WellcogenTM Bacterial Antigen Kit

ZL26/R30859602

www.oxoid.com/ifu
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US 1 855 236 0910 CA 1 855 805 8539 LI +31 20 796 5692 MT +31 20 796 5693

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1
 Instructions for Use
Disposable Reaction Cards (2 packs)
Disposable Mixing Sticks (5 bundles)
Disposable Droppers (1 container)
WellcogenTM Bacterial Antigen Kit Black rubber teat (1)

Test Latexes

ZL26/R30859602 .....................30 Tests EN Strep B (pink cap)

H. influenzae b (pale blue cap)
S. pneumoniae (yellow cap)
1 INTENDED USE
N. meningitidis ACY W135 (grey cap)
The WellcogenTM Bacterial Antigen Kit provides a series of rapid latex N. meningitidis B/E. coli K1 (brown cap)
tests for use in the qualitative detection of antigen from Streptococcus Five dropper bottles, one specific for each of
group B, Haemophilus influenzae type b, Streptococcus pneumoniae the groups above, containing 0.5%
(pneumococcus), Neisseria meningitidis (meningococcus) groups A, suspensions of polystyrene latex particles in
B, C, Y or W135 and Escherichia coli K1 present in cerebrospinal fluid buffer containing 0.05% Bronidox and/or 0.1%
(CSF) as a consequence of infection. The kit can also be used to test sodium azide as preservative. The latex
other body fluids or blood culture supernatants for most of these antigens particles are coated with the appropriate rabbit
and plate cultures for N. meningitidis group B or Escherichia coli K1. antibody, as labelled, except for the
(See Table 1 for indications supported by clinical data). N. meningitidis group B/E. coli K1 reagent,
2 SUMMARY which is coated with murine monoclonal
antibody.
Meningitis has a wide variety of potential causes, either infectious or
non-infectious. If bacterial meningitis is not treated promptly and Control Latexes
effectively, the disease is likely to be fatal. Early identification of the 5 dropper bottles (dark blue cap) containing
infecting agent can be of considerable value in providing the patient 0.5% suspensions of polystyrene latex
with appropriate and adequate chemotherapy. Many bacterial species particles in buffer containing 0.05% Bronidox
have been implicated in meningitis. Streptococcus group B and E. coli and/or 0.1% sodium azide as preservative. The
K1 are two of the most common causes of neonatal sepsis whilst in latex particles are coated with an appropriate
older age groups the commonest isolates are H. influenzae type b, preparation of rabbit globulin or in the case of
S. pneumoniae and N. meningitidis groups A, B, C, Y and W135. These the N. meningitidis group B/E. coli K1 latex, a
organisms carry specific polysaccharide surface antigens, a quantity of murine monoclonal antibody raised against
which diffuses into culture media or body fluids such as CSF or serum, Bordetella bronchiseptica.
and is excreted in the urine. The antigens can be detected by sensitive The latex suspensions are provided ready for
immunological methods such as counterimmuno-electrophoresis and use and should be stored at 2 to 8C in an
latex agglutination2,5,6,10. upright position, until the expiry date of the
3 PRINCIPLE OF THE TEST kit. After prolonged storage some aggregation
or drying of the latex may have occurred
The WellcogenTM reagents consist of polystyrene latex particles which around the top of the bottle. Under these
have been coated with antibodies to the bacterial antigens. These latex circumstances the bottle of latex should be
particles agglutinate in the presence of sufficient homologous antigen. shaken vigorously for a few seconds until
The Streptococcus and H. influenzae reagents are group B and type b resuspension is complete. DO NOT FREEZE.
specific respectively, the S. pneumoniae reagent is sensitised with
antibodies purified from an omnivalent serum and the N. meningitidis Polyvalent Positive Control
polyvalent reagent reacts with groups A, C, Y and W135 antigens. Two bottles (red cap) containing freeze-dried
Meningococcus group B antigen is more difficult to detect 6 as well as bacterial extracts containing antigens from
being structurally and immunologically related to E. coli K1 antigen 7; representative strains of each bacterial
both of these react with the N. meningitidis group B reagent. species for which latex is provided. Contains
4 SYMBOL DEFINITIONS 0.01% bronopol before reconstitution and
0.004% when reconstituted.
Catalogue Number Reconstitute using 3.6 ml of sterile distilled
In Vitro Diagnostic Medical Device water. After the addition of water allow the
bottle to stand for a few minutes and then swirl
Contains sufficient for <n> tests to mix. Store reconstituted antigen at 2 to 8C
for up to 6 months.
