Long-term viability and proliferation of alginate-encapsulated 3-D HepG2 aggregates formed in an ultrasound trap.

We report proof of principle here of a gel encapsulation technique that departs from the minimum surface area to volume restriction of spherical microcapsules and allows gelation of preformed high-density (>or=2x10(4) cells/aggregate) 3-D HepG2 cell aggregates. The process involves forming a discoid 3-D cell aggregate in an ultrasound standing wave trap (USWT), which is subsequently recovered and encapsulated in alginate/CaCl2 hydrogel. The size of the ultrasound-formed aggregates was dependent upon the initial cell concentration, and was in the range of 0.4-2.6 mm in diameter (for cell concentrations ranging between 10(4) and 5x10(6)/ml). At low cell concentrations (or=10(6)/ml, 3-D aggregates were generated. Cells in non- and encapsulated 3-D HepG2 aggregates remained 70-80% viable over 10 days in culture. The proliferative activity of the aggregates resulted in the doubling of the aggregate cell number and a subsequent increase in the aggregate thickness, while albumin secretion levels in encapsulated aggregates was 4.5 times higher compared to non-encapsulated, control aggregates. The results reported here suggest that the ultrasound trap can provide an alternative, novel approach of hydrogel cell encapsulation and thus rapidly (within 5 min) produce in vitro models for hepatocyte functional studies (for example, toxicity studies particularly if primary hepatocytes are used) in a tissue-mimetic manner.

Development of a novel compact sonicator for cell disruption.

Ultrasound microbial cell disrupters operating at around 20 kHz are often physically large and, due to significant heating, can be unsuitable for small sample volumes where biochemical integrity of the extracted product is required. Development of a compact device based on a 63.5-mm diameter, 6.5-mm thick tubular transducer for rapid cell disruption in small-volume samples in a high-intensity acoustic cavitation field with minimal temperature rises is described here. Suspensions of Saccharomyces cerevisiae were exposed to cavitation for various times in the compact device and a 20-kHz probe sonicator. Cell disruption was assessed by protein release and by staining. Yeast cell disruption was greater in the novel 267-kHz sonicator than in the 20-kHz probe sonicator for the same exposure time. A 1-dimensional (1-D) transfer matrix model analysis for piezoelectric resonators was applied to an axial cross-section of the tubular sonicator to predict frequencies of mechanical resonance in the sample volume associated with maximum acoustic pressure. Admittance measurements identified frequencies of electrical resonance. Ultrasonic cavitation noise peaks were detected by a hydrophone at both the mechanical and electrical resonances. Cell breakage efficiency was twice as great in terms of protein released per dissipated watt at the mechanical resonance predicted by the model, compared to those at the electrical resonance frequencies. The results form a basis for rational design of an ultrasound cell disruption technique for small-volume samples.

Cell-cell contact and membrane spreading in an ultrasound trap.

An ultrasonic standing wave trap [Langmuir 19 (2003) 3635] in which the morphologies of 2-D latex-microparticle aggregates, forming a pressure node plane, were characterised has been applied here to different cell suspensions with increasing order of specificity of cross-linking molecule, i.e. polylysine with chondrocytes; wheat germ agglutinin (WGA) with erythrocytes and surface receptors on neural cells. The outcome of initial cell-cell contact, i.e. whether the cells stuck at the point of contact (collision efficiency = 1) or rolled around each other (collision efficiency = 0), was monitored in situ by video-microscopy. The perimeter fractal dimensions (FD) of 2-D hexagonally symmetric, closely packed aggregates of control erythrocytes and chondrocytes were 1.16 and 1.18, respectively while those for the dendrititc aggregates formed initially by erythrocytes in 0.5microg/ml WGA and chondrocytes in 20 microg/ml polylysine were 1.49 and 1.66. The FDs for control and molecularly cross-linked cells were typical of reaction-limited aggregation (RLA) and transport diffusion-limited aggregation (DLA), respectively. The FDs of the aggregates of cross-linked cells decreased with time to give more closely packed aggregates without clear hexagonal symmetry. Suspensions of neural cells formed dendritic aggregates. Spreading of inter-cellular membrane contact area occurred over 15 min for both erythrocyte and neural cell dendritic aggregates. The potential of the technique to characterise and control the progression of cell adhesion in suspension away from solid substrata is discussed.

Manipulation of in vitro toxicant sensors in an ultrasonic standing wave.

