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Cao W, Thorpe PG, O'Callaghan K, Kersh EN. Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis. Expert Rev Anti Infect Ther 2023; 21:1339-1354. [PMID: 37934903 PMCID: PMC10958575 DOI: 10.1080/14787210.2023.2280214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment. AREA COVERED This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis. EXPERT OPINION In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.
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Affiliation(s)
- Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin O'Callaghan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Fang LL, Zhu JH, Cai MJ, Zhang JW, Jiang LC, Dai Z, Lin Y, Liang XM. PCR combined with serologic testing improves the yield and efficiency of SARS-CoV-2 infection hunting: A study in 40,689 consecutive overseas arrivals. Front Public Health 2023; 11:1077075. [PMID: 36860392 PMCID: PMC9969191 DOI: 10.3389/fpubh.2023.1077075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Background The global epidemiological situation of COVID-19 remains serious. The rapid hunting of SARS-CoV-2 infection is the key means for preventing transmission. Methods A total of 40,689 consecutive overseas arrivals were screened for SARS-CoV-2 infection based on PCR and serologic testing. The yield and efficiency of different screening algorithms were evaluated. Result Among the 40,689 consecutive overseas arrivals, 56 (0.14%) subjects were confirmed to have SARS-CoV-2 infection. The asymptomatic rate was 76.8%. When the algorithm based on PCR alone was used, the identification yield of a single round of PCR (PCR1) was only 39.3% (95% CI: 26.1-52.5%). It took at least four rounds of PCR to achieve a yield of 92.9% (95% CI: 85.9-99.8%). Fortunately, an algorithm based on a single round of PCR combined with a single round of serologic testing (PCR1+ Ab1) greatly improved the screening yield to 98.2% (95% CI: 94.6-100.0%) and required 42,299 PCR and 40,689 serologic tests that cost 6,052,855 yuan. By achieving a similar yield, the cost of PCR1+ Ab1 was 39.2% of that of four rounds of PCR. For hunting one case in PCR1+ Ab1, 769 PCR and 740 serologic tests were required, costing 110,052 yuan, which was 63.0% of that of the PCR1 algorithm. Conclusion Comparing an algorithm based on PCR alone, PCR combined with a serologic testing algorithm greatly improved the yield and efficiency of the identification of SARS-CoV-2 infection.
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Affiliation(s)
- Li-Li Fang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, School of Medicine, Xiamen University, Xiamen, China
| | - Jian-Hui Zhu
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Min-Jing Cai
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Jing-Wen Zhang
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Long-Can Jiang
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Zhang Dai
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Yu Lin
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Xian-Ming Liang
- Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
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Pu Y, Weng Y, Wu Y, Gao F, Zheng X, Xiong X, Lv H, Kong Q. Antibody Response to SARS-CoV-2 in the First Batch of COVID-19 Patients in China by a Self-Developed Rapid IgM-IgG Test. Front Cell Infect Microbiol 2022; 12:915751. [PMID: 35719335 PMCID: PMC9204641 DOI: 10.3389/fcimb.2022.915751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
It has been over two years since the COVID-19 pandemic began and it is still an unprecedented global challenge. Here, we aim to characterize the antibody profile from a large batch of early COVID-19 cases in China, from January – March 2020. More than 1,000 serum samples from participants in Hubei and Zhejiang province were collected. A series of serum samples were also collected along the disease course from 70 patients in Shanghai and Chongqing for longitudinal analysis. The serologic assay (ALLtest) we developed was confirmed to have high sensitivity (92.58% - 97.55%) and high specificity (92.14% - 96.28%) for the detection of SARS-CoV-2 nucleocapsid-specific antibodies. Confirmed cases found in the Hubei Provincial Center for Disease Control and Prevention (HBCDC), showed a significantly (p = 0.0018) higher positive rate from the ALLtest than RNA test. Then, we further identified the disease course, age, sex, and symptoms that were correlating factors with our ALLtest results. In summary, we confirmed the high reliability of our ALLtest and its important role in COVID-19 diagnosis. The correlating factors we identified will require special attention during future clinical application.
