Comparison of in-house IgM and IgG ELISAs for the serodiagnosis of melioidosis in Malaysia.

Shirley Yi Fen Hii,Norazah Ahmad,Fairuz Amran,Noor Azila Ali

doi:10.1099/jmm.0.000611

Shirley Yi Fen Hii, Norazah Ahmad + Show 2 more

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https://doi.org/10.1099/jmm.0.000611

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Abstract

Melioidosis is an endemic infectious disease in Southeast Asia and northern Australia, caused by Burkholderia pseudomallei. However, the incidence rate in Malaysia is not well documented. The high mortality rate and broad range of clinical presentations require rapid and accurate diagnosis for appropriate treatment. This study compared the efficacy of in-house IgM and IgG ELISA methods using a local B. pseudomallei strain. The diagnostic accuracy of the in-house IgG ELISA was better than that of the IgM ELISA: sensitivity (IgG: 84.71 %, IgM: 76.14 %) and specificity (IgG: 93.64 %, IgM: 90.17 %); positive predictive value (IgG: 86.75 %, IgM: 79.76 %) and negative predictive value (IgG: 92.57 %, IgM: 89.66 %); likelihood ratio (LR) [IgG: 13.32, IgM: 7.75 (LR+); IgG: 0.16, IgM: 0.26 (LR–)], and was supported by the observation of the absorbance value in comparisons between culture and serology sampling. In-house IgG ELISA was shown to be useful as an early diagnostic tool for melioidosis.

Highlights

Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei and is endemic to Southeast Asia and northern Australia
The likelihood ratio for both assays did not differ to any great extent [13.32, 7.75 (LR+), 0.16, 0.26 (LR–)] (Table 1)
The receiver operating characteristic (ROC) analysis showed that the area under the ROC curve (AUROC) values for both IgM and IgG ELISA were 0.917 [95 % confidence interval (CI): 0.879, 0.955; P

Summary

Introduction

Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei and is endemic to Southeast Asia and northern Australia. Effective antibiotics are available, melioidosis treatment requires prolonged antimicrobial therapy, and the outcome can be fatal if the disease is misdiagnosed [3, 4]. The use of a sensitive and specific serology test can be an alternative for the rapid diagnosis of melioidosis. Routine serological tests for the diagnosis of melioidosis include indirect haemagglutination (IHA), ELISA and immunofluorescent assay (IFAT) [5, 6]. IHA was shown to be less accurate in endemic regions, as documented in Thailand where there was high seropositivity in healthy subjects [7], while IFAT requires a fluorescence microscope and skilled personnel to interpret the results [6]

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