Multi-cellular spheroids are increasingly employed as in vitro sensors of toxicants and a single spheroid can be used as a test object. An ultrasonic standing wave trap (USWT) can hold small particles in a medium-flowing system. This study investigated the conditions for holding HepG2 spheroids in an USWT and its relevance to use in toxicity testing. It can take many hours to reach a detectable end point of cell damage in a standard cellular in vitro toxicant assay and the process might be accelerated through increased sample flow past the spheroid. A USWT was employed here to levitate and hold HepG2 spheroids stationary against a flow of 3 mm s(-1) when the acoustic pressure amplitude is 1.9 MPa. The ultrasonic drive frequency was 1.64 MHz. Acoustic microstreaming in the standing wave chamber generated 1 mm s(-1) flow past a levitated spheroid-scale (80 microm diameter) latex particle in the absence of sample through-flow. The conditions required to form aggregates of cells of a HepG2 cell line in a single half wavelength ultrasonic standing wave mini-chambers are also described here. It is argued that the manipulation capabilities demonstrated may have potential in increasing the efficiency of in vitro toxicant detection by spheroids. Preliminary, visual (unquantified) fluorescence microscopy observations of spheroids levitated in the standing wave in the presence of the toxicant DL-propranolol do suggest accelerated loss of viability compared with controls.

Ultrasound enhanced detection of individual meningococcal serogroups by latex immunoassay.

AIMS: To examine A, C, Y, and W135 Neisseria meningitidis serogroup characterisation by ultrasonic standing wave enhanced latex agglutination tests (USELATs) of clinical samples. In addition, to determine USELAT enhancement of detection sensitivity for the individual antigens compared with conventional card latex agglutination tests (LATs). METHODS: Wellcogen (Abbott Murex), Slidex meningite kit 5 (bioMerieux), and Pastorex (Sanofi) kits and beads coated in house with antibodies to Y and to W135 alone were tested. Positive control antigens consisted of A and C polysaccharide preparations and the Pastorex Y/W135 kit sample. The limiting concentrations of antigen detection were determined by USELAT and by LAT. Thirty five clinical samples (plasma), previously characterised by the polymerase chain reaction (PCR) and culture, were tested by USELAT and, when sample volume allowed, by LAT. RESULTS: USELAT enhancement of control antigen detection ranged from 16 to 128 fold for the different latex systems. Enhancements for the different control antigens were comparable between kits. USELAT tests of clinical (A/C/Y/W135) samples (n = 15) with the Wellcogen (A/C/Y/W135) and Slidex meningite (A/C/Y/W135) kits showed comparable specificities. A set (n = 22) of Y and W135 samples gave 18, 19, and 17 positive results for Wellcogen (A/C/Y/W135), Pastorex (A/C/Y/W135), and in house beads (Y/W135), respectively. Positive USELAT PCR and culture results were concordant. A typical sensitivity for the commercial kits was 80% (Wellcogen). CONCLUSIONS: USELAT identified serogroups for 80% of samples, whereas LATs identified only 40%. The USELAT detection of the A, C, Y, and W135 antigen serogroups showed comparable enhancement for the kits tested. The commercial availability of latex beads coated with antibody to the Y and W135 serogroups would expedite their identification.

Phagocytosis by Acanthamoeba castellanii: ionic strength dependence of the probability of cell attachment; ingestion and contact seam morphology.

The phagocytosis of glutaraldehyde-fixed horse erythrocytes by Acanthamoeba castellanii has been examined in iso-osmolal phosphate buffered saline/sucrose suspending phases of ionic strength, I, ranging from 0.17 to 0.0017. The erythrocytes were exposed, at a ratio of 15:1, to 5x10(6) amoeba in 0.2 ml volumes. The average number of erythrocytes forming a contact with an amoeba over 30 min (T(30)) was well described by T(30)=5.2 exp(-0.112xI(-0.5)). The index of the exponential 'probability of attachment' term may also be expressed in terms of either surface potential (psi(0)) or the Debye length (kappa(-1)). The probability term is formally similar to a Bolzmann factor. Electron microscopy showed that contact spreading of the amoeba over the erythrocyte took place by formation of discrete contacts and that the lateral separation distance between contacts was 0.66, 1.36 and 1.59 &mgr;m for ionic strengths 0.17, 0.052 and 0.0017, respectively. The direction of change in lateral contact separation distance was consistent with published changes in focal contact separation when amoeba move over glass or when human erythrocyte-erythrocyte adhesion occurs in different ionic strength media. The direction was also consistent with interfacial instability theory predictions for the dependence of localised membrane contact formation on interaction potential. The proportion of attached cells that were subsequently ingested correlated more strongly with the number of contacts formed along the cell-cell contact region (seam) than with the seam length at different ionic strengths.