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Affiliation(s)
- Yiyi Pu
- School of Laboratory Medicine and Bioengineering, Hangzhou Medical College, Hangzhou, China
| | - Youhong Weng
- Institute of Parasitic Diseases, Hangzhou Medical College, Hangzhou, China
| | - Yahan Wu
- Institute of Parasitic Diseases, Hangzhou Medical College, Hangzhou, China
| | - Fei Gao
- Department of Research and Development, Hangzhou AllTest Biotech Co., Ltd, Hangzhou, China
| | - Xiaojun Zheng
- Department of Research and Development, Hangzhou AllTest Biotech Co., Ltd, Hangzhou, China
| | - Xianqin Xiong
- Department of Research and Development, Hangzhou AllTest Biotech Co., Ltd, Hangzhou, China
| | - Hangjun Lv
- Institute of Parasitic Diseases, Hangzhou Medical College, Hangzhou, China
| | - Qingming Kong
- School of Laboratory Medicine and Bioengineering, Hangzhou Medical College, Hangzhou, China.,Institute of Parasitic Diseases, Hangzhou Medical College, Hangzhou, China
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4
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Chua PEY, Gwee SXW, Wang MX, Gui H, Pang J. Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostic Tests for Border Screening During the Very Early Phase of Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:748522. [PMID: 35237618 PMCID: PMC8882616 DOI: 10.3389/fmed.2022.748522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during border screening among returning residents and prioritized travelers during the early phase of a pandemic can reduce the risk of importation and transmission in the community. This study aimed to compare the accuracy of various SARS-CoV-2 diagnostics and assess their potential utility as border screening for infection and immunity. Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics (up to April 30, 2020). Meta-analysis and methodological assessment were conducted for all included studies. The performance of the diagnostic tests was evaluated with pooled sensitivity, specificity, and their respective 95% confidence intervals. A total of 5,416 unique studies were identified and 95 studies (at least 29,785 patients/samples) were included. Nucleic acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of the selected viral genes with a pooled sensitivity of 98% and a pooled specificity of 99%. Point-of-care (POC) serology tests had moderately high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96-98%). Serology tests were more sensitive for sampling collected at ≥ 7 days than ≤ 7 days from the disease symptoms onset. POC NAAT and POC serology tests are suitable for detecting infection and immunity against the virus, respectively as border screening. Independent validation in each country is highly encouraged with the preferred choice of diagnostic tool/s.
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Affiliation(s)
- Pearleen Ee Yong Chua
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Sylvia Xiao Wei Gwee
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Min Xian Wang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Hao Gui
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
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5
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Yap TL, Hong SY, Soh JH, Ravichandraprabhu L, Lim VWX, Chan HM, Ong TZX, Chua YP, Koh SE, Wang H, Leo YS, Ying JY, Sun W. Engineered NS1 for Sensitive, Specific Zika Virus Diagnosis from Patient Serology. Emerg Infect Dis 2021; 27:1427-1437. [PMID: 33900180 PMCID: PMC8084482 DOI: 10.3201/eid2705.190121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dengue virus (DENV) and Zika virus (ZIKV) belong to the Flaviviridae family of viruses spread by Aedes aegypti mosquitoes in tropical and subtropical areas. Accurate diagnostic tests to differentiate the 2 infections are necessary for patient management and disease control. Using characterized ZIKV and DENV patient plasma in a blind manner, we validated an ELISA and a rapid immunochromatographic test for ZIKV detection. We engineered the ZIKV nonstructural protein 1 (NS1) for sensitive serologic detection with low cross reactivity against dengue and developed monoclonal antibodies specific for the ZIKV NS1 antigen. As expected, the serologic assays performed better with convalescent than acute plasma samples; the sensitivity ranged from 71% to 88%, depending on the performance of individual tests (IgM/IgG/NS1). Although serologic tests were generally less sensitive with acute samples, our ZIKV NS1 antibodies were able to complement the serologic tests to achieve greater sensitivity for detecting early infections.
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Adachi K, Kishi K, Sakamoto U, Mishiro T, Okimoto E, Ishimura N, Ishihara S. Factors for Negative Result in Serum Anti-Helicobacter pylori IgG Antibody Test in Adult Subjects With Nodular Gastritis: A Single-center Study. Cureus 2021; 13:e15651. [PMID: 34306861 PMCID: PMC8279802 DOI: 10.7759/cureus.15651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Aim: Nodular gastritis has been demonstrated to be strongly associated with Helicobacter pylori infection. The present retrospective study was performed to elucidate factors related to a negative serum antibody test result in adults with nodular gastritis. Materials and methods: We investigated 116 H. pylori-positive subjects endoscopically diagnosed with nodular gastritis and subjected to a serum anti-H. pylori immunoglobulin G (IgG) antibody test. The degree of gastric mucosal atrophy and the presence of spotty redness in the gastric body and fornix were carefully determined by observations of endoscopic images. Results: Of the 116 investigated subjects, 108 were positive and 8 negative in serum anti-H. pylori IgG antibody test results. The degree of gastric mucosal atrophy was mild in seven among eight seronegative cases. The levels of pepsinogen II in serum in patients with negative antibody test findings were significantly lower as compared to those found positive, while the pepsinogen I/II ratio tended to be higher in subjects shown negative by the test. Only 1 of 69 with spotty redness was negative in serum anti-H. pylori IgG antibody testing, while 7 of 47 without spotty redness were negative. Multiple logistic regression analysis of subjects with a negative test result revealed that the absence of spotty redness shown by endoscopy was a significant risk factor. Conclusion: The absence of spotty redness, which may reflect the degree of gastric body inflammation, is a significant factor indicating increased risk for a negative serum anti-H. pylori IgG antibody test result in subjects with nodular gastritis.
