用单克隆抗体酶联免疫法检测临床标本中单纯疱疹病毒抗原

本文报告在太原市6所医院从各类感染性疾病中采取各种临床标本2067份,正常妇女阴道分泌物72份,用ELISA法快速分型检测单纯疱疹病毒抗原(HSV-Ag),总阳性率为24.5％,其中HSV-1占4.4％,HSV-2占20.1％;正常对照总阳性率为7.0％,HSV-1占1.4％,HSV-2占5.6％。HSV-Ag阳性率和型分布因感染部位而不同:肺部感染以HSV-1居多,生殖器疱疹、疱疹性脑炎、宫颈癌和胎儿畸型均以HSV-2为主。     

Detection of enteroviruses from clinical specimens by spin amplification shell vial culture and monoclonal antibody assay.

Conventional tube cell culture was compared with a 72-h, spin-amplified shell vial indirect immunofluorescence assay for the detection of enterovirus from clinical specimens. The sensitivity for the shell vial assay after resolution of discrepant results were 93 and 100%, respectively. The shell vial assay detected 93% of the positive cultures within 72 h of incubation while conventional tube culture detected only 51% of the positive cultures within the same time interval. The data suggest that a spin-amplified shell vial indirect immunofluorescence assay may be useful for the detection of enterovirus from clinical specimens.     

Direct detection of Mycoplasma pneumoniae antigen in clinical specimens by a monoclonal antibody immunoblot assay

Throat swabs from patients with pharyngitis and sputum specimens from patients with atypical pneumonia were tested for the presence of a Mycoplasma pneumoniae polypeptide with a molecular weight of 43,000 with the use of an M. pneumoniae species-specific monoclonal antibody in an immunoblot assay. This 43,000-dalton polypeptide was detectable in 33 of 33 throat swabs from patients with pharyngitis that were positive for M. pneumoniae by conventional culture as well as a culture-amplified enzyme immunoassay. The 43,000-dalton polypeptide was also detected in three of three M. pneumoniae culture-positive sputum specimens. It was not detected in 3 sputum specimens culture-confirmed for Legionella pneumophila, 10 sputum specimens from normal persons, or 25 throat swabs also from normal persons. This immunoblot assay could be completed within five hours and may be an alternative method for detecting M. pneumoniae antigen directly in sputum or throat swab specimens.     

A new enzyme immunoassay for the detection of enteroviruses in faecal specimens

A new enzyme immunoassay (EIA) for direct detection of enteroviruses based on a group-specific monoclonal antibody was evaluated using stool samples from patients with suspected enteroviral infection. The EIA was compared with polymerase chain reaction (PCR) and virus isolation in cell culture. Of 204 samples tested, 20 were positive by EIA, 34 by PCR, and 18 by cell culture. Compared with PCR, the most sensitive method, the sensitivity of EIA was 58% (20/34); the sensitivity of cell culture isolation was 52% (18/34). The results of both assays correlated in only 60% of cases. The combination of EIA and cell culture isolation detected 76% of PCR-positive stool samples. Enterovirus EIA provides results within 3-4 hr and requires only standard EIA equipment. It represents a rapid, reliable, and cost-effective diagnostic tool for enterovirus diagnosis from faecal samples. Negative results must be confirmed by other techniques, such as PCR or virus isolation in cell culture.     

Biotin-avidin-amplified enzyme immunoassay for detection of herpes simplex virus antigen in clinical specimens

A biotin-avidin-amplified enzyme-linked immunosorbent assay (B-A ELISA) has been developed to detect herpes simplex virus type 1 (HSV-1) and HSV-2 antigens in clinical specimens. The test was designed as a solid-phase, double-antibody, sandwich assay in which plates were coated with a polyclonal rabbit immunoglobulin G anti-HSV reagent, and the sandwich antibody was a biotin-labeled mouse immunoglobulin M monoclonal antibody that reacts with a common antigen associated with HSV-1 and HSV-2. The test can be completed in 4 h if antibody-coated plates are available. The detection limit of the B-A ELISA, determined by titration of virus stocks, was found to be approximately 90 PFU or 6 X 10(3) physical particles of either HSV-1 or HSV-2 per 50 microliter of virus stock. The following results were obtained in a study in which swabs were taken from a variety of lesions and assayed for infectivity in tissue culture and by B-A ELISA. Of 421 suspected HSV lesions tested, 69 were positive by both tests and 159 were negative by both tests. A total of 122 were positive by B-A ELISA but negative for infectivity. Seventy-one were negative by B-A ELISA but contained infectious virus. The HSV specificity of the assay was substantiated by partial blocking of reactivity with rabbit immunoglobulin G anti-HSV and by the absence of reactivity with a nonspecific biotin-labeled mouse immunoglobulin M monoclonal antibody.     

Detection of cytomegalovirus in clinical specimens by virus isolation and by a monoclonal antibody against the early nuclear antigen

A commercially available monoclonal antibody against the 72000 Dalton early nuclear protein (EA) of cytomegalovirus (CMV) strain AD169 was used in an indirect immunofluorescence staining procedure (IF) for rapid detection of CMV-infected cells in tissue cultures inoculated with clinical specimens (200 urines, 22 throat washings, 5 stools, 4 bronchoalveolar lavage fluids). The results obtained by this method were compared with those obtained by virus isolation with and without centrifugal enhancement of viral infectivity. In 66 (28.6%) of the 231 samples, CMV was detected by at least one of the methods used. Of 59 specimens producing CMV-specific cytopathic effect (CPE) in tissue culture, 46 (78%) were also positive in the EA test 16 hours after inoculation. Seven CPE-negative samples were, however, positive in the EA test. Five (38%) of the false negative EA test results were due to CMV strains that did not react with the monoclonal antibody used.     

Detection of Coccidioides species in clinical specimens by real-time PCR

Coccidioides spp. are dimorphic fungal pathogens endemic to the semiarid regions of North, Central, and South America. Currently, direct smear and culture are the most common means of identifying Coccidioides spp. While these methods offer relatively sensitive and specific means of detecting Coccidioides spp., growth in culture may take up to 3 weeks, potentially delaying the diagnosis and initiation of appropriate antifungal therapy. In addition, growth of the organism represents a significant safety risk to laboratory personnel. The need for a rapid and safe means of diagnosing coccidioidomycosis prompted us to develop a real-time PCR assay to detect Coccidioides spp. directly from clinical specimens. Primers and fluorescent resonance energy transfer (FRET) probes were designed to target the internal transcribed spacer 2 region of Coccidioides. The assay's limit of detection is below 50 targets per reaction. An analysis of 40 Coccidioides sp. clinical isolates grown in culture demonstrated 100% sensitivity of the assay. A cross-reactivity panel containing fungi, bacteria, mycobacteria, and viruses was tested and demonstrated 100% specificity for Coccidioides spp. An analysis of 266 respiratory specimens by LightCycler PCR demonstrated 100% sensitivity and 98.4% specificity for Coccidioides spp. compared with culture. Analysis of 66 fresh tissue specimens yielded 92.9% sensitivity and 98.1% specificity versus those of the culture method. The sensitivity of the assay testing 148 paraffin-embedded tissue samples is 73.4%. A rapid method for the detection of Coccidioides spp. directly from clinical material will greatly assist in the timely diagnosis and treatment of patients, while at the same time decreasing the risk of accidental exposure to laboratory personnel.     

Rapid and sensitive detection of enteroviruses in specimens from patients with aseptic meningitis.

A 5-h PCR assay (Amplicor enterovirus test) was compared with viral culture for the detection of enteroviruses in cerebrospinal fluid. Of the cerebrospinal fluid specimens collected during a summer outbreak of aseptic meningitis, 34% were positive by viral culture whereas 66% were positive by the Amplicor PCR, suggesting that this technique improves the diagnosis of enteroviral meningitis.     