Consult Instructions for Use (IFU)
Negative Control
Temperature Limitation (Storage Temp.) One dropper bottle (white cap) containing
Glycine saline buffer, pH 8.2, with 0.05%
Batch Code (Lot Number)
Bronidox as preservative.
Use By (Expiration Date)
6 PRECAUTIONS
Manufacturer

Add water
The reagents are for in vitro diagnostic use only.
5 KIT CONTENTS, PREPARATION FOR USE AND For professional use only.
STORAGE Caution: This product contains dry natural rubber.
The WellcogenTM Bacterial Antigen Kit includes sufficient reagents to Please refer to the Material Safety Data Sheet (MSDS) and product
labelling for information on potentially hazardous components.
perform 30 tests.
See also Precautions, section 6.
All components should be stored at 2 to 8C under which condition they
will retain their activity until the expiry date of the kit.
Before use, bring all reagents to room temperature (18 - 30C) and mix.
Return the unused reagents to the refrigerator after use.

2
 HEALTH AND SAFETY INFORMATION as soon after collection as possible. If the fluid cannot be tested
immediately it may be stored overnight at 2 to 8C, or for longer
6.1 The Test and Control Latexes for Streptococcus group B,
periods frozen at 15 to 25C. If bacteriological analyses are
H. influenzae type b, S. pneumoniae and N. meningitidis ACY
required on the sample, these should be set up prior to performing
W135 contain 0.1% sodium azide which is classified per
the latex test, to avoid contaminating the sample.
applicable European Economic Community (EEC) Directives as
harmful (Xn). The following are the appropriate Risk (R) and Safety 7.2 Blood cultures may be sampled and tested after 18 to 24 hours
(S) phrases. incubation at 37C and/or as soon as bacterial growth is observed.
Xn R22 Harmful if swallowed 7.3 Plate cultures (N. meningitidis B/E. coli K1 only). Isolated
S36 Wear suitable protective clothing colonies growing on enriched agar medium (e.g. blood, chocolate
agar) may be tested after overnight incubation at 37C. A Gram
stain should be performed to assist with the interpretation of the
Azides can react with copper and lead used in some plumbing latex test result.
systems to form explosive salts. The quantities used in this kit
are small; nevertheless when disposing of azide-containing 8 TEST PROCEDURE
materials they should be flushed away with large volumes of
water. REQUIRED MATERIALS PROVIDED
6.2 In accordance with the principles of Good Laboratory Practice it See Kit Contents, section 5.
is strongly recommended that body fluids should be treated as
potentially infectious and handled with all necessary precautions. MATERIALS REQUIRED BUT NOT PROVIDED
6.3 When handling radiometric blood culture medium, the basic rules Boiling water bath
of radiation safety should be followed. These include: Laboratory centrifuge or membrane filters (0.45 m)
a) Radioactive material should be stored in a designated area in an Rotator (optional refer to Precautions, section 6)
approved container. PREPARATION OF CLINICAL SPECIMENS
b) Handling of radioactivity should take place in a designated area.
c) No mouth pipetting of radioactive material should be carried out. 8.1 Body fluid samples must be heated before testing by the
d) No eating, drinking or smoking should take place in the designated WellcogenTM procedure to minimise non-specific reactions4,6. The
area. following procedures are recommended:
e) Hands should be washed thoroughly after using radioactive a) For CSF and urine, heat the sample for 5 minutes in a boiling
material. water bath. Cool the sample to room temperature (18 to 30C)
f) The local Radiation Safety Officer should be consulted concerning and clarify by centrifugation or membrane filtration (0.45 m) prior
disposal requirements. to testing. For maximum sensitivity urine samples may be
6.4 Non-disposable apparatus should be sterilised by any appropriate concentrated up to 25-fold in a Minicon B-15 concentrator.
procedure after use, although the preferred method is to autoclave Clarify as above before testing.
for 15 minutes at 121C. Disposables should be autoclaved or b) For serum, add 3 volumes 0.1 M disodium ethylenediaminetetra-
incinerated. Spillage of potentially infectious materials should be acetate (EDTA) pH 7.4 per 1 volume serum, heat the sample for
removed immediately with absorbent paper tissue and the 5 minutes in a boiling water bath, cool to room temperature (18 to
contaminated areas swabbed with a standard bacterial 30C) and clarify as above. A suitable EDTA solution (10 ml) is
available (Code No. ZL29/R30164501).
disinfectant or 70% alcohol. Do NOT use sodium hypochlorite.
