Advancing the Field: Evidence for New Management Strategies in Invasive Fungal Infections

Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in the immunocompromised. The traditional diagnostic methods of culture and histological examination lack sensitivity and often only make a diagnosis late when the fungal burden is high, reducing the chances of cure even with the availability of new more potent and less toxic antifungal agents. New non-culture-based serological and PCR assays have been developed. These appear more sensitive and are able to make an earlier diagnosis as compared with traditional diagnostic methods. Early diagnosis is central to reducing IFI-related morbidity and mortality. This review describes the diagnostic potential of the new serological and PCR assays and outlines how these assays have been incorporated into algorithms to improve the management of IFI.     

Evaluation of serological assays based on a novel excreted antigen preparation for the diagnosis of Cutaneous Leishmaniasis in Panama

The objective of the present study was to determine the efficacy of prototype diagnostic serological assays for American Cutaneous Leishmaniasis (ACL) in Panama. As such, we prospectively sampled 100 cutaneous leishmaniasis case-patients and tested their sera in two serological assays based upon novel soluble antigen preparations made from propagating the parasites in a protein-free, serum free media. Using serum and a Leishmania mexicana antigen preparation to sensitize plates, the assay correctly identified 89% of the case-patients. While using serum with an antigen preparation from Leishmania braziliensis, the assay correctly identified 71% of the patients. Concerning both test formats, performance was near equal in true positive and presumptive positive subsets demonstrating the improved sensitivity of these assays over reference methods of choice. Since the incidence of leishmaniasis in Panama has increased dramatically in the past 10 years, these assays may be useful in clinical and epidemiological studies and control programs.     

Noncorrelation between mouse toxicity and serologically assayed toxin in Clostridium botulinum type A culture fluids.

Toxicity in culture fluids of several Clostridium botulinum type A strains was assayed in mice and converted to weight equivalent. The toxin-related antigen in the samples was quantitated by a radioimmunoassay which used standards of known antigen concentration instead of the usually used toxicity. Freshly prepared samples had reasonably similar titers of toxin and antigen. When the samples were held at room temperature for several weeks, toxicity decreased more than antigenicity, but the relative decreases of the two varied with the samples. The results are discussed as evidence that serological assays of botulinum toxin cannot always be used for accurate determination of toxicity.     

Noncorrelation between mouse toxicity and serologically assayed toxin in Clostridium botulinum type A culture fluids.

Toxicity in culture fluids of several Clostridium botulinum type A strains was assayed in mice and converted to weight equivalent. The toxin-related antigen in the samples was quantitated by a radioimmunoassay which used standards of known antigen concentration instead of the usually used toxicity. Freshly prepared samples had reasonably similar titers of toxin and antigen. When the samples were held at room temperature for several weeks, toxicity decreased more than antigenicity, but the relative decreases of the two varied with the samples. The results are discussed as evidence that serological assays of botulinum toxin cannot always be used for accurate determination of toxicity.     

Identification of tumor antigens as potential target antigens for immunotherapy by serological expression cloning

The presence of tumor infiltrating T cells has been shown to be associated with a favorable prognosis in different tumor types. Several strategies have been developed to identify relevant tumor antigens which can be used for active immunotherapy strategies. The SEREX technique (serological analysis of cDNA expression libraries) identifies tumor antigens based on a spontaneous humoral immune response in cancer patients. This technique is not limited to tumor types that can be grown in cell culture or depends on established T cell clones recognizing the autologous tumor. Several steps of analysis are mandatory to evaluate SEREX-defined antigens before they become new target antigens for active immunotherapy: expression analysis; serological analysis with sera from tumor patients and normal individuals; identification of potential peptide epitopes for CD8 T cells and evaluation in T cell assays. This article summarizes our approach of antigen identification and evaluation giving the example of the recently cloned breast cancer antigen NY-BR-1.This work was presented at the first Cancer Immunology and Immunotherapy Summer School, 8–13 September 2003, Ionian Village, Bartholomeio, Peloponnese, Greece.     

