Interpretation Of Serological Results Research Articles

Management of Suspected Cases of Feline Immunodeficiency Virus Infection in Eurasian Lynx (Lynx lynx) During an International Translocation Program.

The Eurasian lynx (Lynx lynx) population in Switzerland serves as a source for reintroductions in neighboring countries. In 2016–2017, three lynx from the same geographical area were found seropositive for feline immunodeficiency virus (FIV) in the framework of an international translocation program. This novel finding raised questions about the virus origin and pathogenicity to lynx, the emerging character of the infection, and the interpretation of serological results in other lynx caught for translocation. Archived serum samples from 84 lynx captured in 2001–2016 were retrospectively tested for FIV antibodies by Western blot. All archived samples were FIV-negative. The three seropositive lynx were monitored in quarantine enclosures prior to euthanasia and necropsy. They showed disease signs, pathological findings, and occurrence of co-infections reminding of those described in FIV-infected domestic cats. All attempts to isolate and characterize the virus failed but serological data and spatiotemporal proximity of the cases suggested emergence of a lentivirus with antigenic and pathogenic similarities to FIV in the Swiss lynx population. A decision scheme was developed to minimize potential health risks posed by FIV infection, both in the recipient and source lynx populations, considering conservation goals, animal welfare, and the limited action range resulting from local human conflicts. Development and implementation of a cautious decision scheme was particularly challenging because FIV pathogenic potential in lynx was unclear, negative FIV serological results obtained within the first weeks after infection are unpredictable, and neither euthanasia nor repatriation of multiple lynx was acceptable options. The proposed scheme distinguished between three scenarios: release at the capture site, translocation, or euthanasia. Until April 2021, none of the 40 lynx newly captured in Switzerland tested FIV-seropositive. Altogether, seropositivity to FIV was documented in none of 124 lynx tested at their first capture, but three of them seroconverted in 2016–2017. Diagnosis of FIV infection in the three seropositive lynx remains uncertain, but clinical observations and pathological findings confirmed that euthanasia was appropriate. Our experiences underline the necessity to include FIV in pathogen screenings of free-ranging European wild felids, the importance of lynx health monitoring, and the usefulness of health protocols in wildlife translocation.

Longitudinal Protection Following Natural SARS-CoV-2 Infection and Early Vaccine Responses: Insights from a Cohort of Community Based Dental Health Care Professionals

Background: The threshold of protection for anti-SARS-CoV-2 spike glycoprotein antibodies and their longevity are not known. Interpretation of serological results in with respect to international reference material can inform this essential question.Methods: 1,507 West Midlands dental care professionals were recruited into this study in June 2020. Baseline seroprevalence of antibodies directed against the SARS-CoV-2 spike glycoprotein was determined and the cohort was followed longitudinally for 6 months until January/February 2021 through the second wave of the COVID-19 pandemic in the United Kingdom, and commencement of vaccination.Findings: Baseline seroprevalence was 16.3% in this cohort, compared to estimates in the general population of between 6-7%. Seropositivity was retained in over 70% of participants at 3 and 6-month follow up and conferred a 74% reduced risk of infection. During follow-up, no PCR-proven infections occurred in individuals with a baseline anti-SARS-CoV-2 IgG level greater than 3.69 IU/ml with respect to the World Health Organization international standard 20-136. Post-vaccination, antibody responses were more rapid and of higher magnitude in individuals with who were seropositive at baseline.Interpretation: Natural infection leads to a serological response that remains detectable in over 70% of individuals 6 months after initial sampling and 9 months from the peak of the first wave of the pandemic. This response is associated with protection from future infection. Even if serological responses wane, a single dose of the Pfizer-BioNTech vaccine is associated with an antibody response indicative of immunological memory.Funding: The Association of Clinical Biochemistry and Laboratory Medicine and The Institute for Global Innovation (IGI) of the University of Birmingham.Conflict of Interest: MTD reports personal fees from Abingdon Health, outside the submitted work. AMC isan employee of the Binding Site Group. All other authors declare no competing interests.Ethical Approval: The study was approved by the London - Camden and Kings Cross Research EthicsCommittee (reference 20/HRA/1817). All participants provided written informed consent prior to enrolment in the study.

Influence of flavivirus co-circulation in serological diagnostics and surveillance: A model of study using West Nile, Usutu and Bagaza viruses.