Materials used to clean spills, including gloves, should be 8.2 Blood cultures. Centrifuge a 1 to 2 ml sample to pellet the red
disposed of as biohazardous waste. blood cells, for example at 1000 g for 5 to 10 minutes. Perform
the latex test on the supernatant.
6.5 Do not pipette by mouth. Wear disposable gloves and eye
protection while handling specimens and performing the assay. If a non-specific reaction occurs with a blood culture supernatant
Wash hands thoroughly when finished. (see Interpretation of Results, section 10), heat the sample in
a boiling water bath for 5 minutes, cool to room temperature (18
6.6 When used in accordance with the principles of Good Laboratory
to 30C), clarify by centrifugation and repeat the test.
Practice, good standards of occupational hygiene and the
instructions stated in these Instructions for Use, the reagents 8.3 Plate cultures (N. meningitidis B/E. coli K1 only). Test directly
supplied are not considered to present a hazard to health. from the culture plate.

ANALYTICAL PRECAUTIONS PROCEDURE

6.7 Do not use the reagents beyond the stated expiry date. It is recommended that the section on Precautions, section 6, is read
carefully before performing the test.
6.8 Latex reagents should be brought to room temperature (18 to 30C)
before use. Latex reagents which show signs of aggregation or Body fluid samples and Blood culture supernatants:
lumpiness before use may have been frozen and must not be NOTE: If there is only a limited volume of test sample available, it should
used. be used with the Test Latexes first and if a positive result is obtained the
6.9 It is important when using dropper bottles that they are held sample should be tested with the appropriate Control Latex. If sufficient
vertically and that the drop forms at the tip of the nozzle. If the sample is available, it should be tested against both the Test and Control
nozzle becomes wet an incorrect volume will form around the Latexes simultaneously.
end and not at the tip; if this occurs dry the nozzle before Step 1 Process the sample as described under
progressing. Preparation of Clinical Specimens.
Step 2 Shake the latex reagents.
6.10 The reagents provided with each kit are matched in performance
Step 3 Place 1 drop of each Test Latex or Control Latex 1 drop
and should not be used in conjunction with reagents from a kit
into a separate circle on a Reaction Card. Ensure
having a different lot number. that the dropper bottles are held vertically to dispense
6.11 Do not touch the reaction areas on the cards. an accurate drop. (See Precautions, section 6).
6.12 Mechanical rotators may be used in this assay. The following Step 4 Using a Disposable Dropper, dispense 1 drop 1 drop
characteristics have been found to be satisfactory: (approximately 40 l) of Test Sample next to each
drop of latex.
i) Flat bed rotators operating at 100 to 150 rpm and with an orbital
Step 5 Mix the contents of each circle with a Mixing Stick
diameter of 3.0 to 3.4 cm. The card should be removed from the
and spread to cover the complete area of the circle.
rotator and rocked briefly before reading.
Use a separate stick for each circle and discard it for
ii) Orbital rotators (also known as dimensional rotators) operating
safe disposal after use.
at 25 rpm with approximate rotating angle of 9 to 10.5 degrees or
Step 6 Rock the card slowly and observe for agglutination 3 mins
operating at 18 rpm with a rotating angle of 16 to 17.5 degrees.
for 3 minutes, holding the card at normal reading
6.13 Avoid microbial contamination of reagents as this may lead to distance (25 to 35 cm) from the eyes. Do not use a
erroneous results. magnifying lens. Mechanical rotation (3 minutes) may
be used (See Precautions, section 6). The patterns
7 SPECIMEN COLLECTION AND STORAGE obtained are clear cut and can be recognised under all
7.1 Body fluid samples (e.g. CSF, serum, urine) should be tested normal lighting conditions.
Step 7 Discard the used Reaction Card for safe disposal.
3
Plate Cultures: For tests with blood cultures a sample of uninoculated blood culture
(WellcogenTM N. meningitidis B/E. coli K1 only): medium from the same source as the specimen should be used as a
Step 1 Shake the latex reagents. negative control. Note: testing uninoculated media is important as false-
Step 2 For each culture to be tested place 1 drop of 1 drop positives can occur with some formulations of blood culture media.