The role of laboratory diagnostics in emerging viral infections: the example of the Middle East respiratory syndrome epidemic

Rapidly emerging infectious disease outbreaks place a great strain on laboratories to develop and implement sensitive and specific diagnostic tests for patient management and infection control in a timely manner. Furthermore, laboratories also play a role in real-time zoonotic, environmental, and epidemiological investigations to identify the ultimate source of the epidemic, facilitating measures to eventually control the outbreak. Each assay modality has unique pros and cons; therefore, incorporation of a battery of tests using traditional culture-based, molecular and serological diagnostics into diagnostic algorithms is often required. As such, laboratories face challenges in assay development, test evaluation, and subsequent quality assurance. In this review, we describe the different testing modalities available for the ongoing Middle East respiratory syndrome (MERS) epidemic including cell culture, nucleic acid amplification, antigen detection, and antibody detection assays. Applications of such tests in both acute clinical and epidemiological investigation settings are highlighted. Using the MERS epidemic as an example, we illustrate the various challenges faced by laboratories in test development and implementation in the setting of a rapidly emerging infectious disease. Future directions in the diagnosis of MERS and other emerging infectious disease investigations are also highlighted.     

Diagnostic testing for Legionnaires’ disease

Legionnaires’ disease is commonly diagnosed clinically using a urinary antigen test. The urinary antigen test is highly accurate for L. pneumophila serogroup 1, however other diagnostic tests should also be utilized in conjunction with the urinary antigen as many other Legionella species and serogroups are pathogenic. Culturing of patient specimens remains the gold standard for diagnosis of Legionnaires’ disease. Selective media, BYCE with the addition of antibiotics, allows for a high sensitivity and specificity. Culturing can identify all species and serogroups of Legionella. A major benefit of culturing is that it provides the recovery of a patient isolate, which can be used to find an environmental match. Other diagnostic tests, including DFA and molecular tests such as PCR and LAMP, are useful tests to supplement culturing. Molecular tests provide much more rapid results in comparison to culture, however these tests should not be a primary diagnostic tool given their lower sensitivity and specificity in comparison to culturing. It is recommended that all laboratories develop the ability to culture patient specimens in-house with the selective media.     

Purification and antigenic characteristics of a rickettsia-like organism from the oyster Crassostrea ariakensis

A rickettsia-like organism (RLO) has been suggested to be the etiological agent responsible for heavy losses of the oyster Crassostrea ariakensis Gould in China. Because of the lack of molluscan cell lines for in vitro culture of intracellular prokaryotes, antigenic analysis of RLOs has been limited by the inherent difficulties of their purification. In this report, we describe the use of differential speed centrifugation and renografin density gradient centrifugation to purify the RLO directly from infected oyster tissues. The purity and integrity of purified prokaryotes were validated by transmission electron microscopy. Thirteen major constituent proteins, with molecular weights ranging between 17 and 99 kDa, were electrophoretically identified by silver staining, and 8 major proteins were identified with Coomassie blue R staining. Specific mouse polyclonal antiserum was prepared for serological characterization of the RLO and was used in an immunoblot assay, and 3 major antigen groups were identified. The present results advance our knowledge of RLO protein antigens, and several proteins have been identified that could potentially be useful for diagnostic assays or for production of experimental immunostimulants.     

真菌感染的实验室诊断研究进展

随着易感人群逐渐增多,对临床真菌感染标本的快速检测及真菌培养的分离鉴定日益重要。所幸目前有新的检测方法用来辅助早期诊断及指导经验性的抗真菌治疗。主要的进展集中在对标本的真菌抗原直接检测方面(如半乳甘露聚糖和β-葡聚糖);假丝酵母产色培养基等快速培养鉴定法;微生物生化自动分析系统(VITEK2)和显微扫描(MicroScan)等生化自动检测平板;多肽核苷酸原位杂交,特异性的大范围聚合酶链反应(PCR)检测以及针对临床标本或培养阳性标本直接DNA测序技术。     

Epstein-Barr viral antigens used in the diagnosis of nasopharyngeal carcinoma

The major antigen complexes of Epstein-Barr virus (EBV) include the latent infectious proteins, early antigens, membrane antigens and viral capsid antigens. The various polypeptides within each antigen complex have been identified and isolated through gene-cloning technology. These polypeptides are exploited to be used as serological markers for the diagnosis of nasopharyngeal carcinoma (NPC) through enzyme-linked immunosorbent assay. This paper reviews the recent studies on the profile of antibodies in patients with NPC towards these EBV polypeptides of each antigen complex. The sensitivity and specificity of each polypeptide when used as serological markers to NPC patients' sera are summarized.     