This study aims at assessing the serological cross-reactions existing between three mosquito-borne flaviviruses with avian reservoirs co-circulating in Europe: West Nile (WNV), Usutu (USUV) and Bagaza (BAGV). The study is useful for a better interpretation of serological results in diagnostics and surveillance. Serum samples obtained from a natural host, the red-legged partridge (Alectoris rufa), experimentally infected with WNV, USUV or BAGV were analysed using two commercially available WNV competition ELISAs suitable for serological surveillance, and by the confirmatory virus neutralization test (VNT). The ELISAs examined showed different levels of specificity for WNV, as judged by cross-reaction observed with the other flaviviruses. By VNT, virus-specific antibodies were confirmed in 80%, 50% or 0% of sera from WNV-, BAGV-, or USUV-inoculated birds, respectively. The results indicate how the co-circulation of cross-reacting flaviviruses may affect the outcomes of WNV serological surveillance when applying currently available serological tools. On the one hand, the choice of the ELISA test for antibody screening should consider the differences found in specificity, since one test is more specific for WNV while the other one is more suitable for detection of a broader range of flavivirus antibodies. On the other hand, besides corroborating that cross-neutralization occurs between flaviviruses from different serocomplexes (WNV/USUV and BAGV), this study points out that cross-neutralization between WNV and USUV is not symmetric, and reveals the difficulty to identify USUV infections serologically. This finding indicates that actual USUV infections might be underestimated in the current diagnostic schemes.

Reply to comment--Clement et al.: (Prevalence of antibodies against hantaviruses in serum and saliva of adults living or working on farms in Yorkshire, United Kingdom).

We acknowledge Clement and colleagues for their comments [1] on our paper [2]. We agree that many controversies are being discussed by the hantavirus community, particularly surrounding the interpretation of serological results and the designation of new species and strains. Within this setting, we are grateful for the opportunity to respond to the key factual and methodological points raised by Clements et al. [...]

Toxoplasma Seroconversion with Negative or Transient Immunoglobulin M in Pregnant Women: Myth or Reality? A French Multicenter Retrospective Study

Classically, Toxoplasma infection is associated with high levels of specific IgM antibody and a rise in specific IgG levels 1 to 3 weeks later. Atypical IgG seroconversion, without IgM detection or with transient IgM levels, has been described during serologic follow-up of seronegative pregnant women and raises difficulties in interpreting the results. To evaluate the frequency and the characteristics of these atypical cases of seroconversion, an investigation was conducted within the French National Reference Center for Toxoplasmosis, from which 26 cases collected from 12 laboratories belonging to the network were identified. The aim of this work was to retrospectively analyze the results of serologic testing, the treatments administered, and the results of prenatal and postnatal follow-up for these women. In each case, IgG antibodies were detected using both screening and confirmatory tests. IgM antibodies were not detected in 15 cases, and the levels were equivocal or low-positive in 11 cases. The IgG avidity results were low in 16 cases and high in one case. Most of the pregnant women (22/26) were treated with spiramycin from the time that IgG antibodies appeared until delivery. Amniotic fluid was analyzed for Toxoplasma gondii DNA by PCR in 11/26 cases, and the results were negative in all cases. Congenital toxoplasmosis was ruled out in 12/26 newborns. There was no abnormality observed at birth for 10 newborns and no information available for 4 newborns. In conclusion, when the interpretation of serological results is so difficult, it seems cautious to initiate treatment by spiramycin and to follow the pregnant women and their newborns.

Dépistage de la toxoplasmose materno-foetale : étude des cas suivis à l’Institut Pasteur de Tunis (2007–2010)

