no antibody rises were detected by CFT or by IFT despite virus isolation. Results from IFT may permit the interpretation of low CF titers. In contrast to CFT, IFT makes possible the differentiation between vaccinated and unvaccinated persons because vaccinated persons regularly produce IgM antibodies against all strains of the vaccine.     

Use of the immunofluorescence reaction for evaluating the immunological transformation in those inoculated with a chemical typhus vaccine

The results of the serological examination of persons immunized with chemical typhus vaccine (CTV) are presented. The examination was carried out by means of the complement fixation test (CFT), the passive hemagglutination test (PHAT), the toxin neutralization test (TNT) and the immunofluorescence test (IFT). The acetone-fixed live culture of Rickettsia prowazekii, strain Breinl, served as antigen in IFT. If persons immunized with CTV showed positive titers in CFT, TNT and PHAT, the results of IFT were highly correlated with the CFT titers. In 6-12 months after immunization with CTV the titers of CFT, TNT and PHAT became negative, while the IFT titers remained positive for several subsequent years.     

A comparison of several serologic tests to detect antibodies to Toxoplasma gondii in naturally exposed bottlenose dolphins (Tursiops truncatus)

Toxoplasma gondii infection in marine mammals is intriguing and indicative of contamination of the ocean environment and coastal waters with oocysts. In a previous study, 138 of 141 (97.8%) bottlenose dolphins (Tursiops truncatus) from the coasts of Florida and California had antibodies to T. gondii by the modified agglutination test (MAT). Although the MAT has been found to be highly sensitive and specific for T. gondii antibodies from several species of terrestrial animals, it has not yet been validated for T. gondii infections in marine mammals. Furthermore, T. gondii has yet not been isolated from dolphins. In the present study, sera from 146 (60 from the 2004 samples and 86 from the 2003 samples) T. truncatus from the coastal areas of South Carolina and Florida were tested for antibodies to T. gondii. Sera from 2004 were tested by the MAT, the indirect fluorescent antibody test (IFAT), the Sabin-Feldman dye test (DT), an indirect hemagglutination test (IHAT), an enzyme-linked immunosorbent assay (ELISA), and Western blot. All 60 dolphins were seropositive, with MAT titers of 1:20 in 3, 1:40 in 19, 1:80 in 29, 1:160 in 2, 1:1,280 in 3, 1:2,560 in 2, and 1:5,120 or higher in 2, and these results were confirmed in another laboratory. The DT titers of these dolphins were <1:10 in 53, 1:800 in 3, 1:1,600 in 2, and 1:3,200 in 2. The IHAT titers were <1:64 in 52, 1:128 in 1, 1:512 in 2, and 1:2,048 in 5. The IFAT titers were <1:20 in 3, 1:20 in 11, 1:40 in 36, 1:80 in 2, 1:160 in 1, and 1:320 or higher in 7. All 7 DT-positive dolphins had high MAT titers, but 2 were negative by the IHAT. Western blot results closely followed MAT results; ELISA results matched MAT results, which were 1:40 or higher. In sera from the 2003 samples, MAT antibodies were found in 86 of 86 dolphins with titers of 1:25 in 29, 1:50 in 23, 1:100 in 27, 1:200 in 3, 1:1,600 in 1, and 1:3,200 in 3; these sera were not tested by other means. Overall, MAT antibodies were found in all 146 dolphin sera tested. Because marine mammals are considered sentinel animals indicative of contamination of the coastal and marine waters by T. gondii oocysts, serologically positive infections need to be validated by the detection of T. gondii organisms in the tissues of seropositive animals.     

Comparative evaluation of the commercial Sevatest ELISA immunoenzyme set and other serological tests for detecting Toxoplasma gondii antibodies

This work analyzes the results of 4 serologic tests used for the diagnosis of toxoplasmosis: the complement fixation (CFT), indirect immunofluorescence (IIF), passive hemagglutination (PHAT) tests, and the enzyme-linked immunosorbent assay (ELISA). The last-mentioned one was made with the use of the commercial kits Sevatest ELISA IgG/Toxo Micro I. The results of ELISA were in good correlation with those yielded by the traditional tests: 70% coincidence with CFT, 80% with IIF, 84% with PHAT; besides, ELISA has shown a higher sensitivity in the screening of sera.     

Purification and characterization of E. histolytica antigen for diagnosis of amoebiasis

Entamoeba histolytica soluble crude antigen was fractionated by gel filtration on Sephacryl S-300 into four fractions, viz. F1(669 kDa); F2(51.2 kDa); F3(25.1 kDa) and F4(10.5 kDa). F1 fraction was observed to be more sensitive and specific for the detection of antibody in amoebiasis than the crude and other fractions of purified antigens employing IHAT and ELISA. ELISA was found to be better than IHAT since it could detect antibody in the sera (3/6) of asymptomatic cyst passers. The cross reaction of crude antigen with toxocariasis (1/4) and toxoplasmosis (2/5) sera were associated with F4 fraction. F3 and F4 were having low molecular weight and were not sensitive in detection of antibody in amoebiasis. Biochemical characterization revealed glycoprotein nature of the specific (F1) antigen fraction.     

