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Published on: September 6, 2016
Serologic diagnosis of whooping cough by enzyme-linked immunosorbent assay
S P Conway1, A H Balfour, H Ross
1Department of Infectious Diseases, Seacroft Hospital, Leeds, England.
Insights
Serological testing for Bordetella pertussis antibodies using enzyme-linked immunosorbent assay offers higher sensitivity than pernasal swab cultures for diagnosing whooping cough. However, it is not a standalone diagnostic tool, especially in young infants.
Area of Science:
- * Pediatric Infectious Diseases
- * Microbiology and Immunology
Background:
- * Whooping cough, caused by Bordetella pertussis, remains a significant public health concern, necessitating accurate diagnostic methods.
- * Traditional diagnostic approaches, such as pernasal swab culture, have limitations in sensitivity and timeliness.
Purpose of the Study:
- * To evaluate the diagnostic utility of enzyme-linked immunosorbent assay (ELISA) for detecting immunoglobulin A (IgA) and immunoglobulin M (IgM) antibodies to Bordetella pertussis in children with suspected whooping cough.
- * To compare the sensitivity and specificity of serological testing with pernasal swab culture.
Main Methods:
- * Pernasal swabs and serum samples were collected from 146 children hospitalized with suspected whooping cough over three consecutive days.
- * Bordetella pertussis-specific IgA and IgM antibodies were measured using ELISA.
- * Pernasal swab cultures were performed for bacterial identification.
Main Results:
- * Serology confirmed 64 cases, demonstrating higher sensitivity (57%) compared to pernasal swab culture (35%), with equivalent specificity (100%).
- * Paired serum samples were required for diagnosis in 47% of serologically confirmed cases.
- * A significant proportion (43%) of culture-confirmed cases showed negative serological results, particularly in young infants with less reliable antibody responses.
Conclusions:
- * ELISA for detecting Bordetella pertussis antibodies is a valuable supplementary test in the differential diagnosis of whooping cough.
- * Serological testing should not be used as the sole diagnostic method due to potential false negatives, especially in vulnerable populations like young infants.
- * Combined diagnostic approaches, including clinical assessment, serology, and potentially culture, are crucial for accurate whooping cough diagnosis.
Abstract:
Pernasal swabs were obtained on 3 consecutive days from 146 children referred for hospital admission with suspected whooping cough, and immunoglobulin A and immunoglobulin M antibodies to Bordetella pertussis were measured by enzyme-linked immunosorbent assay. The clinical features in 113 of the children were considered consistent with the diagnosis. Sixty-four cases were confirmed by serology, which showed a greater sensitivity (57% vs. 35%) than pernasal swab culture with no loss of specificity (100%). Paired serum samples were necessary for diagnosis in 30 (47%) of these 64 cases. Seventeen (43%) of 40 cases confirmed by pernasal swab culture had negative serologic results. Most of these were young infants who showed a less reliable antibody response. Detection of antibodies to B. pertussis by enzyme-linked immunosorbent assay can be a valuable additional test in the differential diagnosis of whooping cough but is not appropriate as the sole diagnostic test.
