Serum antibodies in Campylobacter enteritis

Abstract

A solid-phase enzyme immunoassay method for the measurement of total and class-specific serum antibodies to Campylobacterjejuni was developed. The test was found to be both sensitive and specific. Immunoglobulin M, G, and A antibodies were detected in about 90% of sera collected from patients recovering from Campylobacter enteritis, with the pattern of appearance and decline of these antibodies conforming to that usually seen in an acute infection. A poor antibody response was noted in patients with intermittent or prolonged enteritis. The clinical implications and diagnostic value of this test are discussed.

Sensitivity and specificity of serology in determining recent acute Campylobacter infection

“…Following an acute rise in Campylobacter-specific antibody levels in the majority of patients, the levels of all three antibody classes appear to fall with time. This finding is out of keeping with previous reports, 18 where IgA and IgM levels fell rapidly to a normal level with IgG antibodies persisting but still falling more slowly with time.…”

“…This finding, although not part of the present study, is consistent with the findings of previously published serological surveys. [15][16][17][18] Therefore, it seems unlikely that a significant proportion of cases where a transient antibody rise occurs have been missed. Following an acute rise in Campylobacter-specific antibody levels in the majority of patients, the levels of all three antibody classes appear to fall with time.…”

“…Conversely, the absence of elevated Campylobacterspecific antibodies does not exclude acute or prior infection, as 40% of patients with a proven Campylobacter infection did not meet the criteria of Kaldor et al for acute infection. 18 If less-stringent criteria are used, such as positivity of a single antibody class, 10% of the population will have evidence of acute infection, a result obviously lacking sensitivity and general applicability. Using the criteria of Kaldor et al, the data in the present study show the sensitivity of Campylobacter serology for an acute infection is only 60% but the specificity is 99.6%.…”

“…33 If the criteria of Kaldor et al were used, where elevation of more than two or more antibody classes is required to demonstrate recent infection, only two of the 420 control patients would be positive for Campylobacter infection (0.48%). 18 If a single class elevation were used, then the percentage would increase to 9.5% of controls, a factor that significantly reduces the specificity of the testing. If IgG alone were used, 5% of control patients and 69% of acute patients would be positive.…”

“…The normal serum antibody response to acute infection has been determined in several patient groups. [15][16][17][18] These studies demonstrated an acute rise in immunoglobulin G (IgG), IgA and IgM antibody levels and a rapid decrease approaching the pre-infection level over a period of 6 weeks. Not all infected patients demonstrated a rise in Campylobacter-specific antibody levels and only in a minority of cases did elevation of all three antibody classes occur.…”