Detection of fungi in clinical specimens by phase-contrast microscopy.

During 1973 and 1974, the following fungi were detected in clinical specimens by using phase-contrast microscopy: Blastomyces dermatitidis, 5; Coccidioides immitis, 3; Cryptococcus neoformans, 11; other yeasts 918; dermatophytes, 863; Mucor species, 1; and Aspergillus fumigatus, 16. This technique allows rapid detection and, in many instances, immediate identification of fungi in clinical specimens.     

Detection of Bacteroides fragilis in clinical specimens by PCR.

The direct detection of Bacteroides fragilis from clinical specimens was examined by using the PCR method for amplifying a specific fragment of the glutamine synthetase gene from B. fragilis. By this method, all five B. fragilis strains tested were detected, but DNAs from anaerobic bacteria of 24 other species tested, from aerobic bacteria of 12 species tested, and from human leukocytes were not amplified. Using the nested PCR method, we were able to detect as little as one bacterial cell or 100 fg of chromosomal DNA of B. fragilis. A total of 39 clinical specimens, which consisted of 19 bronchial aspirates, 10 percutaneous lung aspirates, 2 transtracheal aspirates, 6 pleural fluid specimens, and 2 pus specimens, were tested. All four culture-positive samples, of which two were bronchial aspirates, one was pleural fluid, and one was pus, were positive by PCR. Among 35 culture-negative samples, 2 bronchial aspirates were positive by PCR. One was from a patient whose two previous samples were positive by both culture and PCR. It had been submitted for culture several hours after collection, and clindamycin had been administered to the patient before collection of the specimen. The other bronchial aspirate positive by PCR was from a pneumonia patient who had also been administered clindamycin. We believe that B. fragilis was present in these two specimens but that either it was dead, it was below the level detectable by culture, or the process of anaerobic culture was unsuccessful. Thus, the PCR method may be considered useful for the sensitive and rapid detection of anaerobes in clinical specimens.     

Influenza virus detection in clinical specimens

The authors compared the results of influenza A (H1N1) and influenza A (H3N2) virus detection in nasopharyngeal swabs from flu patients by molecular hybridization (MH), ELISA, virus isolation and seroconversion. Using the immunofluorescence (IF) technique influenza virus was detected in cell suspensions from the first chick embryo passage. Altogether 63 swabs from various epidemic seasons were separated into 3 groups according to specimen sampling and storage. It was shown that influenza virus RNA could be found in 16 out of 22 swab specimens (72%) stored at -70 degrees C without thawing and that ELISA revealed the influenza virus antigen in 19 cases (86%); in contrast, IF was positive in 6 (27%) and virus isolation in 5 (22%) cases only. However, the positive rate of MH decreased to 9% in 21 swab specimens repeatedly thawed and stored at -20 degrees C and was completely negative after prolonged storage of repeatedly thawed samples. Despite these conditions, ELISA was still successful in both latter sample groups (71-80%). For specificity control, 29 samples coming from patients with influenza B virus and other respiratory virus diseases (adeno- and respiratory syncytial virus) were used.     

Detection of respiratory syncytial virus antigen and nucleic acid in clinical specimens using synthetic oligonucleotides

Rapid detection of respiratory syncytial (RS) virus in nasopharyngeal secretions (NPS) was carried out on cytospin cell preparations using a directly labelled monoclonal antiserum to RS virus to detect viral antigen and digoxigenin-labelled synthetic oligonucleotides to detect viral nucleic acid. Sequences of 27 and 30 bases in length from within the fusion protein and nucleocapsid genes respectively were selected for use as probes. The oligonucleotide in situ hybridization test was easy to perform and could be completed within 24 hours, but antigen detection was much more rapid and more sensitive. During 1989-1990, more positive results were obtained by antigen detection (193) than by isolation (185), but of 43 confirmed RS-virus-positive specimens, only 21 (49%) were detected by ISH. Antigen detection remains the most suitable single method of rapid detection of RS virus for a diagnostic laboratory.     

