Table 2.
Reported overall sensitivities and specificities for homemade and commercial tularemia serological tests.
| Method | References | Number of patients/controls (sera) | Detected antibodies | Cutoff titers | Sensitivity | Specificity | Tularemia case definition or gold standard |
|---|---|---|---|---|---|---|---|
| TAT | (Koskela and Salminen, 1985) | 50 (141)/none | mainly IgM | ≥10 | 85.1% | NA | Clinically typical + positive serology |
| ≥80 | 67.4% | NA | |||||
| MAT | (Viljanen et al., 1983) | 70 (70)/none | mainly IgM | ≥80 | 95.7% | NA | ≥4fold rise in MAT or ELISA titers |
| (Helvaci et al., 2000) | 205 (205)/none | mainly IgM | ≥80 | 94.1% | NA | CCF + positive culture (10) or MAT ≥ 1:20 | |
| ≥160 | 85% | NA | |||||
| (Porsch-Ozcürümez et al., 2004) | 50 (50)/50 (50) | mainly IgM | >16 | 100% | 100% | CCF + seroconversion | |
| ≥64 | 92% | 100% | |||||
| (Maurin et al., 2011) | 93 (129)/281 (287) | mainly IgM | ≥160 | 50.5% | 99.3% | CCF + positive culture or PCR, or MAT or IFA ≥ 160, or seroconversion or ≥4fold rise in antibody titers | |
| (Kiliç et al., 2012) | 42 culture-confirmed | mainly IgM | ≥160 | 97.6% | Positive culture | ||
| (Sharma et al., 2013) | 19 (34)/50 (50) | mainly IgM | ≥10 | 82.4% | 100% | ≥4fold rise in TAT or MAT titers | |
| (Yanes et al., 2018) | 74 (122)/134 (134) | mainly IgM | ≥80 | 75.3% | 98.5% | CCF + positive culture or PCR, or seroconversion, or ≥4fold rise in antibody titers | |
| LAT | (Rastawicki et al., 2015) | 77/309 | mainly IgM | ≥25 | 98.7% | 100% | TAT and ELISA |
| IFA | (Porsch-Ozcürümez et al., 2004) | 50 (50)/50 (50) | all | >80 | 100% | 92% | same as MAT |
| >320 | 94% | 100% | |||||
| (Maurin et al., 2011) | 93 (129)/281 (287) | IgM | ≥160 | 49.4% | 99.3% | same as MAT | |
| IgG | ≥160 | 77.4% | 98.6% | ||||
| (Yanes et al., 2018) | 74 (122)/134 (134) | IgM | ≥80 | 72.5% | 99.3% | same as MAT | |
| IgG | ≥160 | 74.5% | 99.3% | ||||
| ELISA | (Carlsson et al., 1979) | 28 (28)/48 (48) | all | ≥500 units | 96.4% | 97.9% | F. tularensis detection by culture or immunofluorescence |
| (Viljanen et al., 1983) | 70 (70, first two weeks of evolution) /none | IgM | OD ≥ mean + 2SD of controls |
21.4% | NA | same as MAT | |
| IgA | 28.6% | NA | |||||
| IgG | 35.7% | NA | |||||
| at least one | 43% | NA | |||||
| (Koskela and Salminen, 1985) | 50 (91)/none | IgM | ≥100 units | 83.5% | NA | same as TAT | |
| IgA | 80.2% | NA | |||||
| IgG | 87.9% | NA | |||||
| (Bevanger et al., 1988) | 44 (44)/50 (50) | IgM | OD ≥ mean+ 3SD of controls | 97.5% | 100% | CCF + MAT ≥ 80 | |
| IgA | 97.5% | 100% | |||||
| IgG | 97.5% | 100% | |||||
| (Porsch-Ozcürümez et al., 2004) | 50 (50)/50 (50) | all | OD > 0.648 | 100% | 98% | same as MAT | |
| OD > 0.780 | 98% | 100% | |||||
| (Schmitt et al., 2005) | 75 (75)/1,149 (1,149) | IgM | OD > mean+ 3SD of controls | 89.3% | 99.5% | Clinically evident tularemia cases | |
| IgA | 96% | 98.9% | |||||
| IgG | 85.3% | 98.2% | |||||
| at least one | 99% | 97.1% | |||||
| (Sharma et al., 2013) | 19 (34)/50 (50) | all | OD ≥ 0.61 | 94.1% | 98% | same as MAT | |
| (Chaignat et al., 2014) | 110 (135)/168 (168) | all | OD ≥ 0.18 | 95.6% | 76.6% | Positive MAT | |
| CF-ELISA | (Koskela and Salminen, 1985) | 50 (91)/none | all | ≥100 units | 81.9% | NA | same as TAT |
| cELISA | (Sharma et al., 2013) | 19 (34)/50 (50) | all | 8.5% rate of inhibition | 97.1% | 100% | same as MAT |
| Serazym ® ELISA | (Chaignat et al., 2014) | 110 (135)/168 (168) | all | (M) | 97% | 91.5% | same as ELISA |
| Serion ® ELISA | (Chaignat et al., 2014) | 110 (135)/168 (168) | IgM | OD ≥ 0.449 (M) | 94.8% | 96.8% | same as ELISA |
| IgG | OD ≥ 0.619 (M) | 96.3% | 96.8% | ||||
| (Yanes et al., 2018) | 74 (122)/134 (134) | IgM | OD ≥ 0.449 (M) | 88.2% | 94.8% | same as MAT | |
| IgG | OD ≥ 0.619 (M) | 86.3% | 95.5% | ||||
| IgM | OD ≥ 0.9 | 86.3% | 97.8% | ||||
| IgG | OD ≥ 1.4 | 84.3% | 97.8% | ||||
| ICT | (Splettstoesser et al., 2010) | 50 (58)/58 (58) | IgG mainly | Visual | 98.3% | 96.6% | Positive MAT |
| Virapid ® ICT | (Kiliç et al., 2012) | 106 (203)/236 (236) | all | ≥0.5 visual Intensity | 99.3% | 94.6% | same as MAT |
| 42 culture-confirmed | 97.6% | same as MAT | |||||
| (Chaignat et al., 2014) | 110 (135)/168 (168) | 97% | 84% | same as ELISA | |||
| (Yanes et al., 2018) | 74 (122)/134 (134) | 90% | 83.6% | same as MAT |
TAT, tube agglutination test; MAT, microagglutination tests; LAT, latex agglutination test; IFA, immunofluorescence assay; ELISA, enzyme-linked immunosorbent assay; CF-ELISA, complement-fixing ELISA; cELISA, competitive ELISA; ICT, immunochromatographic assay; CCF, compatible clinical findings; (M), manufacturer cutoff titer.