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Affiliation(s)
- Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, JPN
| | - Kanako Kishi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, JPN
| | - Utae Sakamoto
- Health Center, Shimane Environment and Health Public Corporation, Matsue, JPN
| | - Tomoko Mishiro
- Health Center, Shimane Environment and Health Public Corporation, Matsue, JPN
| | - Eiko Okimoto
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, JPN
| | - Norihisa Ishimura
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, JPN
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Haymond A, Damluji AA, Narayanan A, Mueller C, Reeder A, Alem F, Maxwell GL, Petricoin EF, Liotta L, deFilippi CR. Durability of Viral Neutralization in Asymptomatic Coronavirus Disease 2019 for at Least 60 Days. J Infect Dis 2021; 223:1677-1680. [PMID: 33718952 PMCID: PMC7989428 DOI: 10.1093/infdis/jiab140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
A cohort consisting of asymptomatic healthcare workers donated temporal serum samples after infection with severe acute respiratory syndrome coronavirus 2. Analysis shows that all asymptomatic healthcare workers had neutralizing antibodies, that these antibodies persist for ≥60 days, and that anti-spike receptor-binding domain immunoglobulin G levels were correspondingly durable over the same time period.
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Affiliation(s)
- Amanda Haymond
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart Vascular Institute, Falls Church, Virginia, USA
| | - Aarthi Narayanan
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, Virginia, USA
| | - Claudius Mueller
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Alex Reeder
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Farhang Alem
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, Virginia, USA
| | - G Larry Maxwell
- Inova Center of Outcomes Research, Inova Heart Vascular Institute, Falls Church, Virginia, USA
| | - Emanuel F Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Lance Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Christopher R deFilippi
- Inova Center of Outcomes Research, Inova Heart Vascular Institute, Falls Church, Virginia, USA
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8
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Davison BA, Edwards C, Loomba R, Harrison SA, Cotter G, Alkhouri N, Koch GG, Dittrich HC. Noninvasive measure of treatment response in non-alcoholic steatohepatitis: Insights from EMMINENCE and meta-analysis. JGH Open 2021; 5:740-749. [PMID: 34263067 PMCID: PMC8264234 DOI: 10.1002/jgh3.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022]
Abstract
Background and Aim Liver histology changes are the current gold standard for evaluating non-alcoholic steatohepatitis (NASH), but are limited by their invasiveness and variability for sampling and interpretation. We evaluated noninvasive biomarkers as an indication of histologic changes in NASH. Methods Associations between 12-month biomarker and NASH Clinical Research Network histologic score changes in 339 patients with NASH in the EMMINENCE trial was examined with multivariable models and partial canonical correlation. A meta-analysis of 17 NASH trials including 3717 patients examined associations between these same changes and histologic response within treatment groups, and treatment effects on biomarkers and on liver histology. Biopsy measures assessed were changes in ballooning, steatosis, inflammation, and fibrosis, NASH improvement without worsening of fibrosis, and fibrosis improvement without worsening of NASH. All analytic methods suggest that a combination of aspartate aminotransferase (AST), cytokeratin-18 (CK-18 [M30 or M65]), and hemoglobin A1C (HbA1c) changes best predicts overall liver biopsy changes in response to interventions. Results The weighted average of standardized mean changes (0.403 × AST, 0.314 × CK-18, 0.283 × HbA1c) facilitated comparisons of within-group responses and treatment effects among studies included in the meta-analysis. This composite in EMMINENCE discriminated between patients with and without NASH resolution without worsening fibrosis with area under the receiver-operator characteristic curve of 0.7880, and for fibrosis improvement without NASH worsening of 0.7553. Conclusion A composite score based on changes in AST, HbA1c, and CK-18 could serve as a surrogate for liver histologic improvement and an effective objective, noninvasive tool for comparative assessment of treatment effects of novel interventions.