New prospects in immunology of toxoplasmosis: skin-tests for control of immunity and immuno-assays and agglutination tests for the detection of specific IgM antibodies

An excretory-secretory (ES) antigen was extracted from supernatants of cell cultures infected with Toxoplasma gondii, purified and controlled according to current standards. In 638 volunteers, the correlation with fluorescent antibody was 94.2% and no false positive skin tests were noted. The skin test did not transform an originally negative serological test into a positive one. For the prevention of congenital toxoplasmosis, this sensitive, specific and inexpensive skin test can be widely used for the detection of immunity to Toxoplasma in women before their first pregnancy. During pregnancy, the detection of specific IgM is very important for the diagnosis of a recently acquired toxoplasmosis and allows for an immediate treatment. For this detection and for the diagnosis of congenital toxoplasmosis, five different serological tests were compared: Indirect Fluorescent Antibody-test (IFA), ELISA test, ELISA test After Capture of IgM (ACCAs), Reverse Enzyme Immuno Assay R-EIA), Double-Sandwich Enzyme Linked ImmunoSorbent Assay (DS-ELISA) and ImmunoSorbent AGglutination Assay (ISAGA). For 37 sera of recently acquired toxoplasmosis, IgM were detected in 98.7% with ISAGA, in 89.5% with DS-ELISA and ELISA in 83% with R-EIA and in 59% with IFA test. The best specificity is obtained with ISAGA, DS-ELISA and R-EIA, from controls with non immune patients (99 cases), patients with chronic toxoplasmosis (77 sera), rheumatoid factors (35 sera) or anti-nuclear antibodies (7 sera). In 21 sera from infants with congenital toxoplasmosis, ISAGA was positive in 13 cases (62%), IFA in 5 cases (24%), ELISA and R-EIA in 2 cases (9.5%) and DS-ELISA in 9 cases (43%).(ABSTRACT TRUNCATED AT 250 WORDS)     

A New IgG Immunoblot Kit for Diagnosis of Toxoplasmosis in Pregnant Women

The determination of the accurate immune status of pregnant women is crucial in order to prevent congenital toxoplasmosis. Equivocal results with conventional serological techniques are not uncommon when IgG titers are close to the cut-off value of the test, so that a confirmatory technique is needed. For this purpose, we developed a homemade immunoblot (IB) using soluble extract of Toxoplasma gondii tachyzoites and assessed it by testing 154 positive, 100 negative, and 123 equivocal sera obtained from pregnant women. In order to select the more valuable bands in terms of sensitivity and specificity, we used the Youden Index (YI). The highest YIs were those given by the 32, 36, 98, 21, and 33 bands. The simultaneous presence on the same blot of at least 3 bands showed a much higher YI (0.964) and was adapted as the positivity criterion. The analysis of results showed that our homemade IB correlated well with the commercial LDBIO Toxo II IgG® kit recently recommended as a confirmatory test (96.7% of concordance).     

Serology of paracoccidioidomycosis

The purposes of the present work were: i) to study the positivity indices and compare titers obtained with the indirect immunofluorescence (II), tube precipitation (TP), complement fixation (CF) and double immunodiffusion on agar gel (ID) tests in the sera of 196 patients with paracoccidioidomycosis before treatment, and ii) to compare the initial titers of II with those obtained 1 year or more after treatment. II was the most sensitive serologic reaction (85.2%), and the positivity indices for CF, ID and TP were 67.7%, 66.0% and 50.0%, respectively. The sera tended to show parallel mean titers in II, CF and TP tests. One year after treatment there was a fall in titers of II in 66.2% of patients. The data, taken as a whole, demonstrate the usefulness of the indirect immunofluorescent test and the importance of using 2 or more serologic tests for the diagnosis and monitoring of patients with paracoccidioidomycosis.     