Erythrocyte agglutination by wheat germ agglutinin: ionic strength dependence of the contact seam topology.

The topology of the cell-cell contact seam formed when normal or pronase pre-treated (PPT) erythrocytes are exposed to wheat germ agglutinin (WGA) in isotonic media of different ionic strengths was examined here. Lectin uptake and cell agglutination were also quantified. Agglutination of normal cells was gradually and significantly inhibited as ionic strength (IS) was reduced from 0.15 (buffered 145 mm NaCl) to 0.105. Agglutination was less inhibited in PPT cells, even when IS was reduced to 0.09. Cell contact seams formed during agglutination showed patterns of localized contacts. The scale of the patterns, i.e. the average lateral separation distance of contact regions, was 0.62 microm for normal cells and was significantly shorter, at 0.44 microm, for PPT cells at an IS of 0.15. The scale increased significantly for both cell types when the IS was reduced to 0.09. Flow cytometry measurements showed that WGA uptake by normal cells increased slightly, whilst that for PPT cells was unchanged, as IS was decreased from 0.15 to 0.09. The results imply that, whilst ionic strength change does not exert a strong influence on intermolecular WGA-ligand binding, physico-chemical modification of the interaction between cells modulates not only the extent and progression of the biospecific lectin-induced cell-cell agglutination but also the topology of the contact seam. The IS dependence of contact separation in WGA-agglutinated cells is contrasted here with that reported for cells adhering in dextran solutions. The influence of IS change and pronase pre-treatment on contact pattern are consistent with predictions, from interfacial instability theory, of punctuate thinning of the aqueous layer separating bilayer membranes in close apposition.

Detection of meningococcal antigen by latex agglutination.

Meningococcal meningitis and septicemia are serious infections with significant morbidity and mortality. A sensitive affordable test is required to provide evidence of meningococcal disease at the earliest opportunity to improve local management and give early warning of potential outbreaks of disease. Culture of organisms is considered the gold standard for diagnosis but is slow (24 h or more) and increasingly influenced by prior antibiotic treatment. Recently, the development of polymerase chain reaction (PCR) has improved diagnosis but this sensitive assay is costly, is not available at most primary care institutions and is not feasible for developing countries. Conventional latex agglutination (LA) enables rapid detection of bacterial antigen in cerebrospinal fluid (CSF) (1,2) and can also be used to test specimens of blood (3,4) or urine (5) and for serogroup determinations on primary cultures (6,7). We discuss here test-card agglutination and also describe a new technique based upon LA in an ultrasonic standing wave that retains the speed of direct antigen testing while significantly increasing sensitivity.

Plasma preparation from whole blood using ultrasound.

A technique to efficiently separate plasma from human whole blood is described. Essentially, 3-mL samples are held on the axis of a tubular transducer and exposed for 5.7 min to an ultrasonic standing wave. The cells concentrate into clumps at radial separations of half wavelength. The clumps grow in size and sediment under gravity. A distinct plasma/cell interface forms as the cells sediment. The volume of clarified plasma increases with time. The separation efficiencies of transducers of 29-mm and 23-mm internal diameters driven, by test equipment, at radial resonances of 3.4 and 1.5 MHz, respectively, were compared. The average efficiency of separation was 99.6% at 1.5 MHz and 99.4% with the 3.4-MHz system. The cleared plasma constituted 30% of the sample volume at 1.5 MHz and 25% at 3. 4 MHz. There was no measurable release of haemoglobin or potassium into the suspending phase, indicating that there was no mechanical damage to cells at either frequency. A total of 114 samples from volunteers and patients were subsequently clarified in a 1.5-MHz system driven by an integrated generator. The average efficiency of clarification of blood was 99.76% for the latter samples. The clarification achieved is a significant improvement on that previously reported (98.5%) for whole blood exposed to a planar ultrasonic standing wave field (Peterson et al. 1986). We have, therefore, now achieved a six-fold reduction of cells in plasma compared to previous results.

Analytical scale ultrasonic standing wave manipulation of cells and microparticles.