Serological diagnosis of Neospora caninum infection

Since the first isolation of the apicomplexan parasite Neospora caninum, a range of serological assays have been developed for use in dogs, cattle and a variety of other potential host species. The tests include the indirect fluorescent antibody test, the direct agglutination test and different enzyme-linked immunosorbent assays. This article reviews the principles and properties of the available tests which are discussed in relation to different applications.     

Serology of H-Y antigen

Summary Anti-H-Y antiserum is generally obtained from female inbred mice or rats that have been hyperimmunized with syngeneic male cells. The specificity of such antiserum is defined by its reactivity for male but not female cells. A number of conventional serological assays have been used to measure that reactivity. However, H-Y is a weak antigen, evidently represented sparingly on the surfaces of cells other than sperm, epidermal cells and brain cells; thus the srological assays for H-Y are technically difficult. Yet H-Y serology has enabled significant progress toward the understanding of primary sex differentiation.A recent advance in H-Y serology is the establishment of monoclonal anti-H-Y antisera which promise to facilitate analysis and clarification of the H-Y system.     

Worldwide detection and identification of new and old rickettsiae and rickettsial diseases

To determine the prevalence and distribution of rickettsial pathogens around the world, scientists have relied more and more upon molecular techniques in addition to serological and culture methods. The ease of use and sensitivity/specificity of molecular techniques such as quantitative real-time PCR assays and multilocus sequence typing have lead to an increase in reports of the detection and identification of new and old rickettsiae in previously known and in new endemic regions. These assays have been successfully used with clinical samples such as serum, blood, and tissue biopsies and with environmental samples such as arthropod vectors including ticks, fleas, lice, and mites, and blood and tissue specimens from small mammal collections and from wild and domestic large animals. These methods have lead to the detection of new and old rickettsial pathogens often in new locations leading investigators to suggest new regions of risk of these rickettsioses.     

Determination of PCR efficiency in chelex-100 purified clinical samples and comparison of real-time quantitative PCR and conventional PCR for detection of Chlamydia pneumoniae

Background  

Chlamydia pneumoniae infection has been detected by serological methods, but PCR is gaining more interest. A number of different PCR assays have been developed and some are used in combination with serology for diagnosis. Real-time PCR could be an attractive new PCR method; therefore it must be evaluated and compared to conventional PCR methods.     

Laboratory diagnosis of melioidosis: Past,present and future

Melioidosis is an emerging, potentially fatal disease caused by Burkholderia pseudomallei, which requires prolonged antibiotic treatment to prevent disease relapse. However, difficulties in laboratory diagnosis of melioidosis may delay treatment and affect disease outcomes. Isolation of B. pseudomallei from clinical specimens has been improved with the use of selective media. However, even with positive cultures, identification of B. pseudomallei can be difficult in clinical microbiology laboratories, especially in non-endemic areas where clinical suspicion is low. Commercial identification systems may fail to distinguish between B. pseudomallei and closely related species such as Burkholderia thailandensis. Genotypic identification of suspected isolates can be achieved by sequencing of gene targets such as groEL which offer higher discriminative power than 16S rRNA. Specific PCR-based identification of B. pseudomallei has also been developed using B. pseudomallei-specific gene targets such as Type III secretion system and Tat-domain protein. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolutionary technique for pathogen identification, has been shown to be potentially useful for rapid identification of B. pseudomallei, although existing databases require optimization by adding reference spectra for B. pseudomallei. Despite these advances in bacterial identification, diagnostic problems encountered in culture-negative cases remain largely unresolved. Although various serological tests have been developed, they are generally unstandardized “in house” assays and have low sensitivities and specificities. Although specific PCR assays have been applied to direct clinical and environmental specimens, the sensitivities for diagnosis remain to be evaluated. Metabolomics is an uprising tool for studying infectious diseases and may offer a novel approach for exploring potential diagnostic biomarkers. The metabolomics profiles of B. pseudomallei culture supernatants can be potentially distinguished from those of related bacterial species including B. thailandensis. Further studies using bacterial cultures and direct patient samples are required to evaluate the potential of metabolomics for improving diagnosis of melioidosis.     