Test Latex in one circle on a Reaction Card and 1 Notes:
drop of Control Latex in a separate circle. a) Previously assayed positive and negative samples, aliquoted and
NOTE: it is essential to use the Control Latex for stored at 15 to 25C or below, may be used as positive and
suspected E. coli cultures. negative controls respectively, if desired. The Positive Control
Step 3 Take a Mixing Stick and pick up some of the culture Sample can also be used in place of the test sample.
by touching it with the flat end of the stick. As a guide, of b) For colony identification tests (WellcogenTM N. meningitidis B/
an amount of growth roughly equivalent to 1 large growth E. coli K1 only), the performance of the Test and Control Latex
colony should be picked. reagents may be confirmed using fresh, overnight cultures of
Step 4 Emulsify the sample of culture in the drop of Test reference strains of bacteria, following the method described in
Latex by rubbing with the flat end of the stick. Rub Test Procedure. Suitable reference strains are:
thoroughly, but not so vigorously as to damage the ATCC 13090 N. meningitidis group B (positive reactivity)
surface of the card. Spread the latex to cover as much ATCC 23503 E. coli type K1 (positive reactivity)
of the circle as possible. Discard the Mixing Stick for ATCC 13077 N. meningitidis group A (negative reactivity)
safe disposal. ATCC 13090 and ATCC 23503 should give agglutination with the
Step 5 Using a separate stick, emulsify a similar sample of Test Latex and no significant agglutination in the Control Latex,
culture in the Control Latex. ATCC 13077 should give no significant agglutination with either
Step 6 Rock the card slowly and observe for agglutination 20 secs the Test or Control Latex.
for 20 seconds holding the card at normal reading
distance (25 to 35 cm) from the eyes. Do not use a 10 RESULTS
magnifying lens. The patterns obtained are clear cut
and can be easily recognised under all normal READING OF RESULTS
lighting conditions.
A positive reaction is indicated by the development of an agglutinated
Step 7 Discard the used Reaction Card for safe disposal.
pattern within 3 minutes (20 seconds for colony testing) of mixing the
9 QUALITY CONTROL latex with the test sample, showing clearly visible clumping of the latex
particles (Figure 1).
The following procedures should be carried out initially with each
shipment of test kits and with each run of test samples. In practice, a The speed of appearance and quality of agglutination depend on the
run may be defined as a testing period of up to 24 hours. Any departure strength of the antigen, varying from large clumps which appear within
from the expected results indicates there may be a problem with the a few seconds of mixing, to small clumps which develop rather slowly.
reagents, which must be resolved before further use with clinical In culture identification, most positive reactions will be almost
samples. instantaneous.
In a negative reaction the latex does not agglutinate and the milky
VISUAL INSPECTION appearance remains substantially unchanged throughout the test (Figure
The latex suspensions should always be inspected for aggregation as 2). Note, however, that faint traces of granularity may be detected in
they are dropped onto the test card and if there is evidence of clumping negative patterns, depending on the visual acuity of the operator. In
before addition of the test sample, the suspension must not be used. culture identification, some strains may cause a stringy aggregation
After prolonged storage some aggregation or drying may have occurred of the latex with a milky background; this should be interpreted as a
around the top of the bottle. If this is observed, the bottle should be negative reaction.
shaken vigorously for a few seconds until resuspension is complete. NOTE: The latex particles used in the WellcogenTM N. meningitidis B/
POSITIVE CONTROL PROCEDURE E. coli K1 Test and Control Latex suspensions are not the same as
those used for the other reagents, and give a finer agglutination.
The reactivity of the test can be confirmed by adding Polyvalent Positive Figure 1 Figure 2
Control to a reaction circle in which the test sample has not agglutinated
the Test Latex after 3 minutes rotation.
Step 1 Use a Disposable Dropper to add 1 drop of Positive 1 drop
Control to the circle containing Test Latex and
specimen.
Step 2 Mix using a Mixing Stick and discard it for safe
disposal.
Step 3 Rock the card manually or by a rotator for a further 3 mins
3 minutes. After this time, definite agglutination
should be visible in the Test Latex.
Step 4 Discard the used Reaction Card for safe disposal.