Overview of the epidemiology of Chagas' disease in Chile]

Chile is a long and narrow country located in the south western coast of South America. Chagas' disease exists in the seven first (18 degrees 30'-34 degrees 36' South lat.) of the total of thirteen administrative regions of the country. In the 1982-1990 period a series of studies considering different epidemiological aspects of this parasitic zoonosis has been carried out with the following results: 5,601 rural of periurban dwellings were surveyed for the presence of Triatoma infestans (the most important and almost exclusive vector of Trypanosoma cruzi in Chile). 37.4% of the dwellings were infested according to the inhabitants and 29.4% were found infested according to the presence of tracks or insects captured. In 659 (17.2%) out of 3,822 T. infestans captured and examined T. cruzi was found in their abdominal contents. The most common sources of T. infestans feeding were mammals (89.0%), including man, and birds (9.5%). An indirect hemagglutination test (IHAT) for Chagas' disease, a very sensitive and specific reaction, was performed to 5,050 domestic mammals, resulting positive 7.9% of cats, 7.0% of dogs, 7.0% of goats, 4.9% of sheep and 4.1% of rabbits. 2,579 (16.9%) out of 15,418 persons were positive for the IAHT for Chagas' disease. The rates of infection were rather similar in males (17.5%) and females (16.2%) with an increase in infection rates in accordance with increase of age of individuals. The overall frequency of ECG abnormalities in positive IHAT persons was 18.7% against 8.8% in those with negative IHAT, whereas ECG abnormalities considered as suggestive of a chagasic etiology were 6.8% and 2.2% respectively. The esophageal motility in 311 persons with a positive IHAT and in 150 with a negative IHAT was found altered in 42.8% and 18.7% respectively. In the corresponding urban sectors of the 7 regions mentioned 2.7% of blood donors, 2.3% of delivering mothers, 2.6% of newborns and 0.6% of school children had positive IHAT. 646 chagasic women and 709 non-chagasic women in their reproductive span of life, and the products of the pregnancies that they had in a 6-year period were followed-up. No significant differences were found neither in the number nor in the evolution of pregnancies in both groups of mothers. Xenodiagnosis of children from chagasic mothers resulted positive in 6.3-8.9%, showing the transmission of T. cruzi by the placental route. Recently, 3 cases of congenital Chagas' disease of second generation have been demonstrated.(ABSTRACT TRUNCATED AT 400 WORDS)     

Household chagasic endemia detected as a consequence of a case of congenital infection]

During a study on prevalence of parasitic and viral serological markers in pregnant adolescents, a 17-year-old primipara from Polpaico, village near Santiago, gave birth to a normal male newborn in a Santiago hospital. As both of them presented positive an indirect hemagglutination test (IHAT) for Chagas' disease and the corresponding xenodiagnosis (XD), the infection in the infant was considered to be acquired through the placental route. According to recent epidemiological surveys Polpaico is an endemo-enzootic chagasic rural settlement, where 14.7% of dwellings were infested with Triatoma infestans, while triatominae, persons and domestic mammals were found infected with Trypanosoma cruzi. One month later the adolescent mother, her son and other 11 consanguineous members of the family were visited in their homes in order to submit each of them to a physical examination and to IHAT for Chagas' disease, and XD to those whose IHAT resulted positive. Thus, in 7 (53.8%) the IHAT was positive and in 4 (57.1%) out of these 7 presented positive the XD, results that as a whole yielded a household chagasic endemics.     

Clinical and serologic evaluation of two llamas (Lama glama) infected with Toxoplasma gondii during gestation

Two pregnant llamas (Lama glama) infected with Toxoplasma gondii and their offspring were evaluated clinically and serologically. Llama 1 was inoculated orally with 1,000 infective occysts of the P89 strain of T. gondii at 82 days of gestation (DOG). Llama 2 became naturally infected with T. gondii between 26 and 119 DOG. Both llamas remained clinically normal and delivered healthy offspring. Sera collected from both llamas during pregnancy and from their offspring before and after colostral ingestion were evaluated for antibodies to T. gondii by the modified agglutination test (MAT), latex agglutination test (LAT), indirect hemagglutination test (IHAT), and the Sabin-Feldman dye test (DT). In llama 1, MAT antibody titers were < 1:20, 1:320, 1:1,280, 1:640, and 1:80 at 82, 97, 109, 132, and 152 DOG, respectively. The MAT titers in naturally infected llama 2 were < 1:32, 1:320-1:640, and 1:1,280 at 26, 119-200, and 346 DOG, respectively. In both llamas, antibody titers in the DT were of similar magnitude as the MAT, but titers in the LAT and IHAT were inconsistent. Antibodies to T. gondii were not detected in precolostral sera obtained from offspring of both llamas suggesting there was no fetal T. gondii infection.     

