The enzyme-linked immunosorbent assay (ELISA) for malaria. III. Antibody response in documented Plasmodium falciparum infections.

Serum specimens from patients in El Salvador, Central America, with slide-proven Plasmodium falciparum infections were examined for antibodies to P. falciparum using the enzyme-linked immunosorbent assay (ELISA) and the indirect fluorescent antibody (IFA) methods. Both serologic tests were positive in 78.1% of the 827 samples, both negative in 5.4%, the ELISA positive alone in 6.3%, and the IFA alone in 10.2%. Agreement between the serologic tests was better in the specimens with high positive titers (high IFA = high ELISA). Seropositivity rates and geometric mean titers were higher in the older (greater than or equal to 15 years) age groups for both ELISA and IFA; in such persons, the IFA was positive in 92% and the ELISA in 88%. The lowest seropositivity rates found by the ELISA were observed in children; 27.6% of 98 children less than or equal to 4 years of age were negative. A longer duration of infection as evidenced by the presence of gametocytes on the blood slide resulted in higher positivity rates by both ELISA and IFA. This phenomenon, particularly apparent in young children, supports the belief that the more important variable in determining the proportion of false negatives is previous malaria experience and not age. The results indicate that, while neither serologic test is appropriate as a diagnostic aid, both the ELISA and the IFA would be useful in epidemiologic investigations.