Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.

<h4>Background</h4>Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in many tropical developing countries and has a high mortality. Here we evaluated combinations of a lateral flow immunoassay (LFI) detecting B. pseudomallei capsular polysaccharide (CPS)...

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Autores principales:	Premjit Amornchai, Viriya Hantrakun, Gumphol Wongsuvan, Vanaporn Wuthiekanun, Surasakdi Wongratanacheewin, Prapit Teparrakkul, T Eoin West, David P AuCoin, Nicholas P J Day, Paul J Brett, Mary N Burtnick, Narisara Chantratitra, Direk Limmathurotsakul
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/b60d27886d474de9a94376eb741d32c8
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spelling	oai:doaj.org-article:b60d27886d474de9a94376eb741d32c82021-12-02T20:23:23ZEvaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.1935-27271935-273510.1371/journal.pntd.0009840https://doaj.org/article/b60d27886d474de9a94376eb741d32c82021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009840https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in many tropical developing countries and has a high mortality. Here we evaluated combinations of a lateral flow immunoassay (LFI) detecting B. pseudomallei capsular polysaccharide (CPS) and enzyme-linked immunosorbent assays (ELISA) detecting antibodies against hemolysin co-regulated protein (Hcp1) or O-polysaccharide (OPS) for diagnosing melioidosis.<h4>Methodology/principal findings</h4>We conducted a cohort-based case-control study. Both cases and controls were derived from a prospective observational study of patients presenting with community-acquired infections and sepsis in northeast Thailand (Ubon-sepsis). Cases included 192 patients with a clinical specimen culture positive for B. pseudomallei. Controls included 502 patients who were blood culture positive for Staphylococcus aureus, Escherichia coli or Klebsiella pneumoniae or were polymerase chain reaction assay positive for malaria or dengue. Serum samples collected within 24 hours of admission were stored and tested using a CPS-LFI, Hcp1-ELISA and OPS-ELISA. When assessing diagnostic tests in combination, results were considered positive if either test was positive. We selected ELISA cut-offs corresponding to a specificity of 95%. Using a positive cut-off OD of 2.912 for Hcp1-ELISA, the combination of the CPS-LFI and Hcp1-ELISA had a sensitivity of 67.7% (130/192 case patients) and a specificity of 95.0% (477/502 control patients). The sensitivity of the combination (67.7%) was higher than that of the CPS-LFI alone (31.3%, p<0.001) and that of Hcp1-ELISA alone (53.6%, p<0.001). A similar phenomenon was also observed for the combination of CPS-LFI and OPS-ELISA. In case patients, positivity of the CPS-LFI was associated with a short duration of symptoms, high modified Sequential (sepsis-related) Organ Failure Assessment (SOFA) score, bacteraemia and mortality outcome, while positivity of Hcp1-ELISA was associated with a longer duration of symptoms, low modified SOFA score, non-bacteraemia and survival outcome.<h4>Conclusions/significance</h4>A combination of antigen-antibody diagnostic tests increased the sensitivity of melioidosis diagnosis over individual tests while preserving high specificity. Point-of-care tests for melioidosis based on the use of combination assays should be further developed and evaluated.Premjit AmornchaiViriya HantrakunGumphol WongsuvanVanaporn WuthiekanunSurasakdi WongratanacheewinPrapit TeparrakkulT Eoin WestDavid P AuCoinNicholas P J DayPaul J BrettMary N BurtnickNarisara ChantratitraDirek LimmathurotsakulPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11, p e0009840 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Premjit Amornchai Viriya Hantrakun Gumphol Wongsuvan Vanaporn Wuthiekanun Surasakdi Wongratanacheewin Prapit Teparrakkul T Eoin West David P AuCoin Nicholas P J Day Paul J Brett Mary N Burtnick Narisara Chantratitra Direk Limmathurotsakul Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
description	<h4>Background</h4>Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in many tropical developing countries and has a high mortality. Here we evaluated combinations of a lateral flow immunoassay (LFI) detecting B. pseudomallei capsular polysaccharide (CPS) and enzyme-linked immunosorbent assays (ELISA) detecting antibodies against hemolysin co-regulated protein (Hcp1) or O-polysaccharide (OPS) for diagnosing melioidosis.<h4>Methodology/principal findings</h4>We conducted a cohort-based case-control study. Both cases and controls were derived from a prospective observational study of patients presenting with community-acquired infections and sepsis in northeast Thailand (Ubon-sepsis). Cases included 192 patients with a clinical specimen culture positive for B. pseudomallei. Controls included 502 patients who were blood culture positive for Staphylococcus aureus, Escherichia coli or Klebsiella pneumoniae or were polymerase chain reaction assay positive for malaria or dengue. Serum samples collected within 24 hours of admission were stored and tested using a CPS-LFI, Hcp1-ELISA and OPS-ELISA. When assessing diagnostic tests in combination, results were considered positive if either test was positive. We selected ELISA cut-offs corresponding to a specificity of 95%. Using a positive cut-off OD of 2.912 for Hcp1-ELISA, the combination of the CPS-LFI and Hcp1-ELISA had a sensitivity of 67.7% (130/192 case patients) and a specificity of 95.0% (477/502 control patients). The sensitivity of the combination (67.7%) was higher than that of the CPS-LFI alone (31.3%, p<0.001) and that of Hcp1-ELISA alone (53.6%, p<0.001). A similar phenomenon was also observed for the combination of CPS-LFI and OPS-ELISA. In case patients, positivity of the CPS-LFI was associated with a short duration of symptoms, high modified Sequential (sepsis-related) Organ Failure Assessment (SOFA) score, bacteraemia and mortality outcome, while positivity of Hcp1-ELISA was associated with a longer duration of symptoms, low modified SOFA score, non-bacteraemia and survival outcome.<h4>Conclusions/significance</h4>A combination of antigen-antibody diagnostic tests increased the sensitivity of melioidosis diagnosis over individual tests while preserving high specificity. Point-of-care tests for melioidosis based on the use of combination assays should be further developed and evaluated.
format	article
author	Premjit Amornchai Viriya Hantrakun Gumphol Wongsuvan Vanaporn Wuthiekanun Surasakdi Wongratanacheewin Prapit Teparrakkul T Eoin West David P AuCoin Nicholas P J Day Paul J Brett Mary N Burtnick Narisara Chantratitra Direk Limmathurotsakul
author_facet	Premjit Amornchai Viriya Hantrakun Gumphol Wongsuvan Vanaporn Wuthiekanun Surasakdi Wongratanacheewin Prapit Teparrakkul T Eoin West David P AuCoin Nicholas P J Day Paul J Brett Mary N Burtnick Narisara Chantratitra Direk Limmathurotsakul
author_sort	Premjit Amornchai
title	Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
title_short	Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
title_full	Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
title_fullStr	Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
title_full_unstemmed	Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
title_sort	evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b60d27886d474de9a94376eb741d32c8
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Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis.

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