Toxoplasma gondii antibodies in naturally exposed wild coyotes, red foxes, and gray foxes and serologic diagnosis of Toxoplasmosis in red foxes fed T. gondii oocysts and tissue cysts

Antibodies to Toxoplasma gondii were determined in sera from 222 coyotes (Canis latrans), 283 red foxes (Vulpes vulpes), and 97 gray foxes (Urocyon cinereoargenteus) from Indiana, Kentucky, Michigan, and Ohio during 1990-1993. Sera were examined in 1:25, 1:100, and 1:500 dilutions by the modified direct agglutination test (MAT) with formalinized whole tachyzoites plus mercaptoethanol. Antibodies were found in 131 (59.0%) of 222 coyotes, 243 (85.9%) of 283 red foxes, and 73 (75.3%) of 97 gray foxes. Antibodies were also measured by different serologic tests in 4 littermate T. gondii-free red foxes fed T. gondii tissue cysts or oocysts; the fifth littermate fox was not fed T. gondii. Antibodies were measured in fox sera obtained 0, 14, and 36-55 days after infection with T. gondii. All 4 foxes fed T. gondii developed MAT and dye test antibody titers of 1:200 or more 14 days later. The latex agglutination test (LAT) and indirect hemagglutination test (IHAT) were less sensitive than MAT for the diagnosis of T. gondii infection in foxes. Antibodies were not detected by LAT (titer 1:64) in the 2 foxes fed tissue cysts nor by IHAT in 1 of the foxes fed tissue cysts. Toxoplasma gondii was isolated by bioassay in mice from tissues of all 4 foxes fed T. gondii. The control fox had no T. gondii antibodies detectable by any of the serologic tests.     

The prevalence of Toxoplasma gondii antibodies in wild and captive cetaceans from Japan

The seroprevalence of Toxoplasma gondii was investigated in wild and captive cetaceans from Japan. Antibodies against T. gondii were examined by both latex agglutination test (LAT) and indirect hemagglutination test (IHAT) for 77 serum or plasma samples obtained from 59 individuals of 6 species, including 2 hybrids. Antibody titers greater than 1:64 in LAT and greater than 1:640 in IHAT, indicative of the presence of T. gondii, were found in 11.9% of 59 individuals. In 7 samples that showed a positive reaction by IHAT, T. gondii titers were examined for each immunoglobulin (Ig) fraction separated by sucrose gradient centrifugation. The antibody peaks in each fraction were divided into 3 types, thought to be a reaction of IgM (type 1), IgG (type 2), and IgM with IgG (type 3). Type 1 was found in serum from a bottle-nosed dolphin (Tursiops truncatus) and a killer whale (Orcinus orca) sampled soon after capture off the Japanese coast in 1988; it was concluded that infection in the wild had occurred less than 15 yr before the study was performed. The prevalence of putative IgM and IgG antibodies from a captive-bred T. truncatus suggested that T. gondii infection also occurred in the aquarium.     

Use of the indirect hemagglutination reaction in studying ornithosis infection. III. The diagnostic value of the IHR with an ornithosis erythocytic diagnosticum]

In both experimental and clinical conditions the passive hemagglutination test (PHAT with the use of an ornithosis erythrocytic diagnostic preparation was found to be sufficiently sensitive and specific as compared with the complement fixation test (CFT), a routine testing method. The study of the dynamics of immune response in infected animals and ornithosis patients allowed to regard the PHAT as a comparatively early method of serological analysis. Hemagglutinins were also found to circulate in the patients' blood sera only for a short time (on the average for 1 1/2--2 months). The CFT and the PHAT with erythrocytic diagnostic preparation, used in combination, will make it possible not only to diagnose ornithosis in patient more effectively, but also to differentiate between the cases of infection and anamnestic reaction.20     

Serological Diagnosis of Paracoccidioidomycosis: High Rate of Inter-laboratorial Variability among Medical Mycology Reference Centers

Background

Serological tests have long been established as rapid, simple and inexpensive tools for the diagnosis and follow-up of PCM. However, different protocols and antigen preparations are used and the few attempts to standardize the routine serological methods have not succeeded.

Methodology/Principal findings

We compared the performance of six Brazilian reference centers for serological diagnosis of PCM. Each center provided 30 sera of PCM patients, with positive high, intermediate and low titers, which were defined as the “reference” titers. Each center then applied its own antigen preparation and serological routine test, either semiquantitative double immunodifusion or counterimmmunoelectrophoresis, in the 150 sera from the other five centers blindly as regard to the “reference” titers. Titers were transformed into scores: 0 (negative), 1 (healing titers), 2 (active disease, low titers) and 3 (active disease, high titers) according to each center''s criteria. Major discordances were considered between scores indicating active disease and scores indicating negative or healing titers; such discordance when associated with proper clinical and other laboratorial data, may correspond to different approaches to the patient''s treatment. Surprisingly, all centers exhibited a high rate of “major” discordances with a mean of 31 (20%) discordant scores. Alternatively, when the scores given by one center to their own sera were compared with the scores given to their sera by the remaining five other centers, a high rate of major discordances was also found, with a mean number of 14.8 sera in 30 presenting a discordance with at least one other center. The data also suggest that centers that used CIE and pool of isolates for antigen preparation performed better.

Conclusion

There are inconsistencies among the laboratories that are strong enough to result in conflicting information regarding the patients'' treatment. Renewed efforts should be promoted to improve standardization of the serological diagnosis of PCM.