Toxoplasmosis when occurring during pregnancy can be transmitted to the fetus and lead to congenital toxoplasmosis (CT). Therefore, pregnant women are a risk group, for which it is necessary to determine the serologic profile. The objective of this study is to determine the serologic profile of toxoplasmosis in pregnant women followed at the Parasitology Laboratory of the Pasteur Institute in Tunis, to establish the prevalence of toxoplasmic infections during pregnancy and the incidence of the CT, noting the difficulties faced in the interpretation of serological results. This is a retrospective study concerning 2833 toxoplasmic serologies practiced on 2070 pregnant women, followed at the Parasitology-Mycology Laboratory of the Pasteur Institute of Tunis, between 2007 and 2010. Serological diagnosis of toxoplasmosis was done by ELISA (Enzyme Linked Immunosorbent Assay) for the detection of Immunoglobulin (Ig) G and M and the study of toxoplasmosis IgG avidity. Prenatal diagnosis was performed for 58 women by amniotic fluid sampling. Toxoplasma gondii was detected by Polymerase Chain Reaction (PCR). At birth, the diagnosis of congenital toxoplasmosis was established based on serology. The toxoplasmic serologies carried out have shown that 45.6% of the pregnant women were formerly immunized while 49.6% had a negative serology. A toxoplasmosis primary infection acquired during pregnancy was detected in 79 cases (3.8%). Among them, 33% had a true seroconversion while 67% had a recent toxoplasmosis infection in view of the positivity of IgG and IgM on the first sample with a low index of avidity (IA). For 21 parturients whose serology showed the presence of IgG, IgM and an intermediate or high IA. Among the 58 parturients in whom prenatal diagnosis was performed, PCR was positive in four cases. After birth, six cases of congenital toxoplasmosis were detected by serology.

Traitement des rhumatismes inflammatoires et risques infectieux : difficultés d’interprétation des sérologies

Summary This case report deals with the infectious side effects induced by anti-TNF-α treatments in a woman with psoriasic rheumatism. It points out the infectious risks induced by this kind of treatment and the enhancement of clinical signs observed during the course of primary toxoplasma infection. This case also underlines the difficulties of interpretation of serological results and particularly the problems of interpretation of specific-IgM results, this class of antibody being not exclusively detected during recent primary infection.

Lyme borreliosis: Diagnostic difficulties in interpreting serological results

Lyme borreliosis is a multi-systemic disease caused by spirochete Borrelia burgdorferi sensu lato. The specific response is influenced by phenotypic characteristics of Borrelia, different antigen structure, their different geographic distribution, and the patient's capability to react to the infection. The immune response to Borrelia burgdorferi sensu lato develops relatively late, whereas in some patients it never develops. The immune response in the early phase of Lyme borreliosis is very similar to the one of healthy population. Clinical manifestation, detailed anamnesis and epidemiological data are crucial for making the diagnosis. The majority of patients in the late phase of Lyme borreliosis have IgG antibody response, which could be followed by IgM also throughout this period of time. The number of serologically positive findings increases with the duration of the infection. Specific borrelial antigens can be detected by a Western blot test. In patients with neuroborreliosis, antibodies could be synthesized only intrathecally. IgG and IgM antibody response can persist for many years after the treatment. There is no positive serological test, which could be the indicator of the disease activity on its own; even if it demonstrates high antibody titre. If there are no clinical signs of Lyme borreliosis, the diagnosis of Lyme borreliosis should be primarily based on clinical findings, and serological results should be used only to confirm but not to make the diagnosis of Lyme borreliosis. Specific antibodies from the IgM class can be proved in about 50% of patients, 2 to 4 weeks after the onset of primary infection, but an early administration of the antibiotics can postpone or inhibit that response. When interpreting the serological test results with high level of sensitivity and specificity used for making diagnosis of Lyme borreliosis, it is necessary to take into consideration the seroprevalence in a certain region. In the population with a low prevalence of the disease, the tests will have a low positive predicative value, i.e. the probability of indicating the real disease will be lower. According to the recommendations given by the Centre for Disease Control in North America, all extreme and positive results of EA and IFA are to be confirmed by a Western blot test. The main problem in making diagnosis of Lyme borreliosis is underestimation and overrating of the diagnosis. Not a single positive serologic test is the indicator of the disease activity on its own, regardless of the antibodies titre level, when clear clinical signs are scarce.

Avidity of IgG antibodies against excreted/secreted antigens of Toxoplasma gondii: immunological marker for acute recent toxoplasmosis

Detection of anti-toxoplasma IgM antibodies has frequently been used as a serological marker for diagnosing recently acquired toxoplasmosis. However, the persistence of these antibodies in some patients has complicated the interpretation of serological results when toxoplasmosis is suspected. The purpose of the present study was to evaluate the avidity of IgG antibodies against excreted/secreted antigens of Toxoplasma gondii by means of immunoblot, to establish a profile for acute recent infection in a single serum sample and confirm the presence of residual IgM antibodies obtained in automated assays. When we evaluated the avidity of IgG antibodies against excreted/secreted antigens of Toxoplasma gondii by means of immunoblot, we observed phase-specific reactivity, i.e. cases of acute recent toxoplasmosis presented low avidity and cases of non-acute recent toxoplasmosis presented high avidity towards the 30 kDa protein fraction, which probably corresponds to the SAG-1 surface antigen. Our results suggest that the avidity of IgG antibodies against excreted/secreted antigens of Toxoplasma gondii is an important immunological marker for distinguishing between recent infections and for determining the presence of residual IgM antibodies obtained from automated assays.

