Use of Peptide-Based Enzyme-Linked Immunosorbent Assay followed by Immunofluorescence Assay To Document Ehrlichia chaffeensis as a Cause of Febrile Illness in Nicaragua.

Journal Article (Journal Article)

Ehrlichia chaffeensis, the etiologic agent of human monocytic ehrlichiosis (HME), has been extensively studied as a cause of acute febrile illness and an emerging tick-borne zoonosis in the United States. Limited data suggest its presence in other regions, including Central and South America but not Nicaragua to date. Diagnosis of E. chaffeensis infection by indirect immunofluorescence assay (IFA) is the reference standard due to its presumed high sensitivity and specificity, but IFA is impractical, variably reproducible, and cumbersome for large epidemiologic studies and for clinical diagnosis in resource-poor regions. We evaluated a high-throughput, objective peptide-based enzyme-linked immunosorbent assay (ELISA) for use alone or in combination with IFA. We found that it performed best as a screening test (sensitivity, 100%; specificity, 84%) to reduce the proportion of serum samples that were required by the more cumbersome and subjective IFA testing to <20%. Using a two-step diagnostic approach (IFA is performed if the ELISA is positive), we identified E. chaffeensis or a serologically and antigenically similar organism as a heretofore unrecognized cause of acute febrile illness in humans in Nicaragua and demonstrated the utility of the peptide ELISA as a screening tool for large-scale clinical studies.

Full Text

Duke Authors

Cited Authors

  • Chikeka, I; Matute, AJ; Dumler, JS; Woods, CW; Mayorga, O; Reller, ME

Published Date

  • June 2016

Published In

Volume / Issue

  • 54 / 6

Start / End Page

  • 1581 - 1585

PubMed ID

  • 27053675

Pubmed Central ID

  • PMC4879277

Electronic International Standard Serial Number (EISSN)

  • 1098-660X

Digital Object Identifier (DOI)

  • 10.1128/JCM.03331-15


  • eng

Conference Location

  • United States