The ultrasonic standing-wave manipulation of suspended eukaryotic cells, bacteria and submicron latex or silica particles has been examined here. The different systems, involving plane or tubular ultrasonic transducers and a range of acoustic pathlengths, have been designed to treat suspension volumes of analytical scale i.e. 5 ml to 50 microliters for both sample batch and 'on-line' situations. Frequencies range from 1 to 12 MHz. The influence of secondary cell-cell interaction forces in determining the cell concentration dependence of harvesting efficiency in batch sedimentation systems is considered. Applications of standing wave radiation forces to (1) clarify cell suspensions, (2) enhance particle agglutination immunoassay detection of cells or cellular products and (3) examine and enhance cell-cell interactions in suspension are described.

Clarification of plasma from whole human blood using ultrasound.

There has been interest for a number of years in the possibility of separating blood into cells and plasma by methods other than centrifugation, so that the plasma can be analysed on-line. Cells in whole blood normally occupy about 45% of the suspension volume. It has been shown with a number of different cell types, such as yeast and bacteria, that for concentrations of this order the cells are not as efficiently harvested by ultrasound as those for lower concentrations. In this study, removal of cells from 3-4 ml whole blood volumes has been examined in ultrasonic standing wave fields from tubular transducers driven at a frequency of 1.6 MHz. Samples of whole human blood (n = 11) from two volunteers have been processed by three tubular transducers where high levels of cell removal, 99.7% on average, have been demonstrated with high reproducibility between samples as well as for different transducers.

Measurement of serum antigen concentration by ultrasound-enhanced immunoassay and correlation with clinical outcome in meningococcal disease.

The distribution of Neisseria meningitidis serogroup B and C polysaccharide antigen in blood and the prognostic significance of antigen concentration was examined by ultrasound-enhanced immunoagglutination of coated microparticles. Specimens (169 sera/plasma from 145 patients with confirmed meningococcal disease) were tested retrospectively. The ultrasonic immunoassay detected serum antigen in 136 samples from 112 patients. Titration of antigen-positive specimens allowed estimation of blood antigen concentration. The modal blood antigen titre was 1/16, corresponding to an estimated polysaccharide concentration of 0.85 microg/ml. The lowest mean blood antigen concentration found ultrasonically was 0.05 microg/ml; compared to the 1.98 microg/ml found by conventional latex agglutination, this represents an approximately 30-fold improvement in sensitivity. Three grades of outcome were correlated with the presenting antigen titre in 83 patients: (i) <2 weeks hospitalisation, (ii) > or =2 weeks hospitalisation and (iii) mortality. High polysaccharide concentrations correlated with mortality. Nine of 15 patients with a serum antigen titre of 1/64 or greater (> or =3.4 microg/ml polysaccharide) died, whereas no patient with titres equal to or less than 1/4 (< or = 0.21 microg/ml) died, including those patients in whom antigen was undetectable by ultrasonic immunoassay. Increasing antigen concentration significantly correlated with severity of outcome (P<0.001). Ultrasound-enhanced agglutination provides a rapid prognostic indicator by sensitive measurement of serum antigen level.

Observation of yeast cell movement and aggregation in a small-scale MHz-ultrasonic standing wave field.

Aggregation of suspended yeast cells in a small-scale ultrasonic standing wave field has been monitored and quantified. The aggregation effect is based on the acoustic radiation force, which concentrates the cells in clumps. The ultrasonic chamber employed (1.9 MHz, one wavelength pathlength) had a sonication volume of 60 microl. The aggregation process was observed from above the transducer through a transparent glass reflector. A distinct, reproducible, pattern of clumps formed rapidly in the sound field. The sound pressure was estimated experimentally to be of the order of 1 MPa. Microscopic observations of the formation of a single clump were recorded onto a PC. The time dependent movement patterns and travelling velocities of the cells during the aggregation process were extracted by particle image velocimetry analysis. A time dependent change was seen in the particle motion pattern during approach to its completion of clump formation after 45 s. Streaming eddies were set-up during the first couple of seconds. The scale of the eddies was consistent with Rayleigh micro-streaming theory. An increase in the travelling velocity of the cells was observed after 30 s from initially about 400 microm s(-1) to about 1 mm s(-1). The influence of a number of mechanisms on particle behaviour (e.g. micro-streaming, particle interactions and convective flow) is considered. The experimental set-up introduced here is a powerful tool for aggregation studies in ultrasonic standing waves and lays the foundation for future quantitative experiments on the individual contributions of the different mechanisms.

Investigation of enhancement of two processes, sedimentation and conjugation, when bacteria are concentrated in ultrasonic standing waves.

