Procedures

This section encapsulates the key concepts and procedures within serology, focusing on the body’s immune response, antigen-antibody interactions, and specific pathogens. It provides a structured framework for understanding the role of serological testing in diagnosing and monitoring infectious diseases

Immunoglobulin Response to Infection

  • IgM: Typically the first antibody produced in response to a new infection, indicating an acute or recent infection
  • IgG: The most abundant antibody in serum, indicating past infection or vaccination, and providing long-term immunity
  • IgA: Predominant antibody in mucosal secretions, providing localized immunity at mucosal surfaces

Antigen-Antibody Interactions

  • Specificity: The ability of an antibody to bind to a specific antigen
  • Affinity and Avidity: Affinity refers to the strength of a single antigen-antibody bond, while avidity describes the overall strength of the interaction
  • Cross-Reactivity: The ability of an antibody to bind to similar, but not identical, antigens
  • Factors Affecting Interactions: Temperature, pH, ionic strength, incubation time, and antigen/antibody concentrations

Testing Methods for Antigen-Antibody Interactions

  • Agglutination: Visible clumping of particles due to antibody-antigen binding
  • EIA/ELISA: Enzyme-labeled antibodies or antigens detect and quantify immune complexes
  • Chemiluminescence: Chemiluminescent-labeled antibodies or antigens detect and quantify immune complexes
  • Immunofluorescence: Fluorescently labeled antibodies detect antigens or antibodies in a sample

Serodiagnosis of Viral Pathogens

  • Hepatitis A (HAV): Anti-HAV IgM (acute), Anti-HAV IgG (past/immune)
  • Hepatitis B (HBV): HBsAg (current), Anti-HBs (immune), Anti-HBc IgM (acute), Anti-HBc IgG (past/chronic)
  • Hepatitis C (HCV): Anti-HCV (exposure), HCV RNA (active infection)
  • Epstein-Barr Virus (EBV): VCA IgM (acute), VCA IgG (past), EA IgG (acute/reactivation), EBNA IgG (past)
  • Human Immunodeficiency Virus (HIV): HIV Antibody/Antigen Combination Assay, HIV Antibody Differentiation Assay, HIV RNA
  • Cytomegalovirus (CMV): CMV IgM (acute/recent), CMV IgG (past), CMV DNA (active infection)
  • Rubella: Rubella IgM (acute), Rubella IgG (immune)
  • Measles: Measles IgM (acute), Measles IgG (immune)

Serodiagnosis of Agents of Encephalitis

  • West Nile Virus (WNV): WNV IgM (recent), WNV IgG (past), Plaque Reduction Neutralization Test (PRNT)
  • St. Louis Encephalitis Virus (SLEV): SLEV IgM (recent), SLEV IgG (past), Plaque Reduction Neutralization Test (PRNT)
  • La Crosse Virus (LACV): LACV IgM (recent), LACV IgG (past)
  • Eastern Equine Encephalitis Virus (EEEV): EEEV IgM (recent), EEEV IgG (past)
  • Western Equine Encephalitis Virus (WEEV): WEEV IgM (recent), WEEV IgG (past)
  • Powassan Virus (POWV): POWV IgM (recent), POWV IgG (past)

Serodiagnosis of Treponema pallidum and Borrelia burgdorferi

  • Treponema pallidum (Syphilis): Nontreponemal tests (RPR, VDRL) for screening, Treponemal tests (FTA-ABS, TP-PA) for confirmation
  • Borrelia burgdorferi (Lyme Disease): EIA or ELISA for screening, Western blot for confirmation

VII. Serodiagnosis of Tuberculosis

  • Tuberculin Skin Test (TST): Based on delayed-type hypersensitivity to tuberculin
  • Interferon-Gamma Release Assays (IGRAs): Measure IFN-γ release in response to M. tuberculosis-specific antigens