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SARS-CoV-2 infection / COVID-19
Clinical information:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, previously called 2019-nCoV) belongs to the family of coronaviruses and, like SARS-CoV, is classified in the genus Betacoronavirus. The new virus has its origin in China. At the end of 2019, it caused a first infection wave that has spread rapidly over the country and worldwide. Just a few days after the first report about patients with pneumonia of unclear origin, SARS-CoV-2 was identified as the causative pathogen.
SARS-CoV-2 is mainly transmitted via aerosols during coughing or sneezing or at close contact with an infected person. The incubation period is three to seven, maximum 14 days. In February 2020, the disease caused by SARS-CoV-2 was named COVID-19 by the WHO. The symptoms of SARS-CoV-19 infection are fever, coughing, breathing difficulties and fatigue. Some patients, especially older and chronically ill persons, develop a severe acute respiratory distress syndrome with sometimes fatal outcome.
Diagnostics:
Suitable methods for diagnosis of SARS-CoV-2 infections are direct detection of the virus by reverse transcriptase polymerase chain reaction (RT-PCR) primarily in sample material from the upper (nasopharyngeal or oropharyngeal swab) or lower (bronchoalveolar lavage fluid, tracheal secretion, sputum, etc.) respiratory tract and the detection of antibodies against SARS-CoV-2 in blood. The latter allows pathogen detection even in subclinical or asymptomatic cases within a few days after virus contact up to approx. 14 days after the onset of symptoms (Liu et al., 2020).
The detection of specific antibodies against SARS-CoV-2 in blood expands the diagnostic window beyond the first one to two weeks. Antibody detection helps to identify persons who present a persisting (no longer acute) or past infection with SARS-CoV-2. Moreover, serology plays an important role in outbreak monitoring and tracking of infection chains, as well as in answering clinical, epidemiological and virological questions related to SARS-CoV-2 and COVID-19.
EUROIMMUN offers a comprehensive portfolio of products for COVID-19 diagnostics, ranging from PCR for diagnostics of acute cases to ELISAs for detection of antibodies of different immunoglobulin classes and against different SARS-CoV-2 antigens.
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Gastrointestinal infections
Clinical information
Gastrointestinal infections can be caused by bacteria, viruses and parasites and are among the most frequent infectious diseases. They manifest as gastritis, diarrhoea, vomiting or unspecific symptoms which occur within only few hours after uptake of the pathogen with some bacterial or viral infections and may, in rare cases, lead to chronic sequelae. Infections with parasitic pathogens, however, usually take a chronic course.
Diagnostics
Viral infections are often self-limiting, which is why it is sufficient to treat the symptoms, and laboratory diagnostic tests are usually not performed. Bacteria such as Yersinia and Campylobacter, however, may cause immunologically mediated secondary diseases, e.g. reactive arthritis. Here, serological tests may support the diagnosis. Infections with Helicobacter pylori may cause chronic active gastritis and complications such as gastroduodenal ulcer disease, stomach carcinoma or lymphoma. Antibody detection is recommended in suspected cases of non-acute or chronic infection. Parasitic pathogens such as Schistosoma and Strongyloides stercoralis can also cause gastrointestinal symptoms with chronic courses. Direct and indirect methods are applied for diagnostics. In general, specific antibody detection is suitable to support the diagnosis in suspected cases of chronic courses or secondary diseases, but not for diagnostics in acute cases.
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Respiratory infections
Respiratory infections
Clinical information
Infections of the respiratory tract are mainly caused by viruses (e.g. influenza viruses, adenoviruses, RSV), but also bacteria (e.g. Legionella, Bordetella pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae). Both the upper (e.g. nasal mucosa, paranasal sinuses) and the lower respiratory tracts (airways and bronchia) can be affected. The pathogens are mainly transmitted by droplet infection. Symptoms of respiratory infections include fever, cough, headaches and pain, pharyngitis, sinusitis, bronchitis or pneumonia.
Diagnostics
Since many respiratory pathogens cause similar symptoms, the diseases cannot usually be diagnosed based on the clinical image alone. Consequently, laboratory diagnostics are particular valuable. Direct pathogen detection (e.g. PCR) is in most cases the method of choice for the detection of acute respiratory infections.
Since antibodies are only formed some days or weeks following infection and the prevalence increases with age, an infection can often only be diagnosed retrospectively by investigation of a serum pair and detection of an IgG titer increase. Serological tests can also contribute to epidemiological monitoring. -
Inhalation
Clinical information
With the inhalation allergies, the allergens enter the body via the air the mucous membranes and lead to measurable IgE concentration. Seasonal allergen source (pollen from trees, grasses and herbs) play a role, as do also indoor allergens (house dust mites, domestic animals and mould spores) which occur the whole year round. The symptoms usually occur shortly after contact with the allergen. This is referred to as immediate type reaction and affects more than 15% of the population in the industrialised countries. Typical allergic reactions are rhinitis, conjunctivitis and allergic asthma. In rare cases, systemic allergic reactions may occur which are associated with severe, sometimes life-threatening symptoms (anaphylactic shock).