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Affiliation(s)
- Beth A Davison
- Momentum Research, Inc. North Carolina USA.,Inserm U942 Cardiovascular Markers in Stressed Conditions (MASCOT) Paris France
| | | | - Rohit Loomba
- NAFLD Research Center Division of Gastroenterology University of California at San Diego La Jolla California USA
| | - Stephen A Harrison
- Hepatology, Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Gad Cotter
- Momentum Research, Inc. North Carolina USA.,Inserm U942 Cardiovascular Markers in Stressed Conditions (MASCOT) Paris France
| | - Naim Alkhouri
- Metabolic Health Center Texas Liver Institute San Antonio Texas USA
| | - Gary G Koch
- Department of Biostatistics, School of Public Health University of North Carolina Chapel Hill North Carolina USA
| | - Howard C Dittrich
- Chief Medical Officer Cirius Therapeutics, Inc. San Diego California USA
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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10
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Mirijello A, Zarrelli M, Miscio G, de Matthaeis A, Piscitelli P, Carbonelli CM, Di Giorgio A, Inglese M, Ciliberti GL, Marciano C, Borelli C, Vergara D, Castorani G, Orciulo GV, Di Mauro L, Carella M, Simeone A, Copetti M, Leone MA, De Cosmo S, The Css-Covid-Group. Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology. Diagnostics (Basel) 2021; 11:386. [PMID: 33668734 DOI: 10.3390/diagnostics11030386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The diagnosis of Coronavirus disease 2019 (COVID-19) relies on the positivity of nasopharyngeal swab. However, a significant percentage of symptomatic patients may test negative. We evaluated the reliability of COVID-19 diagnosis made by radiologists and clinicians and its accuracy versus serology in a sample of patients hospitalized for suspected COVID-19 with multiple negative swabs. Methods: Admission chest CT-scans and clinical records of swab-negative patients, treated according to the COVID-19 protocol or deceased during hospitalization, were retrospectively evaluated by two radiologists and two clinicians, respectively. Results: Of 254 patients, 169 swab-confirmed cases and one patient without chest CT-scan were excluded. A total of 84 patients were eligible for the reliability study. Of these, 21 patients died during hospitalization; the remaining 63 underwent serological testing and were eligible for the accuracy evaluation. Of the 63, 26 patients showed anti-Sars-Cov-2 antibodies, while 37 did not. The inter-rater agreement was “substantial” (kappa 0.683) between radiologists, “moderate” (kappa 0.454) between clinicians, and only “fair” (kappa 0.341) between radiologists and clinicians. Both radiologic and clinical evaluations showed good accuracy compared to serology. Conclusions: The radiologic and clinical diagnosis of COVID-19 for swab-negative patients proved to be sufficiently reliable and accurate to allow a diagnosis of COVID-19, which needs to be confirmed by serology and follow-up.
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11
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Damluji AA, Christenson RH, deFilippi C. Clinical Application of Serologic Testing for Coronavirus Disease 2019 in Contemporary Cardiovascular Practice. J Am Heart Assoc 2021; 10:e019506. [PMID: 33619984 PMCID: PMC8174282 DOI: 10.1161/jaha.120.019506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022]
Abstract
In patients with cardiovascular disease, the use of antibody or serological testing is frequently encountered as the coronavirus disease 2019 pandemic continues to evolve. Antibody testing detects one form of the acquired immunological response to a pathogenic antigen. Once the immune system recognizes a viral antigen or a protein as foreign, a humoral immune response is initiated, which is generally detected by laboratory testing in 5 to 10 days after the initial exposure. While this information is critical from a public health perspective to implement surveillance systems and measures to limit infectivity and transmission rate, the misinterpretation of serologic testing in clinical practice has generated much confusion in the medical community because some attempted to apply these strategies to individual patient's treatment schemes. In this mini-review, we examine the different serologic-based testing strategies, how to interpret their results, and their public health impact at the population level, which are critical to contain the transmission of the virus in the community within a busy cardiovascular practice. Further, this review will also be particularly helpful as vaccination and immune therapy for coronavirus disease 2019 become available to the society as a whole.
