Detection of specific IgM in varicella and herpes zoster by antibody-capture redioimmunoassay

Abstract

A simple and sensitive M antibody-capture radioimmunoassay (MACRIA) is described which utilizes crude commercial VZV antigen and a single monoclonal anti-VZV antibody. This was compared to the immunofluorescence (IF) test for IgM antibody and was used to study IgM responses in sera from 261 patients with varicella and 220 patients with herpes zoster. With MACRIA, IgM antibodies were detected in all patients with varicella. The IgM antibodies appeared shortly after onset of rash, reached peak levels between 1 and 4 weeks after onset and then declined to low or undetectable levels in most, though not all, patients after 3 months. IgM antibodies were also detected in 98.2% of patients with herpes zoster, but the levels of IgM were significantly lower than after varicella and there was wider individual variation both in magnitude and duration of the IgM responses, in some cases only lasting 2-3 weeks. Comparison between MACRIA and IF showed good agreement in the detection of IgM antibodies following varicella. Discordant results were obtained with 13% of sera, of which 81% were taken either early or late after onset of rash and contained very low IgM levels. In contrast, 62 (28%) of the 220 sera from patients with zoster gave discordant results in the two tests, all except five being MACRIA-positive but IF-negative. The largest proportion of discordant results were obtained with sera taken more than 3 months after onset of rash, but 18 (29%) contained high IgM levels and were taken during the period of peak IgM responses. The diagnostic applications of the VZV MACRIA are discussed.

Antibody-capture enzyme-linked immunosorbent assays that use enzyme-labelled antigen for detection of virus-specific immunoglobulin M, A and G in patients with varicella or herpes zoster

“…In the present study VZV-IgM was detected in all 18 patients with varicella, in 7 of these (38-9 %) in the acute-phase serum obtained within a few days after onset of symptoms. This is in agreement with the results of others [2,4,8]. Furthermore, VZV-IgM was detected in serum from 13 out of 19 (68-4 %) patients with herpes zoster.…”

“…Similar results have been obtained by others using both indirect assays as well as antibody-capture assays. In these reports VZV-IgM in patients with herpes zoster was detected by indirect radioimmunoassay in 69 % [4], by indirect immunofluorescense in between 50% and 78 % [1,2,8] and by AC-ELISA in between 50 % and 84% [6,7] of patients. In all studies the VZV-IgM response in patients with herpes zoster was found to be of a lesser magnitude compared to the response in patients with varicella and to be relatively shortlived.…”

“…This test, however, is not very sensitive for determination of past infections and requires detection of a significant antibody 166 A. M. VAN LOON AND OTHERS titre rise in paired serum specimens for diagnosis of acute infection. It has been shown previously [1][2][3][4][5][6][7][8] that detection of VZV-specific immunoglobulin M (VZVIgM) antibody allows rapid diagnosis of acute VZV infection. In all patients with varicella, VZV-IgM was found early in the disease using a variety of methods including the indirect immunofluorescence assay [2], the indirect enzyme-linked immunosorbent assay (ELISA) [3] as well as antibody-capture assays using radioactive [4,5,8] or enzyme labels [6,7].…”

“…It has been shown previously [1][2][3][4][5][6][7][8] that detection of VZV-specific immunoglobulin M (VZVIgM) antibody allows rapid diagnosis of acute VZV infection. In all patients with varicella, VZV-IgM was found early in the disease using a variety of methods including the indirect immunofluorescence assay [2], the indirect enzyme-linked immunosorbent assay (ELISA) [3] as well as antibody-capture assays using radioactive [4,5,8] or enzyme labels [6,7]. In contrast, in patients with herpes zoster an IgM response has been reported in between 20% and 98% of patients [1][2][3][4][5][6][7][8].…”

“…In all patients with varicella, VZV-IgM was found early in the disease using a variety of methods including the indirect immunofluorescence assay [2], the indirect enzyme-linked immunosorbent assay (ELISA) [3] as well as antibody-capture assays using radioactive [4,5,8] or enzyme labels [6,7]. In contrast, in patients with herpes zoster an IgM response has been reported in between 20% and 98% of patients [1][2][3][4][5][6][7][8]. Therefore the value of VZV-IgM detection for rapid diagnosis of herpes zoster is less clear.…”