Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus

Am J Trop Med Hyg. 2013 May;88(5):932-936. doi: 10.4269/ajtmh.12-0325. Epub 2013 Mar 11.

Abstract

Inter- and intra-observer variation was examined among six microscopists who read 50 scrub typhus (ST) and murine typhus (MT) indirect immunofluorescence assay (IFA) immunoglobulin M (IgM) slides. Inter-observer agreement was moderate (κ = 0.45) for MT and fair (κ = 0.32) for ST, and was significantly correlated with experience (P = 0.03 and P = 0.004, respectively); κ-scores for intra-observer agreement between morning and afternoon readings (range = 0.35-0.86) were not correlated between years of experience for ST and MT IFAs (Spearman's ρ = 0.31, P = 0.54 and P = 0.14, respectively; P = 0.78). Storage at 4°C for 2 days showed a change from positive to negative in 20-32% of slides. Although the titers did not dramatically change after 14 days of storage, the final interpretation (positive to negative) did change in 36-50% of samples, and it, therefore, recommended that slides should be read as soon as possible after processing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Fluorescent Antibody Technique, Indirect / methods
  • Fluorescent Antibody Technique, Indirect / standards*
  • Humans
  • Immunoglobulin G / immunology*
  • Immunoglobulin M / blood*
  • Male
  • Observer Variation
  • Orientia tsutsugamushi / immunology
  • Rickettsia typhi / immunology
  • Scrub Typhus / diagnosis*
  • Scrub Typhus / epidemiology*
  • Scrub Typhus / immunology
  • Scrub Typhus / microbiology
  • Typhus, Endemic Flea-Borne / diagnosis*
  • Typhus, Endemic Flea-Borne / epidemiology*
  • Typhus, Endemic Flea-Borne / immunology
  • Typhus, Endemic Flea-Borne / microbiology
  • Young Adult

Substances

  • Immunoglobulin G
  • Immunoglobulin M