Comparison of four assays for the detection of cryptococcal antigen.

We compared the performance of four assays for the detection of cryptococcal antigen in serum samples (n = 634) and cerebrospinal fluid (CSF) samples (n = 51). Compared to latex agglutination, the sensitivity and specificity of the Premier enzyme immunoassay (EIA), Alpha CrAg EIA, and CrAg lateral flow assay (LFA) were 55.6 and 100%, 100 and 99.7%, and 100 and 99.8%, respectively, from serum samples. There was 100% agreement among the four tests for CSF samples, with 18 samples testing positive by each of the assays.

Clinical comparison of the Treponema pallidum CAPTIA syphilis-G enzyme immunoassay with the fluorescent treponemal antibody absorption immunoglobulin G assay for syphilis testing.

Recently, a treponema-specific immunoglobulin G (IgG) enzyme immunoassay (EIA), the CAPTIA Syphilis-G (Trinity Biotech, Jamestown, N.Y.), has become available as a diagnostic test for syphilis. A total of 89 stored sera previously tested by the fluorescent treponemal antibody absorption (FTA-ABS) IgG assay were evaluated by the CAPTIA EIA. The FTA-ABS IgG procedure was performed by technologists unblinded to results of rapid plasmid reagin (RPR) testing of the same specimens. Borderline CAPTIA-positive samples (antibody indices of >/=0.650 and 0.900, the sample was considered positive. Thirteen of 89 (15%) samples had discrepant results. Compared to the FTA-ABS assay, the CAPTIA EIA had a sensitivity and specificity and positive and negative predictive values of 70.7, 97.9, 96.7, and 79.7%, respectively. In another analysis, discrepancies between results were resolved by repeated FTA-ABS testing (technologists were blinded to previous RPR results) and patient chart reviews. Seven CAPTIA-negative samples which were previously interpreted (unblinded) as minimally reactive by the FTA method were subsequently interpreted (blinded) as nonreactive. One other discrepant sample (CAPTIA negative and FTA-ABS positive [at an intensity of 3+], unblinded) was FTA negative with repeated testing (blinded). For the five remaining discrepant samples, chart reviews indicated that one patient (CAPTIA negative and FTA-ABS positive [minimally reactive], blinded) had possible syphilis. These five samples were also evaluated and found to be negative by another treponema-specific test, the Treponema pallidum microhemagglutination assay. Therefore, after repeated testing and chart reviews, 2 of the 89 (2%) samples had discrepant results; the adjusted sensitivity, specificity, and positive and negative predictive values were 96.7, 98.3, 96.7, and 98.3%, respectively. This study demonstrates that the CAPTIA IgG EIA is a reliable method for syphilis testing and that personnel performing tests which require subjective interpretation, like the FTA-ABS test, may be biased by RPR test results.

Evaluation of an enzyme-linked immunoassay for the detection in serum of antibodies to Entamoeba histolytica.

A commercially available enzyme-linked immunoassay (ELISA) was compared to an indirect hemagglutination test (IHA) for the detection of antibodies to Entamoeba histolytica on 225 patients' serums. All of the 107 serums that had IHA titers of < 32 (interpreted as excluding the presence of invasive amebiasis) were ELISA negative. Sixty-three of 68 (93%) serums that had IHA titers of > or = 128 (interpreted as indicative of the presence of active or recent infection) were ELISA positive. Fifty serums had IHA titers of 32 or 64 that were considered "equivocal," and the ELISA results for these were: six positive, 35 negative, and nine "intermediate" (optical density values between the arbitrary positive cutoff and the low positive control). It was concluded that "intermediate" (and negative) ELISA results should be interpreted as excluding the presence of invasive amebiasis. Using these criteria, the results obtained with this ELISA appear to compare favorably with those of the "gold standard" IHA. Therefore, this ELISA provides a reliable alternative to the IHA for the serologic diagnosis of amebiasis, which may be advantageous for some laboratories in terms of lower cost, shorter test time, and improved efficiency.