INTERPRETATION OF RESULTS
NEGATIVE CONTROL PROCEDURE
Positive Result
If at least one test sample within a run gives a negative result with
Test and Control Latexes (or Test Latex only where no Control Latex Clear agglutination of a single Test Latex accompanied by negative
has been used), this constitutes a valid negative control for the reagents reactions with all other Test Latex reagents and the Control Latex
and no further testing is necessary. indicates the presence and identity of a bacterial antigen in the test
sample. As a general rule a positive result with Wellcogen TM
If a test sample gives agglutination with the Test Latex and no N. meningitidis B/E. coli K1 against a neonatal specimen suggests E. coli
agglutination with the Control Latex then the Test Latex should be tested
K1 infection; with older patients, meningococcus group B is more likely.
either with the Negative Control or uninoculated blood culture medium,
as appropriate (see below). Negative Result
Step 1 Place one drop of Test Latex in one circle on a 1 drop Negative reactions with all the Test Latex reagents indicates the absence
Reaction Card. of a detectable level of the bacterial antigens in the test fluid it does
Step 2 Dispense one drop of Negative Control or 1 drop not eliminate the possibility of an infection caused by these organisms,
uninoculated blood culture medium next to the Test and if symptoms persist it may be desirable to perform the test on
Latex. subsequent or alternative specimens, or after concentration of the urine
Step 3 Mix using a Mixing Stick and discard it for safe specimen.
disposal.
Step 4 Rock the card manually or by a rotator for a further 3 mins
With a culture, lack of agglutination in WellcogenTM N. meningitidis B/
3 minutes. After this time, there should be no E. coli K1 reagents indicates that it is unlikely to be N. meningitidis
significant agglutination in the Test Latex. group B or E. coli K1.
Step 5 Discard the used Reaction Card for safe disposal.
For tests with body fluid samples, the Negative Control provided with
the kit should be used.
4
Non-interpretable Result Specificity
Agglutination of more than one Test Latex reagent or corresponding The specificity of each of the WellcogenTM reagents was evaluated
Test and Control Latexes indicates a non-specific reaction. In most cases, using body fluid (fresh and frozen) and blood culture samples
non-specific reactions with body fluids may be eliminated by heating from patients with bacterial or aseptic meningitis and other
and clarifying the sample4 (see Preparation of Clinical Specimens, unrelated conditions.
section 8). If a non-specific reaction occurs with a blood culture The organisms isolated from the infected samples were
supernatant, heat the sample in a boiling water bath for 5 minutes, cool H. influenzae b, S. pneumoniae, N. meningitidis including groups
to room temperature (18 to 30C), clarify by centrifugation and repeat A, B, C, Y, E. coli, Staphylococcus aureus, Enterobacter
the test. aerogenes, Klebsiella pneumoniae, Mycobacterium tuberculosis,
NOTE: Tests performed directly on clinical specimens are intended for Proteus mirabilis, Staphylococcus epidermidis, alpha-haemolytic
screening purposes and should augment, not replace, culture streptococcus, beta-haemolytic streptococcus group A, Klebsiella
procedures. Results must be used in conjunction with other data; e.g. oxytoca, Pseudomonas, Streptococcus sanguis, Toxoplasma
symptoms, results of other tests, clinical impressions etc. gondii and a coliform bacterium.
11 PERFORMANCE LIMITATIONS The specificity of all five WellcogenTM latexes in tests on CSF
was greater than 98%. Details of the number of samples tested
11.1 For infant body fluids (Group B strep only) False negative and the specificity of each WellcogenTM with each type of
test results may occur with specimens containing levels of antigen specimen are given in tables 2 to 6.
below the limits of detection of this device. Negative results should 13.2 Plate Cultures (N. meningitidis B/E. coli K1).
be followed up with selective broth culture. A positive result N. meningitidis and E. coli cultures grown on an enriched agar
indicates the presence of Group B streptococcal antigen; the medium were tested in hospital laboratories and In-house. All
result does not necessarily indicate the presence of viable N. meningitidis group B and E. coli K1 cultures were correctly
organisms. identified. There were no cross-reactions with other groups of
11.2 For infant body fluids (Group B strep only) Use of this device N. meningitidis or other E. coli K antigens (Table 7). A high
should not substitute for microbiological culture. Performance of proportion of the E. coli cultures with other K antigens which
this device for predicting Group B streptococcal disease from were tested gave non-specific reactions (Table 7).
