Published ahead of print on December 13, 2007, doi:10.1164/rccm.200705-771OC Am. J. Respir. Crit. Care Med., Volume 177, Number 7, April 2008, 793-797 A more recent version of this article appeared on April 1, 2008
Submitted on May 25, 2007 Serodiagnosis of Mycobacterium avium Complex Pulmonary Disease Using an Enzyme Immunoassay KitSeigo Kitada1*,1 Department of Internal Medicine, NHO National Toneyama Hospital, Toyonaka-shi, Osaka, Japan, 2 Department of Immunology, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan, 3 Department of Clinical Laboratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto-shi, Kyoto, Japan, 4 Department of Internal Medicine, NHO Kinki-chuo Chest Medical Center, Sakai-shi, Osaka, Japan, 5 Department of Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka, Japan, 6 Department of Laboratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama-shi, Saitama, Japan, 7 Department of Internal Medicine, Sakamoto Hospital, Toyonaka-shi, Osaka, Japan * To whom correspondence should be addressed. E-mail: kitadas{at}toneyama.hosp.go.jp.
Rationale: The diagnosis of Mycobacterium avium complex pulmonary disease (MAC-PD) and/or its discrimination from pulmonary tuberculosis is sometimes complicated and time consuming. Objectives: We investigated in a six-institution multicenter study whether a serological test based on an enzyme immunoassay (EIA) kit was useful for diagnosing MAC-PD and for distinguishing it from other lung diseases. Methods: An EIA kit detecting serum IgA antibody to glycopeptidolipid core antigen specific for MAC was developed. Antibody levels were measured in sera from 70 patients with MAC-PD, 18 with MAC contamination, 37 with pulmonary TB, 45 with other lung diseases, and 76 healthy subjects. Results: Significantly higher serum IgA antibody levels were detected in patients with MAC-PD than in the other groups (p<0.0001). Setting the cut-off point at 0.7 U/ml resulted in a sensitivity and specificity of the kit for diagnosing MAC-PD of 84.3% and 100%, respectively. Significantly higher antibody levels were also found in patients with nodular/bronchiectatic disease compared to fibrocavitary disease in MAC-PD (p<0.05). There was a positive correlation between the extent of disease on chest computed tomography scans and the levels of antibody (r=0.43, p<0.05) in patients with MAC-PD. Conclusions: The EIA kit is useful for the rapid diagnosis of MAC-PD and for differentiating MAC-PD from pulmonary TB and, if validated by studies in other populations, could find wide application in clinical practice. Key words: nontuberculous mycobacteria, immunocompetence, sensitivity, specificity
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