Rheumatoid factor: a cause of fals positive histoplasmin latex agglutination

Immunologic Diagnosis of Endemic Mycoses

The endemic mycoses blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, cryptococcosis, sporotrichosis, talaromycosis, adiaspiromycosis, and emergomycosis are mostly caused by geographically limited thermally dimorphic fungi (except for cryptococcosis), and their diagnoses can be challenging. Usual laboratory methods involved in endemic mycoses diagnosis include microscopic examination and culture of biological samples; however, serologic, histopathologic, and molecular techniques have been implemented in the last few years for the diagnosis of these mycoses since the recovery and identification of their etiologic agents is time-consuming and lacks in sensitivity. In this review, we focus on the immunologic diagnostic methods related to antibody and antigen detection since their evidence is presumptive diagnosis, and in some mycoses, such as cryptococcosis, it is definitive diagnosis.

Bacterial meningitis in children under 15 years of age in Nepal

BACKGROUND

Bacterial meningitis in children is a life-threatening problem resulting in severe morbidity and mortality. For the prompt initiation of antibacterial therapy, rapid and reliable diagnostic methods are of utmost importance. Therefore, this study was designed to find out the rate of bacterial pathogens of meningitis from suspected cases by performing conventional methods and latex agglutination.

METHODS

A descriptive type of study was carried out from May 2012 to April 2013. Cerebrospinal fluid (CSF) specimens from 252 suspected cases of meningitis were subjected for Gram staining, bacterial culture and latex agglutination test. The identification of growth of bacteria was done following standard microbiological methods recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby-Bauer disk diffusion method.

RESULTS

From the total 252 suspected cases, 7.2 % bacterial meningitis was revealed by Gram staining and culture methods whereas latex agglutination method detected 5.6 %. Gram-negative organisms contributed the majority of the cases (72.2 %) with Haemophilus influenzae as the leading pathogen for meningitis. Overall, 33.3 % mortality rate was found.

CONCLUSIONS

In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance.

Improvement of the newly developed latex agglutination test (Katex) for diagnosis of visceral lieshmaniasis

INTRODUCTION

Different methods are available for diagnosis of visceral leishmaniasis (VL), among them the urine-based antigen detection assay, latex agglutination test (Katex), is a recently developed one. The main drawback of the test is false-positive reactivity in some of healthy individuals. The false positivity of the test can be removed by boiling the urine sample for 5 min before testing. In this study an attempt was made to improve Katex by removing unpleasant boiling process, which also decreases field applicability of the test.

METHODS

False-positive and true-positive urine samples were collected from VL patients and healthy individuals. Both samples were then treated by reagents including, sodium dodecyl sulfate, trichloroacetic acid, dithiothreitol (DTT), sulphosalicylic acid and also heating at 56 degrees C.

RESULTS

Findings of this study showed that DTT pretreatment significantly reduced the rate of false-positive reactivity of Katex where 73% of false-positive urine samples changed to negative after DTT treatment. However, the DTT treatment reduced the rate of true positivity by 14%.

CONCLUSION

These data indicate that DTT can be used to eliminate nonspecific reactivity in the Katex. This will improve the performance of Katex and make it a more convenient and field applicable test.

Blood stained cerebrospinal fluid responsible for false positive reactions of latex particle agglutination tests

The accuracy of the latex particle agglutination test (LPAT) was assessed in blood stained cerebrospinal fluid (CSF) specimens from 166 paediatric patients, aged from three months to 13 years. A commercial LPAT kit was used to detect Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis A, B, and C soluble antigens. Culture of CSF specimens was used as the standard and all laboratory procedures were performed blind. The mean CSF erythrocyte count was 66,406 cells/mm3 in the cases and 11,560 cells/mm3 in the controls. The sensitivity and the specificity of LPAT were 83.8 and 94.0%, respectively, suggesting that LPAT is a useful diagnostic tool even in blood stained CSF specimens.

Laboratory diagnosis of bacterial meningitis

Bacterial meningitis is relatively common, can progress rapidly, and can result in death or permanent debilitation. This infection justifiably elicits strong emotional reactions and, hopefully, immediate medical intervention. This review is a brief presentation of the pathogenesis of bacterial meningitis and a review of current knowledge, literature, and recommendations on the subject of laboratory diagnosis of bacterial meningitis. Those who work in clinical microbiology laboratories should be familiar with the tests used in detecting bacteria and bacterial antigens in cerebrospinal fluid (CSF) and should always have the utmost appreciation for the fact that results of such tests must always be reported immediately. Academic and practical aspects of the laboratory diagnosis of bacterial meningitis presented in this review include the following: anatomy of the meninges; pathogenesis; changes in the composition of CSF; etiological agents; processing CSF; microscopic examination of CSF; culturing CSF; methods of detecting bacterial antigens and bacterial components in CSF (counter-immunoelectrophoresis, coagglutination, latex agglutination, enzyme-linked immunosorbent assay, Limulus amebocyte lysate assay, and gas-liquid chromatography); use of the polymerase chain reaction; and practical considerations for testing CSF for bacterial antigens.

Bacterial antigen detection in body fluids: methods for rapid antigen concentration and reduction of nonspecific reactions

We sought procedures which would allow a rapid concentration in high yield of bacterial antigens from tissue fluids of patients and which could be applied also to protein-rich fluids like serum. Ethanol precipitation at a subzero temperature with albumin added as an antigen coprecipitant made it possible to achieve a more than 20-fold concentration of antigen in 15 min and a 200-fold concentration in 45 min. Heat-stable antigens could be concentrated from protein-rich fluids (like serum) after the sample had been deproteinized by boiling. Such heating (100 degrees C, 3 min) also liberated bacterial polysaccharides from antibody complexes and elminated the nonspecific interference of serum in enzyme-linked immunosorbent assay.

Comparison of staphylococcal coagglutination, latex agglutination, and counterimmunoelectrophoresis for bacterial antigen detection

Soluble antigens of Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, and group B streptococcus were looked for in cerebrospinal fluid, serum, and urine by using the staphylococcal coagglutination test, latex agglutination test, and counterimmunoelectrophoresis. The staphylococcal coaggultination and latex agglutination tests were more sensitive than counterimmunoelectrophoresis in identifying antigens of H. influenzae type b, S. pneumoniae, and N. meningitidis. None of the three tests successfully detected group B streptococcal antigens in body fluids. Nonspecific reactions noted with the staphylococcal coagglutination test could be usually eliminated after premixing test specimens with soluble protein A.

Immunodiagnosis of histoplasmosis in a compromised host

Three serological tests for the diagnosis of histoplasmosis were compared for sensitivity and specificity in serum from blood bank donors, patients with histoplasmosis, and infected or noninfected immunosuppressed patients. The histoplasmin latex agglutination test was positive in 9% of the normal patients, 33% of the histoplasmosis patients, and 61% of the noninfected immunosuppressed patients. Since the test is prone to many false-positive results in patients with inflammatory diseases or non-Histoplasma infections, it has limited potential as a screening test among compromised patients. Immunodiffusion and counterimmunoelectrophoresis using a mycelial antigen were found to be more sensitive than either test using a combined yeast and mycelial antigen or a pure yeast phase antigen. Counterimmunoelectrophoresis at pH 7.2 proved to be the test of choice for serodiagnosis of histoplasmosis, resolving 85% of the immunocompetent infected patients and 100% of the infected immunosuppressed patients. Results indicated that counterimmunoelectrophoresis in conjunction with immunodiffusion could be used as a screening protocol to determine infection in incoming patients in a cancer hospital.