tests of infant urine has not been established. Table 1
11.3 Group B streptococcus infections occur primarily in neonates.
Specimens which have been evaluated with
Positive results obtained with body fluid samples from patients
individual Wellcogen TM latex reagents
older than six months should be interpreted with caution. Positive
results obtained with blood culture supernatants from patients of Specimen WellcogenTM
any age may be significant. N. meningitidis N. meningitidis B/
Strep. B H. influenzae b S. pneumoniae
ACY W135 E. coli K1
11.4 A positive result in the test depends on the presence of a
CSF + + + + +
detectable level of antigen in the body fluid or blood culture Serum + + + + +*
medium. Urine + + + +* +*
11.5 Limited clinical data are available for the detection of antigen in Blood Culture + + + + +
Bacterial colonies +
urine or serum using WellcogenTM N. meningitidis B/E. coli K1
(Table 6). No clinical data is available for the detection of antigen Key
in urine using WellcogenTM N. meningitidis ACY W135 (Table 5). + Data available to support this application.
However, antigen has been reported in urine ACY W135 +* Limited data available.
samples 5. No data available.
11.6 A few examples have been reported of unrelated bacteria which Table 2
possess common antigens and, as with any immunological test Results of clinical studies on WellcogenTM Strep B
system, the possibility of cross reactions occurring in the latex
test can not be ruled out1,3,8,9. Sensitivitya Specificity b
Sample No. tested No. positive No. tested No. positive
12 EXPECTED RESULTS CSF 18 12 58 1c
Samples containing a detectable level of group B streptococcal antigen, Serum 19 13 7 0
H. influenzae type b antigen, S. pneumoniae capsular antigen, Urine 20 17 22 1d
N. meningitidis A, C, Y, W135 antigens, or N. meningitidis B / E. coli K1 Blood Culture 9 9 369 4e
antigen will give an agglutination reaction with the appropriate Test Latex. a
beta-haemolytic streptococcus group B isolated/indicated (clinical
diagnosis/other antigen test).
13 PERFORMANCE CHARACTERISTICS b
Bacteria other than Strep. B/no growth.
13.1 Body Fluids and Blood Cultures c
E. coli isolated.
Clinical studies were carried out in 15 centres using body fluid d
P. mirabilis isolated.
samples (fresh and stored frozen) and blood culture supernatants. e
Staph. epidermidis; beta-haemolytic strep. group A; E. coli +
Both traditional and radiometric cultural techniques were used in Enterococcus; Staph. epidermidis + Enterococcus isolated.
the blood culture studies. Stored body fluid samples were not Table 3
heat treated as described under Preparation of Clinical
Specimens, section 8. Extensive laboratory testing has shown Results of clinical studies on Wellcogen TM H. influenzae b
no significant loss of antigen after heating by this procedure. Sensitivity Specificity
Sensitivity Sample No. tested No. positive No. tested No. positive
The sensitivity of each latex in the kit was established from tests CSF 90 87 375a 2b
on samples culture positive for the homologous organism or for Serum 21 20 21 0
which there was other evidence of infection (clinical diagnosis Urine 10 10 236 0
plus other antigen test positive). Blood Culture 54 54 1566 c 5d
Tables 2 to 6 show the numbers of each type of specimen tested a
One additional CSF sample gave a non-specific reaction.
with the individual latexes together with the number of positive b
One sample aseptic; E. coli isolated from other sample.
results obtained. The sensitivity of each latex in detecting bacterial c
Two additional blood culture supernatants gave non-specific reactions.
antigen in CSF was 67% (12/18) for WellcogenTM Strep B, 97% d
One sample aseptic. Other samples grew: Staph. aureus; E. coli +
(87/90) for Wellcogen TM H. influenzae b, 88% (45/51) for
Staph. epidermidis; K. oxytoca; alpha-haemolytic streptococcus.
Wellcogen TM S. pneumoniae, 71% (29/41) for Wellcogen TM
N. meningitidis ACY W135 and 65% (11/17) for WellcogenTM
N. meningitidis B/E. coli K1.

5
 Table 4 14 BIBLIOGRAPHY
Results of clinical studies on WellcogenTM S. pneumoniae 1 Argaman, M., Liu, T.Y., et al (1974).
Polyribitol-phosphate: an antigen of four gram-positive bacteria cross-
Sensitivity Specificity reactive with the capsular polysaccharide of Haemophilus influenzae
Sample No. tested No. positive No. tested No. positive type b.
CSF 51 45 483a 2b J. Immunol., 112, 649.
Serum 6 6 13 0 2 Baker, C.J. and Rench, M.A. (1983).