Problems in the Interpretation of Serological Results of Hepatitis B Testing During an Incident of Hepatitis B Virus Reactivation in a Dialysis Unit •

Problems in the Interpretation of Serological Results of Hepatitis B Testing During an Incident of Hepatitis B Virus Reactivation in a Dialysis Unit •

Persistence of anti-leptospiral IgM, IgG and agglutinating antibodies in patients presenting with acute febrile illness in Barbados 1979-1989.

The persistence of anti-leptospiral IgM and IgG antibodies and agglutinating antibodies was studied in serologically confirmed cases of severe leptospirosis during the acute illness and over periods of several years after recovery. The antibody response in non-leptospirosis patients presenting to hospital with similar symptoms over the same period of time was used to estimate the background antibody level to leptospirosis in the community. All patients enrolled in the study had blood samples collected twice in the acute stage of illness, once during convalescence and then annually from the time of initial hospitalisation until the end of the study period. Six hundred and thirty-eight patients presented to hospital with acute febrile illness, of whom 321 were diagnosed with leptospirosis. Patients who had severe leptospirosis commonly remained seropositive, with IgM, IgG and agglutinating antibodies detectable for several years after infection. A significant proportion of cases had high titres of agglutinating antibody detectable by the microscopic agglutination test (> or = 800). There were marked differences in the magnitude and duration of persistence of agglutinating antibodies directed against different serogroups. More than 20% of cases with evidence of infection with serogroup Autumnalis retained titres of >800, 4 years after the acute illness. In one case a titre of 800 was detected 11 years after infection. Persistence of agglutinating antibody titres can create problems in interpretation of serological results and make it impossible to estimate the time of infection, given a specific titre. This study demonstrates that in endemic areas where seroprevalence is high, use of a single elevated titre is not reliable to define a current infection.

Diagnosis and therapy of Lyme borreliosis in children. Practice guideline of the German Society for Pediatric Infectious Diseases

Lyme borreliosis is the most frequent tickborne++ disease of man in the Northern hemisphere. A variety of systems may be involved. The most frequent manifestations in childhood include erythema migrans, meningitis, cranial nerve palsy and arthritis. Erythema migrans usually is easily recognised and determination of antibodies to Borrelia burgdorferi should not be performed. Childhood neuroborreliosis is characterised mostly by aseptic meningitis with or without cranial nerve palsy, in most cases facial palsy. Basic CSF findings often show a combined evidence of lymphocytic pleocytosis, IgM-class dominance in intrathecal humoral immune++ response, and blood-CSF barrier dysfunction. Calculation of the Borrelia burgdorferi specific antibody index (according to Reiber) proved to be the most sensitive method for detecting intrathecal synthesis of specific antibodies. Lyme arthritis presents initially as episodic oligoarthritis, mostly involving the knee joint, and may turn into chronic monoarthritis of the knee; usually high titers of IgG antibodies to Borrelia burgdorferi are found. The rarer manifestations encephalomyelitis, chronic arthritis, carditis and inflammatory eye disease may be difficult to diagnosis due to clinical ambiguity and problems in the interpretation of serological results. Antibodies to Borrelia burgdorferi found by sensitive Elisa must always be confirmed by immunoblot analysis, but sometimes immunoblot analysis is more sensitive than Elisa. Treatment is by antibiotics, amoxicillin or doxyciclin for erythema migrans, and i.v. third generation cephalosporins for all other manifestations. Even after successful antibiotic therapy, antibodies may persist for months and years and no further antibiotic treatment is necessary in the absence of attributable clinical manifestations. The differentiation between a persisting immune response and a persisting infection therefore has to be based upon the clinical symptoms, non-specific laboratory data and the development of the antibody titers.

Correlation between the detection of viral DNA by the polymerase chain reaction in peripheral blood leukocytes and serological responses to human herpesvirus 6, human herpesvirus 7, and cytomegalovirus in renal allograft recipients.

