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Forty-two subjects with acute tularemia were studied for the occurrence of C-reactive protein (CRP), and 73 subjects with acute tularemia or experience of the disease within the last 11 years were studied for immunoglobulin M (IgM), IgA, and IgG class-specific antibodies, agglutinating antibodies, and complement-fixing antibodies to Francisella tularensis by using an enzyme-linked immunosorbent assay (ELISA), the tube agglutination test, and a complement-fixing ELISA. The incubation time between infection and the outbreak of symptoms varied from 1 to 10 days, averaging 6.5 days. Elevated CRP concentrations were found in all samples taken in the first 6 days of illness, when the antibodies generally were absent. The highest CRP values, up to 165 mg/liter, occurred in the earliest samples and then decreased rapidly, being undetectable (less than 1 mg/liter) from 1 month after the onset of symptoms. Simultaneous though individually varying formation of IgM, IgA, and IgG class-specific antibodies to F. tularensis was demonstrable by ELISA in all the tularemia patients during the acute stage. In most cases, these antibodies appeared 6 to 10 days after the onset of symptoms, i.e., about 2 weeks after infection, reached their highest values at 4 to 7 weeks, and, despite a decreasing trend in their level, were still present 0.5 to 11 years after onset of tularemia, as demonstrable by the agglutination test and by the complement-fixing ELISA. Of the three methods used, ELISA for IgM, IgA, and IgG proved to be the most efficient for the early serodiagnosis of tularemia.
Koskela et al. (Sun,) studied this question.