Urine 105 46 320c 0 Commercial latex agglutination for detection of group B streptococcal
antigen in body fluids.
Blood Culture 113 109 1512 7d
J. Pediatr., 102, 393.
a
One additional CSF gave a non-specific reaction. 3 Bvre, K., Bryn, K., et al (1983).
b
Enterobacter aerogenes; coliform bacterium. Surface polysaccharide of Moraxella non-liquefaciens identical to Neisseria
c
Three additional urine samples gave non-specific reactions. meningitidis group B capsular polysaccharide. A chemical and
d
Pseudomonas; Strep. sanguis; Staph. epidermidis + Enterococcus; immunological investigation.
Strep. viridans isolated from 4 samples. NIPH Annals, 6, 65.
4 Doskeland, S.O. and Berdal, B.P. (1980).
Table 5 Bacterial antigen detection in body fluids: methods for rapid antigen
Results of clinical studies on concentration and reduction of nonspecific reactions.
Wellcogen TM N. meningitidis ACY W135 J. Clin. Microbiol., 11, 380.
5 Feigin, R.D., Wong, M., et al (1976).
Sensitivity Specificity Countercurrent immunoelectrophoresis of urine as well as of CSF and
Sample No. tested No. positive No. tested No. positive blood for diagnosis of bacterial meningitis.
J. Pediatr., 89, 773.
CSF 41a 29 423 2b
6 Kaldor, J., Asznowicz, R., et al (1977).
Serum 5 3 36 0 Latex agglutination in diagnosis of bacterial infections, with special
Urine 0 229c 0 reference to patients with meningitis and septicemia.
Blood Culture 7 7 1615 2d Amer. J. Clin. Path., 68, 284.
a
Includes 8 group A, 25 group C and 1 group Y (the remainder were not 7 Kasper, D.L., Winkelhake, J.L., et al (1973).
grouped). Immunochemical similarity between polysaccharide antigens of
b Escherichia coli 07:K1(L):NM and group B Neisseria meningitidis.
K. aerogenes; E. coli.
c
J. Immunol., 110, 262.
Five additional urine samples gave non-specific reactions.
d 8 Lee, C.J. and Koizumi, K. (1981).
Strep. sanguis; Staph. epidermidis + Enterococcus. Immunochemical relations between pneumococcal group 19 and Klebsiella
Table 6 capsular polysaccharides.
J. Immunol., 127, 1619.
Results of clinical studies on
9 Robbins, J.B., Myerowitz, R.L., et al (1972).
WellcogenTM N. meningitidis B/E. coli K1
Enteric bacteria cross-reactive with Neisseria meningitidis groups A and
Sensitivity Specificity C and Diplococcus pneumoniae types I and III.
Infect. Immun., 6, 651.
Sample No. tested No. positive No. tested No. positive
10 Whittle, H.C., Tugwell, P., et al (1974).
CSF Rapid bacteriological diagnosis of pyogenic meningitis by latex
N. meningitidis B 11 7 128 0 agglutination.
E. coli K1a 6 4 128 0 Lancet, ii, 619.
Serum: Bronidox is the registered trade name of Cognis UK Ltd.
N. meningitidis B 2 1 3 0 Minicon is a trade mark of the Millipore Corporation.
Urine:
N. meningitidis B 2 1 7 0
Blood Culture:
N. meningitidis B 7 5 461 3b
a
Samples stored frozen. All other samples tested fresh. Manufactured by:
b
Aerobic and anaerobic cultures (beta-haemolytic strep A) for same Remel Europe Ltd
patient; coagulase negative staphylococcus. Clipper Boulevard West, Crossways
Table 7 Dartford, Kent, DA2 6PT
Identification of cultures using UK
WellcogenTM N. meningitidis B/E. coli K1
Culturea + Manufactured for:
Oxoid Ltd
N. meningitidis group A 0 16 Wade Road
N. meningitidis group B 10 0 Basingstoke, Hants, RG24 8PW
N. meningitidis group C 0 18 UK
N. meningitidis group 29E 0 8
N. meningitidis group W135 0 7 For technical assistance please contact your local distributor.

N. meningitidis group X 0 4 IFU X7713-EN, Revised May 03, 2011 Printed in the UK
N. meningitidis group Y 0 5
N. meningitidis group Z 0 3
E. coli K1 7 0
E. coli other antigens 0 13b
a
Cultures identified by slide agglutination.
b
An additional 10 cultures gave non-specific reactions.