基于可见光测定的山羊支原体山羊肺炎亚种抗原定量

山羊支原体山羊肺炎亚种(Mycoplasma capricolum subsp. capripneumoniae, Mccp)是山羊传染性胸膜肺炎(contagious caprine pleuropneumonia, CCPP)的病原,可用灭活疫苗和荚膜多糖(capsular polysaccharide, CPS)间接血凝试剂进行预防和血清学检测,但高昂的培养成本和复杂的抗原定量一直困扰着生产人员。为解决生产实际中出现的这些问题,本研究基于Mccp代谢组学的前期理论基础,通过改变初始pH值的方法,初步筛选出初始pH值为7.8的可以同时提高2种抗原产量的糖发酵培养基。利用紫外可吸收光谱可识别酚红,以及十六烷基三甲基溴化铵(cetyltrimethylammonium bromide, CTAB)可与阴离子荚膜多糖结合的理论依据,建立了利用紫外光谱分析Mccp达到的培养阶段,以及利用CTAB沉淀法相对定量发酵液荚膜多糖抗原产量的方法。通过紫外图谱观察的方法可对应Mccp生长曲线进行指导生产,大大节省传统颜色变化单位(color change unit, CCU)法的监测时间,提高了原肉眼观察方法的精确度。建立的CTAB沉淀法可在5 h内完成对CPS含量的监测,与传统的差值法相比大大缩短了时间,并且其准确度得到苯酚-硫酸法的验证。本研究优化的一种培养基和建立的两种相关性比较方法,可有效降低Mccp生产成本,提高生产效率,这些方法已在本实验室的研究阶段得到应用,为进一步改进CCPP灭活疫苗和荚膜多糖的生产工艺以及快速定量提供了实验数据。     

The use of serological techniques for virus surveillance and certification of finfish

Virus surveillance and certification procedures for finfish have traditionally relied upon isolation of replicating agents in cell culture and identification using serological procedures. However, accurate monitoring may also be achieved using techniques to detect fish antibodies against viral disease agents. The serological procedures most used for detection of fish antibodies are the serum neutralization test and immunofluorescence. Other techniques such as enzyme linked immunosorbent assays (ELISA) have been less commonly used. Using infectious hematopoietic necrosis virus (IHNV) and viral hemorrhagic septicemia virus (VHSV) as examples, this paper reviews the serological test procedures used for rhabdoviral surveillance and the applications of this methodology to viral epizootiology and certification of finfish.     

Isolation and Serological Characterization of a Cell Wall Antigen of Rothia dentocariosa

A soluble polysaccharide antigen from the cell wall of Rothia dentocariosa ATCC 17931 has been isolated, purified and characterized by serological and chemical procedures. The polysaccharide (RPS) was found to be located at the surface of cells grown under diverse environmental conditions, and could be easily detected on cells in pure culture or in clinical samples from humans and experimentally infected hamsters by fluorescent-antibody techniques. Fructose, glucose, galactose, and ribose were the major constituents of RPS. Although purified RPS was not immunogenic in rabbits, it was presumed to be a major antigen of the cell because it could specifically absorb approximately one-third of the antibody nitrogen in antisera prepared against whole cells of R. dentocariosa. Haptene inhibition studies indicated that fructose was the principal determinant of serological specificity in RPS. This polysaccharide was found to be serologically unique and did not cross-react with the polysaccharides and surface polymers of other oral actinomycetes and filamentous organisms.     

Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis

We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM). Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339) from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens.     

Role of Serological Tests in the Diagnosis of Mold Infections

Purpose of Review

To understand the role of antibody detection in the diagnosis of infections caused by filamentous fungi (molds). Rapid and accurate profiling of infection-causing fungal pathogens remains a significant challenge in modern health care. Classical fungal culture and serology continue to be relevant even though over the past few decades, antigen (biomarker) assays such as ELISA and lateral flow devices have been developed and validated.

Recent Findings

This article reviews the current antibody detection systems (serological tests) for the diagnosis of mold infections associated with pulmonary disease and introduces new developments. Classic and more recently developed serological techniques and their performance characteristics, including immunodiffusion, complement fixation, and ELISA.

Summary

The diseases covered are allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, invasive aspergillosis, mucormycosis, diseases caused by filamentous basidiomycetes, infection caused by Talaromyces marneffei and pythiosis. Serology remains a cornerstone for fungal diagnostic testing.