Clinical Interpretation of Detection of IgM Anti- Antibody in the Absence of IgG and ; a Diagnostic Challenge for Clinicians.

Non-specific and often misleading clinical presentation of active brucellosis has made it a diagnostic puzzle for treating physicians. Clinicians rely greatly on the detection of IgG and IgM anti- antibodies by ELISA. Different patterns of positivity have been observed for IgG and IgM anti- antibodies in different cases, which further increases the risk of an erroneous diagnosis. Detailed herein is our two-years data with varied serology patterns and their clinical interpretation. Between January 2015 to December 2017, 1102 samples were processed in the Immunology Laboratory of KFHU for serology. 68 samples were positive for both IgG and IgM, 28 samples were positive for IgG and negative for IgM while 15 samples were positive for IgM and negative for IgG antibodies against . Electronic medical records, history of exposure, signs, symptoms, laboratory data, and the final diagnosis were recorded for all these patients. None of the patients with only positive IgM antibodies was finally diagnosed with brucellosis, while a diagnosis of brucellosis was established for only one patient with IgG antibodies positive in his serum. All the double-positive (IgG- and IgM-positive) serology patterns were diagnosed as having brucellosis. We concluded that determination of single IgM or IgG anti--antibodies by ELISA could both be considered as definite and should ideally be interpreted in the context of appropriate clinical scenario and confirmation by other laboratory assays. Non-specific and often misleading clinical presentation of active brucellosis has made it a diagnostic puzzle for treating physicians. Clinicians rely greatly on the detection of IgG and IgM anti- antibodies by ELISA. Different patterns of positivity have been observed for IgG and IgM anti- antibodies in different cases, which further increases the risk of an erroneous diagnosis. Detailed herein is our two-years data with varied serology patterns and their clinical interpretation. Between January 2015 to December 2017, 1102 samples were processed in the Immunology Laboratory of KFHU for serology. 68 samples were positive for both IgG and IgM, 28 samples were positive for IgG and negative for IgM while 15 samples were positive for IgM and negative for IgG antibodies against . Electronic medical records, history of exposure, signs, symptoms, laboratory data, and the final diagnosis were recorded for all these patients. None of the patients with only positive IgM antibodies was finally diagnosed with brucellosis, while a diagnosis of brucellosis was established for only one patient with IgG antibodies positive in his serum. All the double-positive (IgG- and IgM-positive) serology patterns were diagnosed as having brucellosis. We concluded that determination of single IgM or IgG anti--antibodies by ELISA could both be considered as definite and should ideally be interpreted in the context of appropriate clinical scenario and confirmation by other laboratory assays.