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Affiliation(s)
- Abdulla A. Damluji
- The Inova Center of Outcomes ResearchInova Heart and Vascular InstituteFalls ChurchVA
- Division of CardiologyDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMD
| | | | - Christopher deFilippi
- The Inova Center of Outcomes ResearchInova Heart and Vascular InstituteFalls ChurchVA
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Coller KE, Bruce V, Cassidy M, Gersch J, Frankel MB, Vallari A, Cloherty G, Hackett J, Evans JL, Page K, Dawson GJ. Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection. Emerg Infect Dis 2021; 26:265-272. [PMID: 31961294 PMCID: PMC6986836 DOI: 10.3201/eid2602.190434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Most human pegivirus 2 (HPgV-2) infections are associated with past or current hepatitis C virus (HCV) infection. HPgV-2 is thought to be a bloodborne virus: higher prevalence of active infection has been found in populations with a history of parenteral exposure to viruses. We evaluated longitudinally collected blood samples obtained from injection drug users (IDUs) for active and resolved HPgV-2 infections using a combination of HPgV-2–specific molecular and serologic tests. We found evidence of HPgV-2 infection in 11.2% (22/197) of past or current HCV-infected IDUs, compared with 1.9% (4/205) of an HCV-negative IDU population. Testing of available longitudinal blood samples from HPgV-2–positive participants identified 5 with chronic infection (>6 months viremia in >3 timepoints); 2 were identified among the HCV-positive IDUs and 3 among the HCV-negative IDUs. Our findings indicate that HPgV-2 can establish chronic infection and replicate in the absence of HCV.
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Abstract
As the novel coronavirus severe acute respiratory syndrome coronavirus 2 caused coronavirus disease 2019 cases in the United States, the initial test was developed and performed at the Centers for Disease Control and Prevention. As the number of cases increased, the demand for tests multiplied, leading the Centers for Disease Control and Prevention to use the Emergency Utilization Authorization to allow clinical and commercial laboratories to develop tests to detect the presence of the virus. Many nucleic acid tests based on RT-PCR were developed, each with different techniques, specifications, and turnaround time. As the illnesses turned into a pandemic, testing became more crucial. The test supply became inadequate to meet the need and so it had to be prioritized according to guidance. For surveillance, the need for serologic tests emerged. Here, we review the timeline of test development, the turnaround times, and the various approved tests, and compare them as regards the genes they detect. We concentrate on the point-of-care tests and discuss the basis for new serologic tests. We discuss the testing guidance for prioritization and their application in a hospital setting.
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Affiliation(s)
- Stephanie Ward
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew Lindsley
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Josh Courter
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Sulleiro E, Frick MA, Rodó C, Espasa M, Thorne C, Espiau M, Martín-Nalda A, Suy A, Giaquinto C, Melendo S, Rando A, Alarcón A, Martinón-Torres F, Pumarola T, Soler-Palacín P, Soriano-Arandes A. The challenge of the laboratory diagnosis in a confirmed congenital Zika virus syndrome in utero: A case report. Medicine (Baltimore) 2019; 98:e15532. [PMID: 31096455 PMCID: PMC6531038 DOI: 10.1097/md.0000000000015532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible. PATIENT CONCERNS A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS). DIAGNOSIS ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS. INTERVENTIONS The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes. OUTCOMES The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report. CONCLUSION We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection.
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Affiliation(s)
- Elena Sulleiro
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Marie Antoinette Frick
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Carlota Rodó
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Mateu Espasa
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Claire Thorne
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- University College London, London, United Kingdom
| | - María Espiau
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Andrea Martín-Nalda
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Anna Suy
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Carlo Giaquinto
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- University of Padova, PENTA Foundation, Padova, Italy
| | | | - Ariadna Rando
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ana Alarcón
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Federico Martinón-Torres
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - Antoni Soriano-Arandes
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
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Rockstroh A, Barzon L, Kumbukgolla W, Su HX, Lizarazo E, Vincenti-Gonzalez MF, Tami A, Ornelas AMM, Aguiar RS, Cadar D, Schmidt-Chanasit J, Ulbert S. Dengue Virus IgM Serotyping by ELISA with Recombinant Mutant Envelope Proteins. Emerg Infect Dis 2019; 25:1111-1115. [PMID: 30387417 PMCID: PMC6302594 DOI: 10.3201/eid2501.180605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We developed an IgM-based ELISA that identifies the dengue virus serotype of recent infections. Dominant serotypes were detectable in 91.1% of samples from travelers and 86.5% of samples from residents of endemic regions; 97.1% corresponded to the serotype identified by PCR. This ELISA enables more accurate reporting of epidemiologic findings.
