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Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review

Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the “gold standard” to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the d...

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Autores principales: Dhawan, Sandhya, Robinson, Matthew T., Stenos, John, Graves, Stephen R., Wangrangsimakul, Tri, Newton, Paul N., Day, Nicholas P. J., Blacksell, Stuart D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356422/
https://www.ncbi.nlm.nih.gov/pubmed/32274984
http://dx.doi.org/10.4269/ajtmh.19-0818
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author Dhawan, Sandhya
Robinson, Matthew T.
Stenos, John
Graves, Stephen R.
Wangrangsimakul, Tri
Newton, Paul N.
Day, Nicholas P. J.
Blacksell, Stuart D.
author_facet Dhawan, Sandhya
Robinson, Matthew T.
Stenos, John
Graves, Stephen R.
Wangrangsimakul, Tri
Newton, Paul N.
Day, Nicholas P. J.
Blacksell, Stuart D.
author_sort Dhawan, Sandhya
collection PubMed
description Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the “gold standard” to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: “murine typhus,” “rickettsia typhi,” “immunofluorescence,” “IFA,” and “serologic” with restrictions (i.e., “rickettsia typhi” or “murine typhus,” and “IFA” or “immunofluorescence,” or “serologic*”). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients.
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spelling pubmed-73564222020-07-20 Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review Dhawan, Sandhya Robinson, Matthew T. Stenos, John Graves, Stephen R. Wangrangsimakul, Tri Newton, Paul N. Day, Nicholas P. J. Blacksell, Stuart D. Am J Trop Med Hyg Review Article Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the “gold standard” to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: “murine typhus,” “rickettsia typhi,” “immunofluorescence,” “IFA,” and “serologic” with restrictions (i.e., “rickettsia typhi” or “murine typhus,” and “IFA” or “immunofluorescence,” or “serologic*”). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients. The American Society of Tropical Medicine and Hygiene 2020-07 2020-04-06 /pmc/articles/PMC7356422/ /pubmed/32274984 http://dx.doi.org/10.4269/ajtmh.19-0818 Text en © The American Society of Tropical Medicine and Hygiene This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Review Article
Dhawan, Sandhya
Robinson, Matthew T.
Stenos, John
Graves, Stephen R.
Wangrangsimakul, Tri
Newton, Paul N.
Day, Nicholas P. J.
Blacksell, Stuart D.
Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title_full Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title_fullStr Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title_full_unstemmed Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title_short Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review
title_sort selection of diagnostic cutoffs for murine typhus igm and igg immunofluorescence assay: a systematic review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356422/
https://www.ncbi.nlm.nih.gov/pubmed/32274984
http://dx.doi.org/10.4269/ajtmh.19-0818
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