Beaman Miles H, Karimi Mahdad, Hodge Meredith, Keil Anthony D, Campbell Peter
Eur J Microbiol Immunol (Bp). 2014 Dec;4(4):177-83. doi: 10.1556/EUJMI-D-14-00032. Epub 2014 Dec 16.
We assessed IgA antibodies and polymerase chain reaction (PCR) for diagnosis of pertussis in nasopharyngeal aspiration (NPA) samples from outpatients in Australia. A total of 1700 patients (849 adults, 851 children) from Western Australia and the Northern Territory fulfilled the laboratory case definition for pertussis between 2004 and 2013: 732 specimens were positive by NPA IgA alone, 559 by PCR alone, and 409 by both tests. Overall, 968 cases (56.8%) were positive by PCR and 1141 cases (67.2%) by IgA [p < 0.00025]. Among pediatric patients, PCR was positive in 524 (61.3%) and IgA in 569 (67%). In 849 adult cases, the respective proportions were 52.3% and 67.4% [p < 0.00025]. The duration of cough in 507 patients was shorter in 262 pediatric cases (mean, 2.51 weeks; standard deviation [SD], 2.25) than 245 adult patients (3.27 weeks; SD, 2.79) [p = 0.0009]. PCR positivity showed a season-dependent variance (range, 5.6 to 85.9%) and peaked in the second week (71.7%) of illness. IgA antibodies peaked in the fifth week (89.5%) postinfection, and the positivity rate for NPA IgA was less variable (range, 38.3-97.2%). Nasopharyngeal Bordetella pertussis-specific IgA antibodies are valuable in diagnosis of pertussis in Australia. Reliance on PCR alone misses a significant proportion of pertussis cases, especially those with a delayed presentation.
我们评估了澳大利亚门诊患者鼻咽抽吸物（NPA）样本中用于百日咳诊断的IgA抗体和聚合酶链反应（PCR）。2004年至2013年间，来自西澳大利亚州和北领地的1700名患者（849名成人，851名儿童）符合百日咳的实验室病例定义：仅NPA IgA检测呈阳性的标本有732份，仅PCR检测呈阳性的有559份，两种检测均呈阳性的有409份。总体而言，PCR检测呈阳性的病例有968例（56.8%），IgA检测呈阳性的有1141例（67.2%）[p < 0.00025]。在儿科患者中，PCR检测呈阳性的有524例（61.3%），IgA检测呈阳性的有569例（67%）。在849例成人病例中，相应比例分别为52.3%和67.4%[p < 0.00025]。507例患者中，262例儿科病例的咳嗽持续时间（平均2.51周；标准差[SD]为2.25）短于245例成人患者（3.27周；SD为2.79）[p = 0.0009]。PCR阳性呈现出季节依赖性变化（范围为5.6%至85.9%），在发病第二周达到峰值（71.7%）。IgA抗体在感染后第五周达到峰值（89.5%），NPA IgA的阳性率变化较小（范围为38.3% - 97.2%）。鼻咽部百日咳博德特氏菌特异性IgA抗体在澳大利亚百日咳诊断中具有重要价值。仅依靠PCR会遗漏相当一部分百日咳病例，尤其是那些就诊延迟的病例。
