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. 2002 May;9(3):544-9.
doi: 10.1128/cdli.9.3.544-549.2002.

Use of immunoglobulin m cross-reactions in differential diagnosis of human flaviviral encephalitis infections in the United States

Denise A Martin  1 , Brad J Biggerstaff, Becky Allen, Alison J Johnson, Robert S Lanciotti, John T Roehrig
Affiliations

Use of immunoglobulin m cross-reactions in differential diagnosis of human flaviviral encephalitis infections in the United States

Denise A Martin et al. Clin Diagn Lab Immunol. 2002 May.

Abstract

To define the virus specificity of the immunoglobulin M (IgM) antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA) among the medically important members of the Japanese encephalitis (JE) virus serocomplex of flaviviruses, 103 IgM-positive human serum samples from patients with confirmed West Nile (WN) virus, St. Louis encephalitis (SLE) virus, or JE virus infections were assembled and simultaneously tested against all three viral antigens in a standardized MAC-ELISA. Of the serum samples tested, 96 (93%) showed higher positive-to-negative absorbance ratios (P/Ns) with the infecting virus antigen compared to those obtained with the other two virus antigens. Of the seven specimens with higher P/Ns with heterologous virus antigens, six were from patients with SLE virus infections (the serum samples had higher levels of reactivity with WN virus antigen) and one was from a patient with a JE virus infection (this serum sample also had a higher level of reactivity with WN virus antigen). Not surprisingly, similar virus specificity was observed with WN virus-elicited IgM in cerebrospinal fluid. As shown in previous studies, a subset of these specimens was even less reactive in the MAC-ELISA with dengue virus, a member of a different flavivirus serocomplex. The degree of virus cross-reactivity did not appear to be related to days postonset, at least during the first 40 days of infection. Infections with WN virus could be correctly distinguished from infections with SLE virus on the basis of the observed anti-viral IgM cross-reactivities alone 92% of the time. Infections with SLE virus resulted in antibody that was more cross-reactive, so identification of SLE virus as the infecting agent by use of MAC-ELISA cross-reactivity alone was more problematic.

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Figures

FIG. 1.
FIG. 1.
Line scatter graphs illustrating the extent of cross-reaction between four flaviviral antigens and WN, SLE, and JE virus IgM-positive human serum specimens.
FIG. 2.
FIG. 2.
Line scatter graphs illustrating the extent of cross-reaction between WN virus and SLE virus antigens in WN virus IgM-positive CSF.
FIG. 3.
FIG. 3.
Empirical ROC curves by use of P/Ns for WN, SLE, and JE viruses.
See this image and copyright information in PMC

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