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Pertussis toxin IgA testing over-diagnoses recent pertussis infection
Meryta L May1, Jenny Evans2, Thomas Holgate2
1Sullivan Nicolaides Pathology, Brisbane, Qld, Australia; Lady Cilento Children's Hospital, Brisbane, Qld, Australia.
Pathology
|October 20, 2017
Summary
Pertussis toxin (PT) IgA testing offers limited diagnostic value for recent pertussis when combined with PT IgG assays. Isolated PT IgA results, especially in older individuals, do not reliably indicate recent infection.
Area of Science:
- Immunology
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Pertussis diagnosis relies on serological markers like pertussis toxin (PT) IgG.
- The role of PT IgA in diagnosing recent pertussis infection requires further clarification.
Purpose of the Study:
- To evaluate the diagnostic contribution of PT IgA testing in conjunction with PT IgG assays.
- To assess the specificity and utility of new automated assays for PT IgA and IgG.
Main Methods:
- Evaluation of two automated assays (DiaSorin Liaison) for PT IgG and PT IgA.
- Retrospective analysis of Sullivan Nicolaides Pathology PT IgA assay results (2013-2015).
- Comparison of diagnostic specificity between PT IgG alone versus combined PT IgG and PT IgA testing.
Main Results:
- Combined PT IgG and PT IgA testing reduced specificity compared to PT IgG alone for both evaluated assays.
- An algorithm restricting PT IgA testing to equivocal PT IgG results improved specificity for the DiaSorin Liaison assay.
- Isolated PT IgA responses were uncommon and showed an age-related increase not linked to recent pertussis.
Conclusions:
- PT IgA testing provides minimal additional diagnostic value to accurate PT IgG assays in an Australian population.
- Reflex testing of PT IgA for equivocal PT IgG results may be considered if laboratory workflow allows.
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