Diagnostics
For clarification of sensitisation to inhalation allergens, EUROIMMUN offers different inhalation profiles (EUROLINE). These permit the in vitro determination of human IgE antibodies against the most frequent inhalation allergens in serum or plasma. Moreover, country-specific inhalation profiles are available which vary in their allergen composition and are optimised with regard to the regional conditions.
Moreover, the Total IgE ELISA can determine the total IgE concentration, allowing differentiation between allergic and intrinsic asthma, between rhinitis allergica and vasomotorica and between atopical and seborrhoic dermatitis.
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Sexually transmitted infections
Clinical information
Sexually transmitted infections (STIs) can be caused by bacteria (e.g. Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma), viruses (e.g. HSV) or parasites (Trichomonas vaginalis), which are transmitted from person to person by vaginal, anal or oral sex. The course, symptoms and consequences of STIs can differ significantly depending on the causative pathogen. In many cases, the infection is asymptomatic, so that it remains undiscovered for a long time and is only diagnosed when it has become chronic. Infections with these pathogens often cause inflammation of the urogenital tract, which may ascend and lead to e.g. infertility.
In addition to the consequences for the patient, infections with most of the mentioned pathogens can also lead to intrauterine foetal loss, preterm birth or damage to the unborn child. Moreover, many pathogens can be transmitted to the newborn during birth, causing severe postnatal infections.
Diagnostics
The commonly used detection methods for STI are direct methods, in which the pathogen is detected by PCR or culture, and indirect methods, i.e. detection of pathogen-specific antibodies. Since detection by culturing is especially time-consuming and difficult for Chlamydia, Mycoplasma, Ureaplasma and Treponema, other detection methods, e.g. PCR-based and/or serological procedures, are generally recommended or required for these pathogens.
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Food
Clinical information
Food allergens enter the body via the gastrointestinal tract. Within a short time after consumption, the IgE-mediated immune reaction may lead to symptoms such as burning or itching in the mouth, nausea, intestinal and stomach cramps, diarrhoea or skin redness. Severe reactions are associated with bouts of asthma, dyspnoea and increased pulse. In rare cases they lead to an anaphylactic shock. The foods which most frequently trigger allergic reactions include nuts, peanuts, soy, wheat, fish, milk and eggs. With a prevalence of 5 to 10%, primary allergic sensitisations to foods play an important role particularly in babies and infants. Food allergies in adults occur with a prevalence of 1 to 5%
Diagnostics
For clarification of sensitisations to food allergens, EUROMMUN offers differs food profiles (EUROLINE). These permit the in vitro determination of human IgE antibodies against the most frequent food allergens in serum or in plasma. Moreover, country-specific food allergy profiles are available which have been developed with regard to the regional eating habits.
In addition, the total IgE concentration can be determined using the Total IgE ELISA.
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Atopy
Clinical information
The term atopy describes the innate tendency to allergic hypersensitivity reactions which may present with different clinical images. The allergens responsible for the reaction enter the body either through the air and the mucous membranes (in the case of inhalation allergies), or through food ingestion (in the case of food allergies).
Diagnostics
For clarification of multiple sensitisations, EUROIMMUN offers different atopy profiles (EUROLINE). These permit the simultaneous in vitro determination of different human IgE antibodies against the most frequent inhalation and food allergens in serum or plasma. Moreover, country-specific profiles are available which take into account the characteristics of the regional allergen exposure.
In addition, the total IgE concentration can be determined using the Total IgE ELISA.
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Anti-CCD absorbent
Clinical
Anti-CCD absorbent is an additional reagent designed for the incubation with blot-based allergy profiles. The absorbent eliminates anti-CCD IgE antibodies from patient serum, which increases the specificity of test results if these antibodies are present in the sample.
Anti-CCD IgE antibodies are directed against sugar structures of proteins and can be detected in around 25 % of allergy patients as well as in non-allergic individuals. They generally have no clinical relevance.
In extract-based in vitro allergy diagnostics, these antibodies complicate the interpretation of positive results because the following cases cannot be differentiated:
- positive reaction caused by IgE antibodies against peptide epitopes
- positive reaction caused by anti-CCD IgE antibodies
- positive reaction caused by a combination of the two antibody types
Differentiation between the described reactions is possible if the absorbent is used and the anti-CCD IgE antibodies are eliminated.
The anti-CCD absorbent is useful if the patient sample demonstrably contains IgE antibodies against CCD structures. This is indicated by a positive CCD band on the incubated allergy profile. In this case, the serum should be retested using the anti-CCD absorbent.
Diagnostics
The patient sample is incubated with anti-CCD absorbent for 60 minutes at room temperature according to the instruction provided with the reagent. The sample can then be used directly in the incubation with the respective allergy profile.
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