Rasoamanana B, Leroy F, Boisier P, Rasolomaharo M, Buchy P, Carniel E, Chanteau S
Institut Pasteur, Antananarivo, Madagascar.
Clin Diagn Lab Immunol. 1997 Sep;4(5):587-91. doi: 10.1128/cdli.4.5.587-591.1997.
Bacteriological isolation of Yersinia pestis is the reference test for confirming plague infection, but recovery of the pathogen from human samples is usually very poor. When the etiology of the disease cannot be bacteriologically confirmed, it may be useful to possess alternative tests such as detection of specific circulating antibodies to help guide the diagnosis. In the present study, the immunoglobulin G (IgG) anti-F1 enzyme-linked immunosorbent assay (ELISA) has been applied to various human sera to evaluate its large-scale applicability in the high-endemicity plague foci of Madagascar. The sensitivity of the test was found to be 91.4%, and its specificity was 98.5%. The positive and negative predictive values were 96 and 96.6%, respectively. Seroconversion was observed on day 7 after onset of the disease. Patients with a positive ELISA result could be separated into high (82%) and low (18%) IgG anti-F1 responders. Cross-reactions with eight other infectious diseases prevalent in Madagascar were scarce and were found in 1 of 27 Mycobacterium tuberculosis-, 3 of 34 Schistosoma haematobium-, and 1 of 41 Salmonella-infected patients. Finally, the efficiency of the IgG anti-F1 ELISA was evaluated during the Mahajanga, Madagascar, plague outbreak of 1995. When the number of ELISA-positive patients was added to the number of bacteriologically confirmed and probable cases, the number of positive patients was increased by 35%. In conclusion, although it does not replace bacteriology, IgG anti-F1 ELISA is a useful and powerful tool for retrospective diagnosis and epidemiological surveillance of plague outbreaks.
鼠疫耶尔森菌的细菌学分离是确诊鼠疫感染的参考检测方法，但从人类样本中分离出病原体的成功率通常很低。当疾病的病因无法通过细菌学得到证实时，拥有诸如检测特异性循环抗体等替代检测方法可能有助于指导诊断。在本研究中，免疫球蛋白G（IgG）抗F1酶联免疫吸附测定（ELISA）已应用于各种人类血清，以评估其在马达加斯加高流行鼠疫疫源地的大规模适用性。该检测的灵敏度为91.4%，特异性为98.5%。阳性和阴性预测值分别为96%和96.6%。在疾病发作后第7天观察到血清转化。ELISA结果呈阳性的患者可分为高IgG抗F1反应者（82%）和低IgG抗F1反应者（18%）。与马达加斯加流行的其他8种传染病的交叉反应很少，在27例结核分枝杆菌感染患者中有1例、34例埃及血吸虫感染患者中有3例、41例沙门氏菌感染患者中有1例出现交叉反应。最后，在1995年马达加斯加马任加鼠疫疫情期间评估了IgG抗F1 ELISA的效率。当将ELISA阳性患者的数量加到细菌学确诊和疑似病例的数量中时，阳性患者的数量增加了35%。总之，尽管IgG抗F1 ELISA不能替代细菌学检测，但它是鼠疫疫情回顾性诊断和流行病学监测的一种有用且强大的工具。