Diagnosis of significant infections by human herpesvirus 6 (HHV6) and 7 (HHV7) in transplant patients has proved difficult because both viruses are ubiquitous and can cause persistent infections in their hosts. The significance of viral DNA detected in peripheral blood leukocytes (PBLs; DNAemia) by PCR is therefore unclear. The interpretation of serological results is complicated by the fact that both primary and secondary infections with other herpesviruses may be associated with a concurrent antibody response to HHV6. Fifty-four renal allograft recipients were studied prospectively and their serological response to HHV6, HHV7 and CMV were compared with the detection of viral DNAemia from the homologous and heterologous viruses. Serum and heparinished blood samples were collected prospectively from 54 renal allograft recipients. DNA was extracted from PBLs and tested for the presence of HHV6, HHV7 and CMV DNA by PCR. Antibodies to HHV6 and HHV7 were measured by an indirect immunofluorescence test and to CMV by an anticomplement immunofluorescence (ACIF) test. CMV IgM antibodies were detected by a commercial enzyme immunoassay. CMV and HHV7 DNAemia were each significantly associated with serological responses to the homologous virus but no such association was found for HHV6 DNAemia. However, patients with consecutively positive DNAemia to any of the viruses (including HHV6) were more likely to have a homologous serological response. Patients who had detectable CMV IgM without a concurrent rise in CMV antibodies were significantly less likely to have CMV DNAemia (odds ratio = 0.16; 95% CI 0.02-0.9). CMV IgM antibodies may be associated with HHV6 or HHV7 DNAemia (odds ratio 2.3; 95% CI 0.5-15). This serological profile may reflect a crossreactive response to HHV6, HHV7 or other herpesviruses. CMV IgM should not be used in isolation for the diagnosis of CMV infection or disease in this group of patients.

Chlamydia trachomatis: serological diagnosis.

Satisfactory methods for the serodiagnosis of Chlamydia trachomatis have been widely discussed in recent years. Until a decade ago, the complement-fixation test measuring group-specific antibody was the most widely applied technique. However, despite showing relatively high diagnostic sensitivity in systemic chlamydial infections, it is of little value in the serodiagnosis of localized chlamydial oculo-genital infections or of trachoma. The more recently developed microimmunofluorescence (micro-IF) test is not only a very sensitive technique, but can also reach a high degree of serodiagnostic specificity in certain chlamydial infections. Unlike the complement-fixation test, it measures type-specific antibody which may be directed against one or more C trachomatis serotypes. By nature, chlamydia infections often lead to high background rates of antibody in affected populations. Interpretation of serological results may therefore be difficult, particularly when only single-serum samples are available. However, in seroepidemiological work, in the study of transmission patterns and in the detection of predominant serotypes in a community, the micro-IF test is especially valuable, and if results are interpreted with care, the test may also serve as an indicator of chlamydial infection. The predictability, sensitivity and specificity of serological tests for C. trachomatis will be discussed.

IgM ANTIBODIES IN ACUTE TOXOPLASMOSIS: I. DIAGNOSTIC SIGNIFICANCE IN CONGENITAL CASES AND A METHOD FOR THEIR RAPID DEMONSTRATION

The present study was undertaken to develop a simple technique for demonstration of IgM-toxoplasma antibodies in acute congenital toxoplasmosis. Such antibodies were demonstrable by each of the four methods used, but their sensitivities varied considerably. The underlying difficulty in interpretation of results obtained in the dye and hemagglutination tests following reductive cleavage appeared to be the high titer of IgG-toxo-plasma antibodies in all sera tested, which "hides" the effect of 2-ME on the IgM-toxoplasma antibodies. Because IgG-toxoplasma antibodies do not interfere with the demonstration of IgM-toxoplasma antibodies in fractions obtained by sucrose density gradient ultracentrifugation or with the IgM-fluorescent antibody test, these two methods proved the most sensitive for demonstration of IgM-toxoplasma antibodies in congenital cases. Whereas the former of these two methods is a laborious procedure requiring facilities rarely available in clinical laboratories, the IgM-fluorescent antibody test is easily learned and it can be performed in 2 hours. Serologic diagnosis of infection in newborns is often complicated by the presence in the infant of maternal antibodies. The difficulty in interpretation of serologic results in cases of suspect congenital toxoplasmosis is magnified by the high prevalence of toxoplasma antibodies in the normal childbearing population (and thus in their offspring). Demonstration of IgM antibodies in newborn infants (in the absence of a placental leak) appears to be diagnostic of congenital toxoplasmosis. Because of the difficulty encountered in recognition of congenital cases which do not appear to have the "classical" signs and because of the infrequency with which the diagnosis can be established, even in these latter cases, the IgM-fluorescent antibody test will hopefully prove simple enough to perform to be useful as a test for the definitive diagnosis of acute congenital toxoplasmosis.