Cells aggregate and can be recovered from suspension when exposed to an ultrasonic standing wave field. The acoustic force on individual cells in a standing wave decreases with particle volume. A plane ultrasonic field generated by a transducer driven at 3.3 MHz was used here to investigate the removal of Escherischia coli, cells with dimensions of the order of 1.0 microm, from batch suspension by sedimentation over a range of concentrations (10(3) to 10(10) cells ml(-1)). Cell removal efficiencies greater than 90% were achieved at initial concentrations of 10(10) cells ml(-1). Removal efficiencies decreased gradually to zero, as initial bacterial concentration was reduced to 10(7) cells ml(-1). It was found that, when low concentrations of E. coli (10(3) to 10(5) cells ml(-1)) were added to suspensions of larger particles (i.e. yeast cells) that were of sufficient concentration to form aggregates in the sound field, E. coli could be harvested to an efficiency of 40%. The results imply that the E. coli became trapped and sediment with aggregates of larger particles. Some strains of bacteria are capable of DNA transfer by conjugation. The transfer rate of E. coli RP4 plasmid is order of magnitudes greater when conjugation occurs on solid medium rather than in liquid suspension. We have investigated whether the conjugation rate would also be higher in ultrasonically induced E. coli clumps than in free suspension. The donor strain was mixed with a recipient strain of E. coli, then sonicated in a capillary at 4.6 MHz in a tubular transducer for 5 min. The bacteria aggregated successfully. Results showed a three-fold increase in the rate of conjugation compared to a liquid mating control.

Sub-micron particle manipulation in an ultrasonic standing wave: applications in detection of clinically important biomolecules.

Separation of particles from the suspending phase is of interest, among others, to clinical analysts. A system that enables manipulation of sub-micron sized particles in suspensions of analytical scale volume (10-50 microl) using a non-cavitating ultrasonic standing wave is described. Particle suspensions, contained in glass capillary tubes of 1-2 mm internal dimension, are treated on the axis of a tubular transducer generating a radial standing wave field at 4.5 MHz. Microparticles (of average diameter range 0.3-10 microm) suspended in buffer are concentrated within seconds at preferred regions separated by submillimetre distances. Concentration of suspended latex particles was inhibited in solutions containing protein at levels similar to those occurring in clinical specimens when the suspensions were sonicated in capillaries of circular cross-section. This effect was associated with acoustic streaming of the suspending fluid. Silica microparticles (more dense and less compressible than latex) could be concentrated in the presence of streaming. Latex particles concentrated readily in square cross-section capillaries where no streaming was observed. With sub-micron particles, the geometry of the sample chamber, the suspending phase composition and the size, density and compressibility of the microparticles all influence particle manipulation. The radial standing wave system has been used to enhance agglutination of antibody-coated latex microparticles in the presence of antigen allowing rapid and highly sensitive detection of clinically important biomolecules. The sensitivity of conventional diagnostic tests for microbial antigen has been improved by application of ultrasound and clinical utility has been demonstrated, in particular, for detection of meningitis-causing bacteria.

Development of an automated on-line analysis system using flow injection, ultrasound filtration and CCD detection.

The design and construction of an automated on-line analysis system is described with reference to applications in bioprocess control, clinical, and environmental analysis. The new system is built around three main elements: ultrasound filtration, a micro flow injection analysis (FIA) system, and direct readout spectrophotometry. The advantages of three on-line ultrasound filtration devices, developed for clarification of water, human blood and mammalian cell culture samples, are described. The filters avoid off-line centrifugation and do not suffer from the blockage problems associated with conventional filters. The separation efficiency of the ultrasound filters is also discussed. The delivery system is based on a gas driven FIA technique, using helium to avoid bubble formation, with the carrier and reagent flow being controlled by computer switched solenoid valves. Direct readout spectrometers are used, based on charge coupled devices (CCDs) covering the wavelength range 200-900 nm. These detectors provide near instantaneous capture of full spectra, allowing several analytes to be monitored simultaneously, and are much smaller than conventional spectrophotometers. Optical fibres are used to link the light source to the detector via a flow cell in the FIA system. Software to run the entire system was developed using the LabVIEWtrade mark graphical programming environment, enabling rapid development of the control system and user interface. The integration of these components has shown significant improvement in the application of FIA techniques to on-line analysis.

Ionic strength dependence of localized contact formation between membranes: nonlinear theory and experiment.

