Performance of Antibody-Detection Tests for Human Melioidosis: A Systematic Review and Meta-analysis

Melioidosis is a life-threatening infectious disease caused by the bacterium Burkholderia pseudomallei. Although culture is the gold standard for diagnosing melioidosis, it is timeconsuming and delays timely treatment. Non-culture-based diagnostic techniques are interesting alternatives for the rapid detection of melioidosis. This systematic review provides an overview of the performance of antibody-detection tests for melioidosis. A thorough literature search was conducted in two databases to identify relevant studies published until 31 December 2023. Among the 453 studies identified, 29 were included for further analysis. Various antibodydetection methods have been developed, primarily enzyme-linked immunosorbent assays (ELISAs). Recombinant outer membrane protein A–(OmpA)-specific immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin D (IgD) exhibited the highest accuracy, with a sensitivity of 95.0% and a specificity of 98.0% in ELISA. Furthermore, immunochromatographic testing has emerged as a promising rapid diagnostic test (RDT), with haemolysin co-regulated protein 1 (Hcp1) demonstrating significant accuracy, a sensitivity of 88.3%, and a specificity of 91.6%. Additionally, IgG against Burkholderia invasion protein D (BipD) showed excellent accuracy, with a sensitivity of 100.0% and a specificity of 100.0% in surface plasmon resonance assay. Combining multiple antigens or employing different detection techniques can enhance the accuracy of melioidosis diagnosis.