Objective:
To evaluate a multiplex immunoassay for species-specific serodiagnosis of filarial infections and strongyloidiasis in travelers and immigrants.
Approach:
- Assay Design: The assay measures IgG and IgG4 responses to Brugia malayi adult antigen and seven recombinant antigens specific to Loa loa, Wuchereria bancrofti, Onchocerca volvulus, and Strongyloides stercoralis.
- Validation: Used serum samples from patients with parasitologically confirmed single infections and 70 uninfected controls to establish assay performance.
- Testing: Prospectively tested samples from 1,865 unique patients to assess species-specific serodiagnosis, with 318 seropositive samples analyzed.
Key Findings:
- The multiplex assay provided a species-specific serodiagnosis for 80% of seropositive samples.
- Specificity exceeded 98% for all recombinant antigens.
- Coinfection was observed in 10% of seropositive samples.
- 20% of seropositive samples had undetermined infecting species despite filarial antibody reactivity.
- Specific sensitivity and specificity values for each antigen were reported.
Interpretation:
The assay improves diagnostic accuracy for filarial infections and strongyloidiasis, utilizing both IgG and IgG4 responses.
Limitations:
- Antibody testing may not accurately reflect active infection.
- Cross-reactivity can lead to false positives.
- Antibodies may persist post-treatment.
- Recent exposure may not show seroconversion.
- A positive antibody result may reflect prior rather than active infection.
Conclusion:
IgG- and IgG4-based serology offers a sensitive approach for diagnosing filarial infections.
Sources:
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