Antibody response and the clinical presentation of patients with COVID-19 in Croatia: the importance of a two-step testi
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ORIGINAL ARTICLE
Antibody response and the clinical presentation of patients with COVID-19 in Croatia: the importance of a two-step testing approach Oktavija Đaković Rode 1,2 & Ivan-Christian Kurolt 1 & Ivan Puljiz 1,3 & Rok Čivljak 1,3 & Nataša Cetinić Balent 1 & Renata Laškaj 1 & Mirjana Kujundžić Tiljak 3,4 & Radojka Mikulić 1 & Alemka Markotić 1,5,6 Received: 26 June 2020 / Accepted: 24 August 2020 # The Author(s) 2020
Abstract According to anti-SARS-CoV-2 seroresponse in patients with COVID-19 from Croatia, we emphasised the issue of different serological tests and need for combining diagnostic methods for COVID-19 diagnosis. Anti-SARS-CoV-2 IgA and IgG ELISA and IgM/IgG immunochromatographic assay (ICA) were used for testing 60 sera from 21 patients (6 with severe, 10 moderate, and 5 with mild disease). The main clinical, demographic, and haemato-biochemical data were analysed. The most common symptoms were cough (95.2%), fever (90.5%), and fatigue and shortness of breath (42.9%). Pulmonary opacities showed 76.2% of patients. Within the first 7 days of illness, seropositivity for ELISA IgA and IgG was 42.9% and 7.1%, and for ICA IgM and IgG 25% and 10.7%, respectively. From day 8 after onset, ELISA IgA and IgG seropositivity was 90.6% and 68.8%, and for ICA IgM and IgG 84.4% and 75%, respectively. In general, sensitivity for ELISA IgA and IgG was 68.3% and 40%, and for ICA IgM and IgG 56.7% and 45.0%, respectively. The anti-SARS-CoV-2 antibody distributions by each method were statistically different (ICA IgM vs. IgG, p = 0.016; ELISA IgG vs. IgA, p < 0.001). Antibody response in COVID-19 varies and depends on the time the serum is taken, on the severity of disease, and on the type of test used. IgM and IgA antibodies as early-stage disease markers are comparable, although they cannot replace each other. Simultaneous IgM/IgG/IgA anti-SARS-CoV-2 antibody testing followed by the confirmation of positive findings with another test in a two-tier testing is recommended. Keywords COVID-19 diagnostics . Clinical and laboratory findings . Anti-SARS-CoV-2 antibody response . Serological methods . Two-step testing approach . Croatia
Introduction At the end of 2019, a new severe respiratory infection caused by SARS-CoV-2 spread rapidly and resulted in a high mortality rate in Wuhan, China [1, 2]. In Croatia, this infection
* Oktavija Đaković Rode [email protected]; [email protected] 1
University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Mirogojska 8, 10000 Zagreb, Croatia
2
School of Dental Medicine, University of Zagreb, Zagreb, Croatia
3
School of Medicine, University of Zagreb, Zagreb, Croatia
4
Andrija Štampar School of Public Health, Zagreb, Croatia
5
Catholic University of Croatia, Zagreb, Croatia
6
Faculty of Medicine, University of Rijeka, Rijeka, Croatia
was soon recognised as a potential global threat, prompting the government and health officials to prepare a strategy for the emerging situation [3, 4]. Intensive epidemiological investigations were conducted in an attempt to cont
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