title: Application of ELISA for IgM, IgA and antigen detection for rapid diagnosis of respiratory syncytial virus infections: a comparative study.
abstract: BACKGROUND
  Infection with Respiratory Syncytial Virus (RSV) can be rapidly diagnosed by detection of viral antigen in nasopharyngeal secretions (NPS) or serologically by detecting IgM and IgA antibodies.
  
  
  OBJECTIVE
  To evaluate the above methods for reliability and rapidity, and compare them with the complement fixation (CF) test and virus isolation.
  
  
  METHODS
  Viral antigen was tested in 145 NPS samples by ELISA in parallel with tissue culture isolation. The geometric mean titer (GMT) of complement fixing antibodies in various age groups was determined from 92 individual serum samples by CF test. The diagnostic methods, CF test, ELISA-IgM and ELISA-IgA, were evaluated using 21 pairs of acute and convalescent sera. Appearance of IgM and IgA in serum samples with low or negative CF titers was studied in two age groups: 0-10 months (n = 82), and 11 months-9 years (n = 47).
  
  
  RESULTS
  From the 145 NPS samples, 20 samples were positive by both ELISA and virus isolation, 9 were positive only by ELISA and 5 were positive only by virus isolation. The GMT by age group for 92 sera evaluated by CF test were 40 (0-10 months), 195 (11-24 months), 269 (2-4 years), 173 (5-12 years) and 132 (adults). Among the 21 paired sera examined, CF test detected 13 RSV infections by antibody rise or seroconversion while the ELISA-IgM/IgA tests identified all 21 infections, 7 of them in the first sample. The presence of IgM alone or IgM and IgA antibodies was demonstrated in both age groups examined; however, IgA alone was found only in the age group 11 months and older.
  
  
  CONCLUSIONS
  ELISA for antigen detection is better than virus isolation because it is faster (6-20 h vs. 3-20 days, respectively) and more sensitive (29/34 vs. 25/34 positives, respectively). ELISA-IgM and ELISA-IgA was more sensitive and reliable than the CF test, particularly for the 0-10 month age group. Thus, when necessary, serological diagnosis of RSV infection can be based on the presence of IgM and/or IgA antibodies in serum samples obtained early after onset of symptoms.
authors.affiliation: Central Virology Laboratory, Public Health Laboratories, The Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Varsano
authors.forename: R
authors.initials: R
authors.lastname: Azar
authors.forename: M
authors.initials: M
authors.lastname: Ben-Bassat
authors.forename: E
authors.initials: E
authors.lastname: Mendelson