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Tsai WY, Youn HH, Tyson J, Brites C, Tsai JJ, Pedroso C, Drexler JF, Balmaseda A, Harris E, Wang WK. Use of Urea Wash ELISA to Distinguish Zika and Dengue Virus Infections. Emerg Infect Dis 2018; 24:1355-1359. [PMID: 29912689 PMCID: PMC6038735 DOI: 10.3201/eid2407.171170] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Serologic testing remains crucial for Zika virus diagnosis. We found that urea wash in a Zika virus nonstructural protein 1 IgG ELISA distinguishes secondary dengue virus infection from Zika virus infection with previous dengue (sensitivity 87.5%, specificity 93.8%). This test will aid serodiagnosis, serosurveillance, and monitoring of Zika complications in dengue-endemic regions.
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Shady MMA, Fathy HA, Ali A, Galal EM, Fathy GA, Sibaii H. Comparison of Serum IgG Antibody Test with Gastric Biopsy for the Detection of Helicobacter Pylori Infection among Egyptian Children. Open Access Maced J Med Sci 2015; 3:303-6. [PMID: 27275240 PMCID: PMC4877872 DOI: 10.3889/oamjms.2015.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: In developing countries, Helicobacter pylori (H. pylori) infection is mainly acquired during childhood and may be a predisposing factor for peptic ulcer or gastric cancer later in life. Noninvasive diagnostic tools are particularly useful in children for screening tests and epidemiological studies. Data on serologic testing of children are lacking. Accurate noninvasive tests for diagnosing Helicobacter pylori infection in children are strongly required. AIM: The aim of this study was to evaluate the performance of a serological test (serum IgG antibody for H. pylori) in Egyptian children with recurrent abdominal pain necessitating endoscopy. SUBJECTS AND METHODS: One hundred children, referred to the endoscopy unit at Mansoura University. Upper endoscopy was done for each with rapid urease test (RUT) and histological examination as the gold standard test for detection of H. pylori infection. Serum samples were collected for detecting IgG for H. pylori infection. RESULTS: The mean age of the subjects included in the study was 7.23 ± 1.94 year. Serological test (IgG to H. pylori) was positive in 60% of all cases. A highly significant association between the standard test and the serological test at a cutoff > 10 U/ml at p = 0.001 were detected for the diagnosis of H. pylori infection. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the IgG antibody a cutoff > 10 U/ml, were 96.5%, 93%, 13.83, 0.038 respectively. CONCLUSION: Serum IgG antibody to H. pylori infection has a high diagnostic value and can be considered as a suitable and reliable noninvasive test for detection of H. pylori infection.
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Affiliation(s)
- Mones M Abu Shady
- Department of Child Health, Medical Research Division, National Research Centre, Dokki, Giza, Egypt
| | - Hanan A Fathy
- Health Radiation Research Department, National Center for Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
| | - Alaa Ali
- Department of Child Health, Medical Research Division, National Research Centre, Dokki, Giza, Egypt
| | - Essam M Galal
- Department of Child Health, Medical Research Division, National Research Centre, Dokki, Giza, Egypt
| | - Gihan A Fathy
- Department of Child Health, Medical Research Division, National Research Centre, Dokki, Giza, Egypt
| | - Hiba Sibaii
- Department of Medical Physiology, National Research Centre, Cairo, Egypt
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Abstract
PURPOSE To investigate the prevalence of Toxoplasma gondii and Toxocara canis in patients with uveitis. METHODS Patients with uveitis were examined. Serum antibodies to T. gondii and T. canis were tested by using the enzyme-linked immunosorbent assay. Polymerase chain reaction (PCR) was done using blood and aqueous humor (AH). RESULTS Ninety-eight patients were enrolled. Mean age was 43.5 ± 13.2 years. Six patients were seropositive for T. gondii with the following pattern: anterior uveitis, 1; posterior uveitis with retinitis, 2; pan uveitis, 2. One patient had a positive PCR result for T. gondii in AH, who showed panuveitis. Twenty-three patients were positive to serum IgG for T. canis with the following clinical manifestation: granuloma, 6; pigmented scar, 3; vitritis, 6--but none were PCR positive. CONCLUSIONS T. gondii and T. canis are still important causes of uveitis. Ocular toxocariasis is not an uncommon cause of uveitis, even in adults.
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Affiliation(s)
- Su Jin Lim
- The Retina Center of Nune Eye Hospital , Seoul , Korea
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