Studies of the Acute Diarrheal Diseases: XV. The Agglutination Test in Shigella paradysenteriae Infections

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Abstract
A group of 45 patients in a mental hospital were kept under observation for 1 yr. They were watched for diarrheal disorders during this period. For the first 6 months stool cultures were made daily and for the next 6 months, twice weekly. Blood was obtained after observation for periods of 5, 10, and 12 months and agglutination tests were performed on the serums. Standardized suspensions of S. paradysenteriae Flexner V, W, and Z, Newcastle, Schmitz and Sonne were employed as antigens in the tests. The technique was standardized throughout and positive and negative controls were used. Agglutinins against all of the Flexner antigens were commonly demonstrated in the group. When these were compared with the results of stool cultures it was apparent that, although individuals found to be positive showed a definite tendency to have higher agglutinin titres, these were neither sufficiently high nor consistent to permit interpretation of individual results. Examination using the same antigen, repeated at intervals, also failed to provide a reliable means of interpretation. The presence of diarrheal disease associated with positive cultures did not show any different piciure. Significant change in titre was not observed consistently in the presence of known infection. There was no apparent relation between the titre level of the group and prevalence of infection. Persons with a positive agglutination test were just as likely to have positive stool cultures after the test as those with no agglutinins. The evidence with Newcastle, Schmitz, and Sonne is not as complete but it is apparent that infection with the first 2 of these organisms did not cause the production of agglutinins in high titre and that such agglutinins may be present in the absence of detectable infection. The serums of several individuals agglutinated the Sonne antigen although cultures were negative in all cases examined. The agglutination test as performed did not provide a reliable means of diagnosing past infection with any of the members of the Shigella group studied; nor did it provide any index of immunity or susceptibility in the case of the Flexner organisms.

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