Detection of Mycoplasma hominis antigen in clinical specimens by using a four-layer modification of enzyme immunoassay (EIA)

A 4-layer modification of enzyme immunoassay (EIA) was developed for the detection of Mycoplasma hominis antigen in clinical specimens. Microtiter plates were sensitized with rabbit anti-mycoplasma immunoglobulin, guinea pig anti-mycoplasma immunoglobulin was used as the secondary antibody, and horseradish peroxidase-conjugated anti-guinea pig immunoglobulin was used as the indicator antibody. The specificity of the assay was confirmed by using guinea pig immunoglobulins from preimmunization sera. The sensitivity of the assay is down to 10 ng/ml of antigen protein. Marked cross-reactivity was demonstrated for different strains within the species M. hominis, whereas the other genital mycoplasma species tested showed no reactivity in the assay. A comparison was made of EIA and conventional culture of vaginal specimens from 24 women. All 6 specimens positive by culture were also positive for M. hominis antigen by EIA. Antigen detection by EIA is a sensitive, rapid and simple method for the detection of M. hominis in clinical specimens.     

Detection of HTLV-I in clinical specimens.

The American Red Cross, which collects 50% of blood for transfusion in the United States, now tests all prospective blood donors for HTLV-I and HTLV-II antibodies. It will therefore be important to recognize the significance and clinical spectrum of diseases associated with these viruses, and to become familiar with the current methods used to diagnose infection. This review summarizes the techniques currently in use to screen for HTLV-I/II antibodies, as well as methods to detect viral genome and/or gene products in blood and tissue specimens.     

Detection of enteroviruses by spot hybridization.

A cloned partial cDNA copy of the coxsackievirus B3 genome was used for detecting enteroviruses in infected cells by employing a nucleic acid hybridization procedure. Cells infected with coxsackieviruses A and B, echovirus, and poliovirus gave positive hybridization signals, whereas cells infected with nonrelated viruses did not.     

Specific detection of enteroviruses in clinical samples by molecular hybridization using poliovirus subgenomic riboprobes.

Enteroviruses were specifically detected in crude clinical specimens or in cell cultures in which the viruses were amplified by dot hybridization by using poliovirus type 1-derived, subgenomic radiolabeled cRNA probes (riboprobes). The sensitivity of this test varied from 2.5 to 33%, when clinical specimens without cell culture were examined, and was about 85% in cell culture lysates. The specificity of the test was 90 to 100%. The riboprobe corresponding to the 5'-noncoding sequence specifically detected the majority of enteroviruses (56 of 57 tested); the riboprobe derived from the VPI capsid region hybridized with the three poliovirus serotypes and with some coxsackieviruses type A and with echovirus type 7. Echovirus 22 did not hybridize with any riboprobe. In stool specimens, nasal aspirates, and cerebrospinal fluids from patients with meningitis, only one type of virus was identified in different clinical samples from the same patient by the seroneutralization test. Hybridization allowed the detection of enteroviral RNAs easily in stool specimens and nasal aspirates but with a low efficiency in cerebrospinal fluids without amplification of the viruses in cell cultures.     

Detection of enteroviruses by reverse-transcriptase polymerase chain reaction in cell culture negative stool specimens of patients with acute flaccid paralysis

The aim of this study was the detection of a 114 base pairs amplicon in 5' non-translated region of enterovirus genome in stool specimens of patients with acute flaccid paralysis (AFP) which were negative on cell culture. One hundred and twenty stool specimens were collected from AFP cases and tested with cell culture (RD, L20B and Hep2 cell lines). RT-PCR was carried out for the specimens with negative cell culture result. A 10% raise in enterovirus detection was observed with RT-PCR. This increased sensitivity can improve the detection of enterovirus serotypes which grow poorly in cell culture, and can thus alter significantly the medical care of patients with acute flaccid paralysis.