The Diagnosis of Pre-Clinical or Latent (Biological) Tubercle in Suspects and Contacts by Caulfeild's Inhibitive and the T. C. F. Reactions; Clinical Application,,

Article1 October 1930The Diagnosis of Pre-Clinical or Latent (Biological) Tubercle in Suspects and Contacts by Caulfeild's Inhibitive and the T. C. F. Reactions; Clinical Application,,W. E. OGDENW. E. OGDENSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-4-4-379 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe tuberculosis problem to the internist or practitioner today, is summarized in two questions.1. Is there a specific cure in sight, if so, perhaps, we can wait for it?; if not then follows question―2. Have we adequate means of anticipation and prevention?Q. 1. is answered in the negative.Q. 2. (we believe) can be answered in the affirmative.This answer to Question No. 2, that wehaveadequate means of anticipation of tuberculosis and of its prevention appears a radical statement, but I think I can show you today, sufficient proof that with certain minor qualifications it is...References1 CAULFEILD AH: Investigations in Pulmonary Tuberculosis, Journ. Med. Res., 1911, xxiv, 100. Google Scholar2 CAULFEILD AH: Factors in the Interpretation of Inhibitive and Fixation Serum Reactions in Tuberculosis, Proc. Royal Soc., Sec. B., 1911, lxxxiv. Google Scholar3 OGDEN WE: Prognosis and Diagnosis in Tuberculosis as Aided by Serology, Journ. Can. Med. Assn., Dec. 1921. Google Scholar4 PERLA D: The Inhibitive Reaction of Caulfeild, Amer. Res. Tuberc., 1926, xiv, 718. Google Scholar5 NORWICHMACLENNANBASSINGTHWAIGTHE ACMFMF: The Inhibitive Reaction of Caulfeild, ibid., 1930, xxi, 142. Google Scholar6 HODGEMACLENNAN WRMF: The Relationship of Lipsids and Proteins to Serum Reactions in Tuberculosis, Journ. Immunol., 1922, vii, 253. Google Scholar7 CAULFEILD AH: Correlation of Clinical Progress with the Results of Immunological Studies in Pulmonary Tuberculosis, Arch. Int. Med., 1911, viii, 440. CrossrefGoogle Scholar8 OGDEN WE: Difficulties in Prognosis in Pulmonary Tuberculosis, Can. Med. Assoc. Journ., vol. ii., March, 1912. Google Scholar9 CAULFEILD AH: The Tuberculo-complement-fixation and Inhibitive Tests, Amer. Res. Tuberc., 1925, ix, 508. Google Scholar10 OGDEN WE: Expert and Limitations of Serology in the Diagnosis of Tuberculosis, presented before combined meeting of D. P. & N. H. Tuberculosis officers and Can. Tuberculosis Association, Ottawa, Can., Feb. 1924. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Toronto, Ontario*1.Read in part before the Section of Pathology, Academy of Medicine, Toronto, February 26, 1926, under title of "The Interpretation of Serological Results in Tuberculosis over Periods up to Ten Years."2.Read in part before the Academy of Medicine, Cleveland, November 15, 1929, under title of "Clinical Interpretation of Serial Serological Reactions, being Caulfeild's Inhibitive and the T.C.F., as Specific for Tubercle."3.Read 'in toto' before the American College of Physicians, Minneapolis, Minn., February 14, 1930. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Diagnosis of Pre-Clinical Tubercle in Suspects and Contacts by Caulfeild's Inhibitive and the T.C.F. Clinical Application: Part II. Graphs and X-Rays*WILLIAM E. OGDEN, M.D. 1 October 1930Volume 4, Issue 4Page: 379-386KeywordsClinical pathology ePublished: 1 December 2008 Issue Published: 1 October 1930 PDF downloadLoading ...