Shigellosis in Vietnam: seroepidemiologic studies with use of lipopolysaccharide antigens in enzyme immunoassays.

The performance of enzyme immunoassays (EIAs) with use of O-antigen-containing lipopolysaccharides (LPSs) extracted with phenol-water from Shigella dysenteriae type 1, Shigella flexneri serotypes 1a-5b, and Shigella sonnei for determination of the serum antibody responses after onset of bacillary dysentery is reviewed. For the purpose of several studies, serum samples from a total of 175 Vietnamese and 47 Swedish patients, for whom Shigella species had been isolated from fecal specimens, were obtained at various intervals until less than or equal to 1 year after the onset of infection. Titers of antibodies in serum samples from infected patients were compared with those in serum samples from healthy control subjects; the combined control population of all studies comprised 426 Vietnamese and 154 Swedes. The sensitivity of the EIAs ranged from 78% to 100% for patients whose fecal culture was positive for Shigella. For diagnosis of S. flexneri, a species-specific but no serotype-specific assay based on LPS antigens is possible. Among Vietnamese patients the EIA with use of S. flexneri was sensitive and diagnostic only for children less than 3 years of age, most likely because healthy older Vietnamese children and adults have high titers of antibody to the O-antigens of S. flexneri. Among Swedish patients the same EIA was diagnostic for adults as well as children. Increased titers of IgA in the early phase and of IgG in the convalescent phase, as determined by EIA, were the best indicators of infection due to Shigella species.