Agglutination Tests for the Diagnosis of Undulant Fever

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Abstract
Account of a cooperative investigation of undulant fever by 17 laboratories in New York State. An antigen composed of a suspension of killed Brucella abortus was used and a standard procedure was followed. Reports were made on agglutination tests with sera from 3,716 patients. Of these, 64 gave positive agglutination reactions with the Br. abortus antigen; all except 1 patient lived in the State. While the final diagnosis in some cases had not been made, this investigation seemed to indicate that all of these were cases of undulant fever. Agglutination reactions with dilutions less than 1:100 were obtained with 93 specimens of serum. With the possible exception of 2 old recovered cases of undulant fever, diagnosis of undulant fever was not made in these cases. Some degree of agglutination with abortus or melitensis antigens was obtained with 165 sera. False positives were given with sera containing hemoglobin. No other known false positives occurred among many specimens from patients with a great variety of diseases. Among the patients with positive sera, those between the ages of 15 and 39 yrs. were most numerous (53%). Males occurred in the series twice as often as females. Farming and occupations associated with farming and cattle-raising were most frequently associated with positive agglutinations for undulant fever. While drinking of raw milk and contact with cows in herds having infectious abortion could be established in nearly every case in which a positive agglutination reaction was found, there were some instances in which these factors could not be shown. Contact with swine was infrequent and unimportant. The discovery of cases of undulant fever was made through use of the agglutination test. The experience of this investigation, however, indicates that very few positives will be found from tests with the sera submitted for serological tests for syphilis in the ordinary course of medical practice. On the other hand, valuable and often decisive information will be obtained from routine agglutination tests with sera from patients suffering from obscure and periodical fevers, arthritis, intestinal and abdominal disorders, and with suspected tuberculosis and typhoid fever.

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