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Here we evaluated combinations of a lateral flow immunoassay (LFI) detecting <jats:italic>B<\/jats:italic>. <jats:italic>pseudomallei<\/jats:italic> capsular polysaccharide (CPS) and enzyme-linked immunosorbent assays (ELISA) detecting antibodies against hemolysin co-regulated protein (Hcp1) or O-polysaccharide (OPS) for diagnosing melioidosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>We conducted a cohort-based case-control study. Both cases and controls were derived from a prospective observational study of patients presenting with community-acquired infections and sepsis in northeast Thailand (Ubon-sepsis). Cases included 192 patients with a clinical specimen culture positive for <jats:italic>B<\/jats:italic>. <jats:italic>pseudomallei<\/jats:italic>. Controls included 502 patients who were blood culture positive for <jats:italic>Staphylococcus aureus<\/jats:italic>, <jats:italic>Escherichia coli<\/jats:italic> or <jats:italic>Klebsiella pneumoniae<\/jats:italic> or were polymerase chain reaction assay positive for malaria or dengue. Serum samples collected within 24 hours of admission were stored and tested using a CPS-LFI, Hcp1-ELISA and OPS-ELISA. When assessing diagnostic tests in combination, results were considered positive if either test was positive. We selected ELISA cut-offs corresponding to a specificity of 95%. Using a positive cut-off OD of 2.912 for Hcp1-ELISA, the combination of the CPS-LFI and Hcp1-ELISA had a sensitivity of 67.7% (130\/192 case patients) and a specificity of 95.0% (477\/502 control patients). The sensitivity of the combination (67.7%) was higher than that of the CPS-LFI alone (31.3%, p&lt;0.001) and that of Hcp1-ELISA alone (53.6%, p&lt;0.001). A similar phenomenon was also observed for the combination of CPS-LFI and OPS-ELISA. In case patients, positivity of the CPS-LFI was associated with a short duration of symptoms, high modified Sequential (sepsis-related) Organ Failure Assessment (SOFA) score, bacteraemia and mortality outcome, while positivity of Hcp1-ELISA was associated with a longer duration of symptoms, low modified SOFA score, non-bacteraemia and survival outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>A combination of antigen-antibody diagnostic tests increased the sensitivity of melioidosis diagnosis over individual tests while preserving high specificity. Point-of-care tests for melioidosis based on the use of combination assays should be further developed and evaluated.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009840","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T19:15:45Z","timestamp":1635880545000},"page":"e0009840","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5850-762X","authenticated-orcid":true,"given":"Premjit","family":"Amornchai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6727-3404","authenticated-orcid":true,"given":"Viriya","family":"Hantrakun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gumphol","family":"Wongsuvan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanaporn","family":"Wuthiekanun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surasakdi","family":"Wongratanacheewin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1075-4135","authenticated-orcid":true,"given":"Prapit","family":"Teparrakkul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-7204","authenticated-orcid":true,"given":"T. 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