title: Evaluation of serologic tests for diagnosis of anthrax after an outbreak of cutaneous anthrax in Paraguay.
abstract: An outbreak of at least 21 cases of cutaneous anthrax occurred in rural Paraguay. A case-control study revealed that disease was associated with touching the raw meat of an ill cow (odds ration = 16.5, P = .02). Serum drawn from 12 cases and 16 colony and 2 noncolony controls 6 w after the outbreak were analyzed by electrophoretic-immunotransblots (EITB) to detect serum antibodies to the protective antigen (PA) and lethal factor components of anthrax toxin. Serum was also tested by enzyme-linked immunosorbent assay (ELISA) for the presence of antibodies to poly-D-glutamic acid capsule. Of 12 cases, 11 had a positive PA screen, for a sensitivity of 91.7% (76.1%-100%, 95% confidence interval [CI]) whereas none of the 18 controls was positive for a specificity of 100% (84.8%, one-sided binomial 95% CI). Only 6 (50%) of 12 cases (21.7%-78.3%, 95% CI) had positive lethal factor titers; all controls were negative. At a cutoff of greater than or equal to 1:32 for antibodies to capsule, 11 (91.7%) of 12 (76.1%-100%, 95% CI) were positive; 16 (88.9%) of 18 controls (74.5%-100%, 95% CI) were negative. These data suggest that the EITB for detection of antibody to PA, and ELISA for detection of anticapsule antibodies are both sensitive for the retrospective diagnosis of anthrax. Both tests were specific, but EITB may be more so than ELISA.
authors.affiliation: Division of Bacterial Diseases, Centers for Disease Control, Atlanta, Georgia 30333.
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: J W
authors.initials: JW
authors.lastname: Ezzell
authors.forename: T G
authors.initials: TG
authors.lastname: Abshire
authors.forename: S
authors.initials: S
authors.lastname: Kidd
authors.forename: A F
authors.initials: AF
authors.lastname: Kaufmann
mesh_terms: D000818:Animals; D000881:Anthrax / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D000907:Antibodies, Bacterial / Q000032:analysis; D000942:Antigens, Bacterial; D001408:Bacillus anthracis / Q000276:immunology; D001427:Bacterial Toxins / Q000276:immunology; D016022:Case-Control Studies; D002417:Cattle; D004196:Disease Outbreaks; D004591:Electrophoresis, Polyacrylamide Gel; D004797:Enzyme-Linked Immunosorbent Assay; D005506:Food Contamination; D006801:Humans; D015151:Immunoblotting; D007199:Indians, South American; D008460:Meat; D010239:Paraguay / Q000453:epidemiology; D011237:Predictive Value of Tests; D012874:Skin Diseases, Infectious / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001427:Bacterial Toxins; C030325:anthrax toxin