Erythrocyte membrane surface or suspending phase properties can be experimentally modified to give either spatially periodic local contacts or continuous contact along the seams of interacting membranes. Here, for cells suspended in a solution of the uncharged polysaccharide dextran, the average lateral separation between localized contacts in spatially periodic seams at eight ionic strengths, decreasing from 0.15 to 0.065, increased from 0.65 to 3.4 micrometers. The interacting membranes and intermembrane aqueous layer were modeled as a fluid film, submitted to a disjoining pressure, responding to a displacement perturbation either through wave growth resulting in spatially periodic contacts or in perturbation decay, to give a plane continuous film. Measured changes of lateral contact separations with ionic strength change were quantitatively consistent with analytical predictions of linear theory for an instability mechanism dependent on the membrane bending modulus. Introduction of a nonlinear approach established the consequences of the changing interaction potential experienced by different parts of the membrane as the disturbance grew. Numerical solutions of the full nonlinear governing equations correctly identified the ionic strength at which the bifurcation from continuous seam to a stationary periodic contact pattern occurred and showed a decrease in lateral contact and wave crest separation with increasing ionic strength. The nonlinear approach has the potential to recognize the role of nonspecific interactions in initiating the localized approach of membranes, and then incorporate the contribution of specific molecular interactions, of too short a range to influence the beginning of perturbation growth. This new approach can be applied to other biological processes such as neural cell adhesion, phagocytosis, and the acrosome reaction.

Ultrasonic enhancement of coated particle agglutination immunoassays: influence of particle density and compressibility.

The detection rate and sensitivity (analyte concentration limit) of coated particle agglutination immunoassays are increased in ultrasonic standing waves. The influence of particle volume, density and compressibility, properties that modify the ultrasonic radiation, and interaction forces the particles experience, on assay sensitivity with latex and silica particles in the range 0.25-1.0 microm is examined here. Streptavidin-coated 0.3-microm silica particles and 0.25-microm and 1.0-microm latex particles were examined for agglutination with biotinylated bovine serum albumin (bBSA) following exposure on axis in a 4.6-MHz radial standing wave. The lowest detection limit, 2 ng/mL bBSA, was achieved with the 0.3-microm silica. The detection limit decreased with increasing latex particle size. The limit of an ultrasound-enhanced agglutination immunoassay of rabbit antimouse immunoglobulin was 6-fold better with 1.0-microm coated silica than with equal-sized latex particles. Calculations show that the particle density-dependent ultrasonic interaction force dominates the particle compressibility force for the present case. The density-dependent force on silica, but not on latex particles, is shown to be comparable in magnitude to both the long-range van der Waal's attractive force and the electrostatic repulsion between the particles. This density-dependent force may explain the improved enhancement of analyte detection by coated silica compared with latex particles.

Ultrasound-enhanced latex immunoagglutination and PCR as complementary methods for non-culture-based confirmation of meningococcal disease.

Preadmission administration of antibiotics to patients with suspected meningococcal infection has decreased the likelihood of obtaining an isolate and has stimulated development of rapid and reliable non-culture-based diagnostic methods. The sensitivity of the conventional test card latex agglutination test (TCLAT) for detection of capsular polysaccharide has been reported to be suboptimal. In the United Kingdom meningococcal DNA detection by PCR has become readily available and is now used as a first-line investigation. Recently, the performance of latex antigen detection has been markedly improved by ultrasound enhancement. Three tests for laboratory confirmation of meningococcal infection, (i) PCR assays, (ii) TCLAT, and (iii) ultrasound-enhanced latex agglutination test (USELAT), were compared in a retrospective study of 125 specimens (serum, plasma, and cerebrospinal fluid specimens) from 90 patients in whom meningococcal disease was suspected on clinical grounds. Samples were from patients with (i) culture-confirmed meningococcal disease, (ii) culture-negative but PCR-confirmed meningococcal disease, and (iii) clinically suspected but non-laboratory-confirmed meningococcal disease. USELAT was found to be nearly five times more sensitive than TCLAT. Serogroup characterization was obtained by both PCR and USELAT for 44 samples; all results were concordant and agreed with the serogroups determined for the isolates when the serogroups were available. For 12 samples negative by USELAT, the serogroup was determined by PCR; however, for 12 other specimens for which PCR had failed to indicate the serogroup, USELAT gave a result. USELAT is a rapid, low-cost method which can confirm a diagnosis, identify serogroups, and guide appropriate management of meningococcal disease contacts. A complementary non-culture-based confirmation strategy of USELAT for local use supported by a centralized PCR assay service for detection of meningococci would give the benefits of timely information and improved epidemiological data.