Serological tests in the differentiation of staphylococcal and tuberculous bone disease.

Abstract

SYNOPSISThe haemagglutination test for antileucocidin is frequently positive in cases of bone tuberculosis in the absence of obvious staphylococcal infection. This test is therefore of little practical use in the differentiation of staphylococcal and tuberculous bone disease, and its use has been discontinued at the Royal National Orthopaedic Hospital.The antigamma haemolysin test in bone tuberculosis appears to give rise to few false positive results. Our observations confirm that the anti-alpha haemolysin and antigamma haemolysin tests used together reveal about 80% of cases of staphylococcal bone infection on first presentation or relapse.

An evaluation of the usefulness of Staphylococcus aureus serodiagnosis in clinical practice

“…The small number of positive tests included cases with positive S. aureus culture; equivocal test results suggestive of S. aureus infection included cases where an alternative pathogen was isolated; and several "false negative" results in individuals with proven deep seated staphylococcal infection were noted. These results are consistent with the findings of previous studies [1][2][3]. There was no evidence that test results influenced clinical decision making in any of the individuals tested.…”

“…The Health Protection Agency (HPA), UK, currently offers testing to detect antibodies to alpha haemolysin (staphylolysin) and the nuclease enzyme in parallel. However, a lack of high specificity and sensitivity of the anti-staphylolysin test has been demonstrated repeatedly in occult S. aureus infections [1][2][3], whilst there is little information on the usefulness of the anti-nuclease test. It is understood that serological tests, even in combination, are an imperfect marker of staphylococcal infection.…”

Enzyme-linked immunosorbent assay for detection of antibodies to Staphylococcus aureus cell walls in experimental osteomyelitis

“…Our findings, however, as well as those of several previous studies, do not support this conclusion. For example, Taylor et al (17) have shown that approximately 80% of patients with staphylococcal osteomyelitis produced high levels of antibodies to the gamma hemolysin of S. aureus, and Williams et al (25) reported that some patients with chronic staphylococcal osteomyelitis possessed elevated levels of agglutinating, opsonic, as well as complement fixing antibodies. Rahn et al (16), using a Clq-binding assay, detected a 40-fold increase in the levels of circulating immune complexes in a patient with Pseudomonas aeruginosa osteomy- "Compound fracture of infected femur.…”

“…These studies did reveal, however, that teichoic acid antibodies are encountered more frequently in patients with acute osteomyelitis than in those with chronic osteo-myelitis. Taylor et al (17), using a hemolysin inhibition assay, reported the presence of antibodies to the gamma hemolysin of S. aureus in 80% of patients with staphylococcal osteomyelitis. This assay, however, lacked specificity, as evidenced by the fact that approximately 20% of patients with tuberculous osteomyelitis possessed cross-reacting antibodies to the gamma hemolysin of S. aureus.…”

Antibody response to teichoic acid and peptidoglycan in Staphylococcus aureus osteomyelitis

“…The serological diagnosis of deep-seated S. aureus infections has been the subject of intensive investigation. Whereas earlier assays measured antibodies to extracellular S. aureus, products, notably alpha and gamma hemolysins (13,23), more recently the focus has shifted toward the detection of antibodies to cell-associated components, including TA (8,10,15,25,31,36), PG (2,26,27,30,35), and cell walls (12). These previous studies have shown that significantly elevated levels of antibodies to TA or PG can be detected in the vast majority of patients with complicated S. aureus bacteremia as measured by gel diffusion, ELISA, or radioimmunoassay.…”