Brucellosis: serological methods compared.

At least 12 persons contracted clinical, and 4 persons subclinical Brucella melitensis infection during a brucellosis epidemic in the spring and summer of 1983 in Southern Germany, a region which had been free of this disease for the past 20 years. All cases of illness were traced to one infected herd of sheep. The presence of antibodies against B. melitensis was examined in 72 sera of infected patients using the following tests: agglutination, Coomb's test, two complement fixation tests with different antigen preparations (CFT 1 and 2), IgG and IgM enzyme-linked immunosorbent assay (ELISA), and opsonophagocytosis; and the occurrence of cross-reacting antibodies against Yersinia enterocolitica O 9 was investigated in the agglutination and complement fixation tests. Sera from 100 blood donors and 112 other people with close contact with sheep were also examined. The results revealed the need to consider an intermediate range in the interpretation of ELISA results--due to elevated values of persons in groups at risk but without clinical signs of illness. In all other tests, however, such persons revealed the same cut-off levels as the general population. Results from all initial sera of infected persons revealed titres of optical densities above the baseline levels determined in the present study, with the exception of the Coomb's and CFT2 tests. The agglutination test, but not brucella CFT2, revealed complete cross-reactivity between Y. enterocolitica O 9 and B. melitensis. ELISA stood out as the only test which is suited to diagnosis of both recent and past infection, since ELISA IgM determination permits conclusions about the time of the onset of illness, and determination of IgG may still yield values above the cut-off level up to 623 days after the onset of illness. In 2 of the 16 infected persons, IgG ELISA was the only test revealing previous infection 424 and 528 days after the onset of illness. A procedural scheme is presented which may help to simplify the diagnosis of brucellosis.