Search for Anti-EA(D) Antibodies in Subjects with an “Isolated VCA IgG” Pattern

The presence of an “isolated viral capsid antigen (VCA) IgG” pattern in serum is not easy to interpret without the aid of further tests, such as specific immunoblotting or a virus genome search, that often give rise to organisational and economic problems. However, one alternative is to use an enzyme-linked immunosorbent assay (ELISA) to detect anti-early antigen (EA) antibodies, which can be found in about 85% of subjects with acute Epstein-Barr virus (EBV) infections. The purpose of this work was to search for anti-EA(D) antibodies in 130 samples with an isolated VCA IgG pattern at ELISA screening and classified as being indicative of past (102 cases) or acute (28 cases) infection on the basis of the immunoblotting results. Thirty-seven samples (28.5%) were positive for anti-EA(D), of which 25 (89.3%) had been classified by immunoblotting as indicating acute and 12 (11.8%) past EBV infection. This difference was statistically significant (P < .01). The results of our search for anti-EA(D) antibodies correctly identified nearly 90% of acute (presence) or past EBV infections (absence). When other tests are not available, the search for anti-EA antibodies may therefore be helpful in diagnosing patients with an isolated VCA IgG pattern at screening tests

Significance of the “isolated EBNA-1 IgG” pattern in past EBV infection

The ELISA screening detection of anti-EBNA-1 IgG in the absence of VCA IgG and IgM is rare but may lead to doubts in interpretation.We used immunoblotting to characterise 23 serum samples with “isolated EBNA-1 IgG” upon ELISA screening, and found that all showed VCA anti-p23 and 13 (56.6%) also showed VCA anti-p18 antibodies. It therefore seems impossible for a sample to show anti-EBNA-1 IgG without anti-VCA IgG antibodies. Furthermore, although anti-p18 antibodies are thought to develop later and therefore considered to be markers of past infection, about 1% of all previously infected EBNA-1 IgG-positive patients do not have them

Necessity of External Quality Control for anti-Mycoplasma pneumoniae IgM antibodies

We evaluated the correlation among four commercial ELISA tests for the presence of anti-Mycoplasma pneumoniae IgM antibodies in 36 samples obtained from patients with respiratory infections.The overall concordance among the four tests was 30%, while the one among single tests varies from 39% to 75%. Given the variability of the results, it is necessary to implement a External Quality Control specific for anti-Mycoplasma pneumoniae IgM antibodies

Percorso rapido per la validazione di analizzatori automatici per test immunoenzimatici in micropiastra

The introduction of new diagnostic instruments in the Microbiology Laboratory imposes a trial period which must precede introduction in the routine. This period is aimed to minimize any organizational difficulty and/or staff distress. In this context, we suggest an organizational model that can quickly evaluate accuracy, repeatability and carry over of new diagnostic instruments

Management of Toxoplasma gondii screening in pregnancy: light and shade

The aim of our study was to evaluate the performance of screening for toxoplasmosis in pregnancy through comparing the data obtained from Italian and foreign women. 3074 women, 2465 Italians (80.2%) and 609 foreigners (19.8%) had undergone screening for serological detection of anti-Toxoplasma IgG and IgM antibodies in the years 2005-2007. 85.0% of the Italian women and 84.1% of the foreign women had the first blood test in the first trimester of pregnancy (difference not statistically significant).Among anti-Toxoplasma negative women average of blood tests during pregnancy was 3.69 for the Italians and 3.42 for the foreigners (p &lt;0.01). 32.2% of Italian and 28.3% of foreign women were subjected to five or more blood tests (difference not statistically significant). Considering the trimester of pregnancy, the percentage of Italian and foreign women tested at least once in every trimester was respectively 58.0% and 45.2% (p &lt;0.01). In conclusion, our data show that on the one hand the screening is active in controlling women within the first trimester of pregnancy, while on the other it appears weak in fully implementing the follow up, as indicated by the legislation currently in force. In addition, foreign women undergo fewer tests covering all trimesters compare to Italian women. This problem should be taken into account in terms of health policy

Revision of the positive predictive value of IgM anti-Toxoplasma antibodies as an index of recent infection

The severity of congenital Toxoplasma gondii infection underlines the need for a precise diagnosis of acute infection during pregnancy. The search for specific IgM has been widely used for this purpose, but their possible early disappearance or persistence over time limits their meaning. In order to estimate the positive predictive value of antiToxoplasma IgM testing, we made an epidemiological analysis of the presence of anti-Toxoplasma IgG and IgM using ELISA in 4786 subjects attending the Hospital of Legnano in [2004][2005]: 1360 seen for a clinical check-up and 3426 pregnant women for serological screening. In relation to IgG avidity, the positive predictive value of IgM was 45.98% (95% CI: 35.51-56.45) as a whole: this increased to 83.87% (95% CI: 70.92-96.82) in the patients with a highly positive test for IgM, but decreased to 9.52% (95% CI: 0.00-22.07) in pregnant women with a weakly positive test for IgM. Our results indicate that a highly positive IgM value in patients can be a good index of recent infection, but its poor predictive value in pregnant women underlines the need for additional tests with a follow-up if necessary

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys