US20160116466A1 - Rapid Screening Assay for Qualitative Detection of Multiple Febrile Illnesses - Google Patents

Abstract

A single-use multiplex, or assay, screening test for the detection of one or more of a plurality of unrelated febrile illnesses is provided. The febrile illnesses for which the test is designed are unrelated, in that the illnesses may be caused, by way of example, by infection from viruses, bacterium and/or parasites; by infection from viruses, bacterium, parasites or other contagions that are animal borne; by infection from viruses, bacterium, parasites, or other contagions that can be aerosolized for transmission; by infection from viruses, bacterium, parasites or other contagions that are transmitted from direct contact; by infection from viruses, bacterium, parasites or other contagions that are generally transmitted in the tropics and/or subtropics; and/or by infection from a virus, bacteria, parasite sharing one or more related feature and which causes a febrile illness. The assay test provides rapid results to a point of care center or other facility requiring such results to facilitate treatment and or containment of the illnesses.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to immunochromatographic, rapid screening test for the in vitro detection of illnesses from a bodily fluid, including, but not limited to, blood. More particularly, the test is a qualitative assay test for the quick screening of multiple febrile illnesses from the bodily fluid.
• 2. State of the Art
• A sudden and often severe fever is indicative of a febrile illness. In many parts of the world, febrile illnesses are often misdiagnosed due to the inherent variability associated with febrile-related diseases. Misdiagnosis is followed by presumptive treatment which may not address the causative infection. Improper treatment and control may allow infectious febrile illnesses to spread through populations. Febrile illnesses with potentially high morbidity and mortality include but are not limited to Ebola, Malaria, Dengue fever, Plague, and Melioidosis.
• Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). Ebola is caused by infection with a virus of the familyFiloviridae,genusEbolavirus.There are four identified Ebola virus species known to cause disease in humans: Ebola virus (Zaire ebolavirus);Sudanvirus (Sudan ebolavirus);Tai Forestvirus (Tai Forest ebolavirus, formerlyCote d'Ivoire ebolavirus); andBundibugyovirus (Bundibugyo ebolavirus). Researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Transmission occurs through direct contact with blood or other body fluids, objects contaminated with the virus and infected animals. Early symptoms such as fever are non-specific and often seen in patients with other illnesses, including, e.g., Malaria.
• Malaria results from infection with the parasitePlasmodium.ThePlasmodiumparasite is transmitted via the bite of an infectedAnophelesmosquito. The infected mosquito deposits parasites onto its human host, which then invade the host's liver followed by the red blood cells. The rupturing of infected red blood cells release parasites into the blood stream, giving rise to Malaria symptoms such as nausea, fever, vomiting, headache, sweating, and chills. These flu-like symptoms can be mild, severe, or even fatal.
• The Dengue virus is a single-stranded RNA virus from the Flaviviridae family that can cause Dengue Fever, Dengue hemorrhagic fever, and/or Dengue shock syndrome. Dengue is considered to be one of the leading causes of illness in tropical and subtropical regions. It is estimated that nearly100 million people are infected with Dengue on an annual basis. Dengue fever, the most common presentation of infection with Dengue virus, is caused by any of the four Dengue serotypes (Dengue 1, 2, 3,; or 4). Transmission is carried out by the mosquito vectorsAedes aegyptiandAedes albopictus.
• Infection with the gram-negative bacteriumBurkholderia pseudomalleioften presents as the tropical disease Melioidosis, also known as Whitmore's disease, which is found primarily in Southeast Asia and Australia. The bacteria are spread through direct contact with or inhalation of contaminated water or soil. Localized, pulmonary, bloodstream, or disseminated infection can occur and symptoms, such as fever, pain, ulceration, cough, respiratory distress, weight loss, headache, or seizures, generally appear two to four weeks after exposure. However, there are indications that the bacteria may remain latent in a host for up to several years. The infection, characterized most often by the CPS antigen, can be treated with appropriate antimicrobial therapy when diagnosed properly. Due to the severity of illness and its aerosol transmission, there is concern regarding the use ofBurkholderia pseudomalleias a bioterrorism agent.
• Yersinia pestisis a gram negative, rod-shaped bacterium that results in Plague. It is found in rodents and their fleas, and occurs in many parts of the world including the United States. Historically, three large pandemics have killed approximately 200 million people. While large outbreaks are now rare, a few cases of plague still arise in endemic areas around the world including the southwestern region of the United States. There are three forms of plague: pneumonic, bubonic and septicemic plague. Bubonic plague is the most common, while pneumonic plague is considered to be the most likely to be encountered in a bioterrorism event. The pneumonic form of the disease occurs whenYersinia pestisinfects the lungs. It can be transmitted through the air when a person breathes in aerosolized bacteria. With pneumonic plague, the first signs of illness are fever, headache, weakness and a rapidly developing pneumonia. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. To reduce the likelihood of death, antibiotics must be administered within the first 24 hours; thus, early diagnosis is essential.
• All of the above illnesses are non-specifically characterized by a high grade fever.
• Many types of ligand-receptor assays have been used to detect the presence of various substances that are indicative of a bodily response to an illness state. Such substances, often generally called ligands, are present in body fluids such as blood, urine, or saliva. These assays involve antigen antibody reactions, synthetic conjugates comprising radioactive, enzymatic, fluorescent, or visually observable polystyrene or metal sol tags, and specially designed chambers in which the antigens and antibodies react. In all these assays, there is a receptor, e.g., an antibody, which is specific for the selected ligand or antigen, and a means for detecting the presence, and in some cases the amount, of the ligand-receptor reaction product. Some tests are designed to make a quantitative determination, but in many circumstances all that is required is a positive/negative qualitative indication. A visually observable indicator such as the presence of agglutination or a color change is preferred.
• Even the qualitative assays must be very sensitive because of the often small concentration of the ligand of interest in the test fluid. False positives can also be troublesome, particularly with agglutination and other rapid detection methods such as dipstick and color change tests. Because of these problems, so-called “sandwich” assays and other sensitive detection mechanisms which use metal sols or other types of colored particles have been developed.
• In a “sandwich” assay, a target analyte such as an antigen is “sandwiched” between a labeled antibody and an antibody immobilized onto a solid support. The assay is read by observing the presence and/or amount of bound antigen-labeled antibody complex. In a “competition” immunoassay, antibody bound to a solid surface is contacted with a sample containing an unknown quantity of antigen analyte and with labeled antigen of the same type. The amount of labeled antigen bound on the solid surface is then determined to provide an indirect measure of the amount of antigen analyte in the sample.
• Because these and other assays can detect both antibodies and antigens, they are generally referred to as immunochemical ligand-receptor assays or simply immunoassays.
• Solid phase immunoassay devices, whether of the sandwich or competition type, provide sensitive detection of an analyte in a biological fluid sample such as blood, urine, or saliva. Solid phase immunoassay devices incorporate a solid support to which one member of a ligand-receptor pair, usually an antibody, antigen, or hapten, is bound. Common early forms of solid supports were plates, tubes, or beads of polystyrene which were well known from the fields of radioimmunoas say and enzyme immunoassay. More recently, a number of porous materials such as nylon, nitrocellulose, cellulose acetate, glass fibers, and other porous polymers have been employed as solid supports.
• A number of self-contained immunoassay kits using porous materials as solid phase carriers of immunochemical components such as antigens, haptens, or antibodies have been described. These kits are usually dipstick, flow-through, or migratory in design. One test kit is disclosed in co-owned U.S. Pat. No. 7,879,597 to Esfandiari which is hereby incorporated by reference herein in its entirety. This reference teaches an accurate self-contained immunoassay that can be used by minimally trained personnel to obtain valid qualitative assay results. The test also requires a relatively small amount of ligand molecule and can be manufactured at low cost. In addition, the test can be operated in a sensitive manner with a small sample volume while providing accurate results.
SUMMARY
• Early and appropriate diagnosis of febrile illnesses and infection may allow for effective treatment options against associated complications and may also prevent transmission of the diseases.
• A single-use multiplex, or assay, screening test for the detection of febrile illnesses is provided. The febrile illness assay test is intended for use as a point-of-care device to aid in the diagnosis of several severe febrile illnesses using a body fluid such a fingerstick whole blood. The assay test provides relatively quick results and facilitates clinical decision making.
• According to one aspect, the early manifestation of many febrile diseases is very similar. Accordingly, a multiplex assay that can distinguish among febrile diseases at an early stage can enable a more efficient rapid response.
• The assay test is an in vitro qualitative detection test preferably utilized for the presumptive detection of infection with one or more of various febrile illnesses, i.e., to detect (“positive”) or reject (“negative”) the illnesses.
• In one embodiment, the assay test is adapted to provide presumptive (i.e., confirmatory) detection of at least two unrelated febrile illnesses. In one embodiment, the assay test is adapted to provide presumptive detection of at least three unrelated febrile illnesses. The febrile illnesses can be selected for testing on the assay using common features of (or alternatively dissimilar features relative to) the two or more of the unrelated febrile illnesses. By way of example, the selection of febrile illnesses for which the test is designed may include illnesses caused by one or more of the following: viruses, bacterium and/or parasites (different pathogens); viruses, bacterium, parasites or other contagions that are animal borne, whether selected to be animal borne by the same animal (mosquitos) or by different animals (e.g., bat, rodent, mosquito, flea); viruses, bacterium, parasites, or other contagions that can be aerosolized for transmission; viruses, bacterium, parasites or other contagions that are transmitted from direct contact; viruses, bacterium, parasites or other contagions that are generally transmitted in the tropics and/or subtropics; virus, bacteria, parasite sharing one or more related features and which causes a febrile illness.
• It is specifically recognized that the febrile illnesses tested by the assay test do not share any particularly common cause for their respective disease states. That is, the positive detection of one febrile illness is not presumptive, indicative or otherwise suggestive of testing positive for a second febrile illness which is the subject of the assay test. Febrile illnesses under the test are epidemiologically independent; i.e., are known to have different etiologies. That is, there is no known pattern, causation, or other relationship from one illness to the other because each results from at least a different pathogen. As such, to the extent the test provides a positive detection for one febrile illness, it is expected that only one positive detection for a febrile illness will be indicated on any one test. It is, of course, possible that a test sample can provide positive detection of two or even more febrile illnesses. But given the lack of relationship of the febrile illnesses for which the test is administered, such results would not be expected. Nonetheless, it is anticipated that the unrelated febrile illnesses for which any test is designed will have a rationale in their selection for inclusion together on a test.
• In accord with one aspect of the assay test, the febrile illnesses detectable by the assay test may be linked by those febrile illnesses having a prevalence within a geographical proximity (by of example, within a state, or within a country, or within neighboring countries, or within proximate countries, or within a continent, or within 20° latitude of the equator, or as bounded by geological formations including rivers and/or mountains and/or valleys, or subject to environmental disaster, or geopolitical hardships, or other geographically definable boundary), and/or those febrile illnesses having a prevalence within a population in a given time period, and/or those febrile illnesses to which a group or population may be subject (by way of example, general population of western Africa, or aid workers of one or more relief organizations, whether localized or scattered, or inhabitants of one or more temporary or semi-permanent shelter or housing systems, including shelter or housing established by the United Nations or another relief aid organization), and/or those febrile illnesses which are potentially borne by travelers at a point of entry at a geographical location (e.g., air travelers at an airport arriving from selected points of origination or going to selected points of destination, or similar sea travelers at a sea port). For each of the potential groups identified above, an assay test may be designed to test for febrile illnesses that are appropriate for the circumstance.
• By way of example, the febrile illnesses detected can include Ebola Virus (viral infection and animal borne),Plasmodiumparasites (Malaria)(parasitic infection and animal borne by mosquito), Dengue virus (viral infection, animal borne by mosquito, and tropical/subtropical),Yersinia pestis(Plague)(bacterial infection, animal borne by rodent and their fleas, specific endemic regions, can be in aerosol form),Burkholderia pseudomallei(Melioidosis)(bacterial infection, tropical illness, can be in aerosol form or in contaminated soil). Other febrile illnesses that may be tested for include, by way of example, Anthrax, Lassa fever, Marburg hemorrhagic Fever, Leptospirosis, Rickettsial disease, Tularemia, Thyphoid, Chikungunya,Coxiella burnetiibacteria (Q-fever), Meningococcal, Pneomococcus, and Crimean-Congo haemorrhagic fever (CCHF).
• In accord with embodiments of the assay, and not by way of limitation, the assay is adapted to detect for at least three of, or all of, Ebola Virus,Plasmodium parasites(Malaria), Dengue virus, as well as the bacteriaYersinia pestis(Plague) andBurkholderia pseudomallei(Melioidosis) in a bodily fluid. In accord with one embodiment of the assay test, the assay is adapted to use the bodily fluid of fingerstick whole blood, venous whole blood, serum and/or plasma. In one aspect, these febrile illnesses are chosen to be part of a single assay because of their potential use in bioterrorism.
• In accord with an embodiment, the febrile illness assay test includes at least one lateral flow sorbent material test strip having a first width and a first length substantially longer than said first width, and defining a lateral flow pathway along its length. A test site is provided on or in the test strip with distinct test lines, each comprising a ligand-binding protein or particle adapted to couple with an antigen (antibody) of a distinct one of the febrile illnesses under test. Spaced apart from the test site are a plurality of conjugates adapted to combine with an antigen (or antibody) of the respective febrile illnesses under test. The conjugates include colloidal gold dye particles, and are bound to the test strip in a solid phase. Ligand binding proteins and their conjugates for use in a test cell are described in U.S. Pat. No. 5,714,389 to Charlton, the teaching of which is hereby incorporated by reference herein in its entirety. The test strip is provided in a housing, and includes a clear test window over a testing area under which results of the tests are displayed. An optionally diluted sample (sample and buffer) is applied to the test strip and allowed to flow across the test lines. The antibodies (or antigens), if any, in the sample laterally flow to the test site and combine with the antigens (or antibodies) immobilized at the respective test lines. The conjugates are also released from the test strip and caused to laterally flow to the test site. The conjugates are captured by antibodies (or antigens) of the febrile illnesses which are retained at the respective test lines. In a positive test, a conjugated antigen (or antibody) migrates along the test strip and is captured by its respective antigen-bound antibody at one of the test lines, producing a visible, colored line to positively indicate a febrile illness. The test lines are keyed to indicate which febrile illness is associated with each test line. It is appreciated that the test may be indicative of one or more febrile illnesses, on the showing of one or more colored lines at the test site. In the absence of the antibodies (or antigens) indicative of the febrile illnesses of interest, no associated colored line would be observed under the test window area.
• In accord with one embodiment of the assay test, the assay test includes a first sorbent material having a first location for receiving a buffer solution (in the case of a dry conjugate system) or a conjugate solution (in the case of a liquid conjugate system) with the first sorbent material defining a first horizontal flow path, a second sorbent material having a second location for receiving a sample with the second sorbent material defining a second horizontal flow path distinct from the first flow path, and a plurality of longitudinally displaced test lines or test sites with immobilized antigens or antibodies or other ligand binding molecules such as aptamers, nucleic acids, etc. associated with a plurality of distinct febrile illnesses, all located in a test zone at a junction of the first and second sorbent materials. For purposes herein, the term “distinct” when used in conjunction with the words “flow path” or “migration path” shall be understood to mean “not in fluid communication except via a test zone”. Where the test cell of the invention is provided in a housing, the housing is provided with a first opening adjacent the first location and a second opening adjacent the second location. A viewing window is provided in the housing above the test zone. In an embodiment, the first sorbent material and second sorbent material are separate pieces which overlie one another and the test line is printed on one or both of the sorbent materials at the junction. Alternatively, although not preferred, the first and second sorbent materials can be integral with each other. The systems of the invention preferably also include a control line or site which may be seen from the viewing window. According to an embodiment, the sorbent materials are laid out in a T shape, where the first location for receiving the buffer or buffer-conjugate solution is located near one end of the top bar of the T, the second location for receiving the sample is located near the end of the stem of the T, and the sorbent materials overlie each other at the intersection. Of course, the sorbent materials may be laid out in other configurations. The materials, thicknesses and lengths of the first and second sorbent materials are chosen to adjust the timing regarding the liquid sample and liquid buffer reaching the test site. In the dry conjugate system of the invention, a dry conjugate is provided between the first opening and the test site. The conjugate is supported on or within the sorbent material such that when a buffer is added in the first opening, the sorbent material wicks the buffer to the conjugate which is then carried by the buffer to the test site. In the liquid conjugate system of the invention, a buffer-conjugate liquid subsystem is provided and applied to the first opening. The sorbent material then wicks the buffer-conjugate subsystem to the test site.
• According to a method of using the test cell, sample of interest is provided to the second opening or location and allowed to travel to the test site. If any antigens or antibodies are present in the sample, the antigens or antibodies will bind with respective ligand-binding molecules at an associated test line. After a desired amount of time to ensure the sample has traveled to the test site, a liquid such as a buffer solution is added to the first opening or location. If the sorbent material is supporting a conjugate (i.e., in a dry conjugate system), the liquid is preferably simply a buffer solution. If the sorbent material is not supporting a conjugate (i.e., in a liquid conjugate system), the liquid is preferably a buffer-conjugate liquid subsystem. In any event, after sufficient time to permit the conjugate to migrate to the test site (and control site if provided), the test site (and control site if provided) is inspected in order to determine whether the sample is “positive” or not. In a “positive” sample, conjugate have bound with each antigen or antibody attached at the test lines and associated with a respective one of the febrile illnesses. In a positive sample, at least one test line corresponding to at least febrile illness and the control line will be colored. In a negative sample, none of the test lines corresponding to a febrile illness is colored, but the control line is colored.
• In accord with another embodiment of the assay test, the assay test includes three sorbent test materials, one to initially receive the diluted sample, and one each for the detection of different stage antibodies for a plurality of febrile illnesses. This expedites detection of one or more of the plurality of febrile illnesses at different stages of the illness, for example, within a few days after symptoms begin and later in a disease course or after recovery.
• The assay test includes a test cell having a first buffer-receiving location which receives a buffer solution and a first sorbent material defining a first horizontal flow path for the first buffer solution, a second sorbent material defining a second horizontal flow path distinct from the first horizontal flow path for the same or a different buffer solution provided to the first buffer-receiving location or to a second buffer-receiving location, a third sorbent material defining a third horizontal flow path for a sample provided at a sample-receiving location, the third horizontal flow path being distinct from the first and second horizontal flow paths, a fourth flow path for the sample provided at the sample-receiving location, the fourth horizontal flow path being distinct from the first, second, and third horizontal flow paths, a first test site with a plurality of distinct and longitudinally displaced test lines with one of immobilized antigens or antibodies associated with distinct pathogenically unrelated febrile illnesses, preferably all located in a first test zone at a junction of the first and third sorbent materials, and a second test site with a plurality of distinct and longitudinally displaced test lines with one of immobilized antigens or antibodies associated with the distinct pathogenically unrelated febrile illnesses. In one embodiment, the first and second test sites includes immobilized antibodies or antigens that distinguish for different stages of the respective febrile illnesses, e.g., early and late stage detection. In another embodiment, the first test site include immobilized antibodies associated with the unrelated febrile illnesses, whereas the second test site include immobilized antigens associated with the unrelated febrile illnesses. The second test site is located in a second test zone at a junction of the second and fourth sorbent materials. For purposes herein, the term “distinct” when used in conjunction with the words “flow path” or “migration path” shall be understood to mean “not in fluid communication except either (i) via a test zone, or (ii) at a buffer receiving or sample receiving location”.
• Where the test cell of the invention is provided in a housing, the housing is provided with a first opening adjacent the first buffer-receiving location and a sample-receiving opening adjacent the sample receiving location. Where a second buffer-receiving location is utilized, a second buffer-receiving opening is provided in the housing adjacent the second buffer-receiving location. A first viewing window is provided in the housing above the first test line and a second viewing window is provided in the housing above the second test line.
• In use, a reactive sample, and positive test, may include one of the first and second test windows indicating a positive reaction for only one or both of the stages of illness for one or more of the plurality of febrile illnesses. In the absence of the antigens or antibodies indicative of a stage of illness for the febrile illnesses of interest, no associated colored line would be observed under the test window area, and the test would be indicated as negative. The sample continues to migrate along the second and third sorbent materials and produces a colored line in each of the respective control areas of the first and second test windows to indicate that the sample and reagents have been properly applied and have migrated through the along the first, second and third second sorbent materials.
• Other multi-assay test designs, provided with the requisite combination of antibodies or antigens, specific to antigens and/or antibodies associated with the plurality of febrile illnesses for which the test is designed can be used as well, including wet tests and other constructs.
• The assay test is adapted to simply, quickly and accurately determine whether the carrier of a bodily fluid sample is the subject of one of plurality of a febrile illnesses. This allows important point-of-care decisions to be made before additional individual, regional, or even and global complications occur.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a top view of a first embodiment of an assay test for testing multiple unrelated febrile illnesses.
• FIG. 1A is a section view acrossline1A-1A inFIG. 1.
• FIG. 1B is a section view acrossline1B-1B inFIG. 1.
• FIGS. 2A-2E illustrate use of a febrile illness test.
• FIGS. 3A-3E described another embodiment of a febrile illness test, adapted to test for different stages of multiple febrile illnesses.
• FIG. 4 is a top view of another embodiment of a febrile illness test.
• FIG. 5 is a section view through line5-5 ofFIG. 4.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• Turning now toFIGS. 1, 1A and 1B, a dual path lateral flow immunoassaydevice test cell10 is provided and includes: ahousing20 having atop wall21 defining first andsecond holes24,26, and aclear plastic window28; and a carrier in the form of first and second sorbent orbibulous materials30,32 defining perpendicular horizontal flow paths in the housing. Thefirst sorbent material30 includes at least two and preferably three or four zones and may be made from a plurality of materials. A first zone31 (sometimes called a filter zone) is located at thefirst hole24 and extends to a second zone33 (sometimes called a test zone) which is located at the junction of a “T”. Thefirst zone31 may include afilter31a, apad31bon or in which a plurality of conjugates having desired antigens or antibodies with attached colored markers are deposited and immobilized, and a first portion of a thin membrane or sorbent orbibulous material30 typically made from nitrocellulose with a plastic backing (not shown). Thefirst zone31 is adapted to receive a buffer solution, to cause the buffer solution to contact the conjugate, thereby mobilizing the conjugate, and to wick the conjugate-carrying buffer solution to thesecond zone33. The second (test)zone33 includes a second portion of thethin membrane30 which is preferably printed with a plurality of longitudinally displaced test lines50A,50B,50C,50D,50E (collectively50A-E) having immobilized antigens or antibodies (depending on whether the test cell is designed to test for the presence of antibodies or antigens) for unrelated febrile illnesses on the membrane.Indicia70 are provided on thetop wall21 to associate the test lines with a key72 identifying the respective febrile illnesses under test. The selection of the febrile illnesses for the associated immobilized antigens or antibodies positioned on respective test lines, is discussed in detail below. The test lines50A-E may be seen through thewindow28 provided in the housing. An optional third zone35 (sometimes called a control zone) which includes a third portion of thethin membrane30 may also be printed with acontrol line60 typically containing antibodies to the conjugate antigens (or in some cases antibodies which will bind to conjugate antibodies, or even antigens which will bind to conjugate antibodies) as is well known in the art. Where thethird zone35 is provided, thewindow28 extends above thecontrol line60; alternatively a separate window may be provided for the control line. If desired, an optional fourth zone37 (sometimes called a reservoir zone) may be provided as a wicking reservoir as is also well known in the art. Thefourth zone37 includes a relatively thickerabsorbent paper31d. In an embodiment, overlying all the zones is a thin, transparent plastic film orcard38ahaving an adhesive which keeps the sorbent materials in place. The card38 may be cut with an opening athole24 so that it does not block liquid access to thehole24.
• Thesecond sorbent material32 may also be made from a plurality of materials and preferably includes twozones61,63. The first zone61 (sometimes called a filter zone) includes a filter orpad62 and a first portion of a thin membrane or sorbent orbibulous material32 typically made from nitrocellulose with a backing (not shown). Thefirst zone61 is located at thesecond hole26 and extends to thesecond zone63. Thesecond zone63 includes a second portion of thethin membrane32 which is in contact with thesecond zone33 of thefirst sorbent material30. As is seen inFIGS. 1A and 1B, thefirst sorbent material30 overlies thesecond sorbent material32 such that the membranes are in contact with each other (as opposed to the backings contacting the membranes or each other), and such that the test lines50A-E are effectively located between the membranes, although in one embodiment the second sorbent material touches the first sorbent material at or adjacent the test lines, but does not overlie the test zones. Thus, test lines50A-E could be printed on thesecond zone63 of thesecond sorbent material32 instead of, or in addition to thesecond zone33 of thefirst sorbent material30. If desired, a thin plastic film orcard38bhaving an adhesive which keeps the second sorbent material in place may be utilized. The sorbent materials may be in the form of strips and may be constructed from a standard-type nitrocellulose, and provided with different pore sizes to aid in the flow and migration of sample and solution, as described hereafter. Additional details and variations on the construction of the test cell, including materials, orientation and configuration of the sorbent material, shapes of the test cell housing, etc. are described in U.S. Pat. Nos. 7,189,522, 7569,397, and 7,879,597, all to Esfandiari, which are incorporated by reference herein in their entireties.
• The immunoassay ofFIGS. 1, 1A and 1B may be utilized as follows. First, a sample (not shown) possibly containing antibodies (or antigens) is provided to the second opening orhole26 and allowed to migrate through thesecond sorbent material32 to itssecond zone63 which is in contact with thesecond zone33 of thefirst sorbent material30. The sample is preferably fingerstick whole blood. However, venous whole blood, serum, and/or plasma can similarly be used.
• Optionally, after providing the sample intohole26, a preferably measured amount of liquid such as a buffer solution may be added tohole26 to help in the migration of the sample. Alternatively, the sample and buffer solution are premixed before being added intohole26. Regardless, the sample reaches the test lines50A-E which are printed atop thesecond zone33 of the first sorbent material or infused therein. After a desired amount of time, by which time the antibodies (or antigens) in the sample (if present) will have had an opportunity to bind to the antigens (or antibodies) immobilized at the test lines50A-E, a preferably measured amount of liquid such as a buffer solution (not shown) is added to thefirst opening24. After another period of time, sufficient to permit the conjugate to migrate to the test lines50A-E (andcontrol site60 if provided), the test lines50A-E (andcontrol site60 if provided) are inspected viawindow28 in order to determine whether the sample is “positive” or not for any of the febrile illnesses for which the test is adapted. Typically, a “positive” test indicating the presence of the antibody (or antigen) in the sample is obtained when both a test line of test lines50A-E and thecontrol site60 show lines of color. A “positive” test will be indicative for only the febrile illness(es) associated with the colored test line(s). A “negative” test indicating the lack of the presence of the antibody (or antigen) in the sample is obtained when only thecontrol site60 shows a line of color; i.e., none of the test lines50A-E show color.
• Those skilled in the art will appreciate that theimmunoassay10 functions as follows. Because the test lines50A-E are provided with antigens (or antibodies) for febrile illnesses immobilized on a membrane, if the test sample contains antibodies to the antigens (or antigens to the antibodies) for the respective febrile illnesses, the antibodies (or antigens) will bind themselves to the antigens (or antibodies) at the respective test line. Thereafter, when the conjugate39 containing an antigen for the antibody (or antibody for the antigen) coupled to a colored marker is caused to migrate to the test lines50A-E, if the test sample contains the antibodies (or antigens) which are now held at the test lines50A-E, the antigen (or antibody) of the conjugate will bind itself to the antibodies (or antigens) and the colored marker will cause a colored line to appear at the respective lines50A-E. If the test sample does not contain antibodies (or antigens), the conjugate will not have the antibodies (antigens) to bind to at the test lines50A-E, and no colored line will appear at the test site. On the other hand, because thecontrol line60 is provided with antibodies (or antigens), the antigens (or antibodies) of the conjugate will always bind to the antibodies (or antigens) in thecontrol line60, thereby causing a colored line to appear at thecontrol site60 if the conjugate reaches thecontrol site60. Thus, if sufficient buffer solution is provided to the test cell, a colored line should always appear at thecontrol site60, thereby providing a control for the test.
• Now, in accord with one aspect of the invention, the test lines50A-E are adapted to indicate presence of one or more febrile illness selected from a plurality of unrelated febrile illnesses. The febrile illnesses indicated by test lines50A-50E do not share any particularly common pathogen or other cause for their respective illness states, such that a positive detection of one illness is in no way presumptive, indicative or in any way etiologically related to a positive outcome for another of the febrile illnesses on the test.
• In accord with an assay test described herein, the assay test is adapted to provide presumptive (i.e., confirmatory) detection of at least two unrelated febrile illnesses. In one embodiment, the assay test more preferably is adapted to provide presumptive detection of at least three unrelated febrile illnesses. The febrile illnesses can be selected for testing on the assay using one or more common features of (or alternatively dissimilar features relative to) the one or more of the unrelated febrile illnesses. By way of example, the selection of febrile illnesses for which the test is designed may include a illnesses caused by one or more of the following: distinct viruses, bacterium and/or parasites; infection from distinct viruses, bacterium, parasites or other contagions that are animal borne, whether selected to be animal borne by the same animal (mosquitos) or by different animals (e.g., bat, rodent, mosquito, flea); infection from distinct viruses, bacterium, parasites, or other contagions that can be aerosolized for transmission; infection from viruses, bacterium, parasites or other contagions that are transmitted from direct contact; infection from viruses, bacterium, parasites or other contagions that are generally transmitted in the tropics and/or subtropics; infection from a virus, bacteria, parasite sharing one or more related features and which causes a febrile illness. The selection of febrile illness in a test may optionally include a set or subset of illnesses meeting any one or more criteria.
• It is specifically recognized that the febrile illnesses tested by the assay test do not share any particularly common cause for their respective disease states. That is, there is no known pathogenic pattern, pathogenic causation, or other pathogenic relationship from one illness to the other. As such, to the extent the test provides a positive detection for one febrile illness, it is expected that only one positive detection for a febrile illness will be indicated on any one test. It is, of course, possible that a particular test sample, when tested, can provide positive detection of two or even more febrile illnesses. But given the lack of relationship of the febrile illnesses for which the test is administered, such results would not necessarily be expected or a part of the design of the test. Nonetheless, it is anticipated that the unrelated febrile illnesses which can be detected on any one test will nonetheless have a rationale in the arrangement by which they are together tested; i.e., to facilitate and expedite early detection and diagnosis of febrile illness at point of detection or point of care facility.
• In accord with that aspect of the assay test, the febrile illnesses detected by the assay test may be linked by those febrile illnesses having a prevalence within a geographical proximity (by of example, within a state, or within a country, or within neighboring countries, or within proximate countries, or within a continent, or within a defined range of latitude, such as ±20° latitude about the equator, or as bounded by geological formations including rivers and/or mountains and/or valleys, or an geographical area subject to a common or like environmental conditions or a disaster, or geopolitical hardships, or other geographically definable boundary), and/or those febrile illnesses having a prevalence within a population in a given time period, and/or those febrile illnesses to which a group or population may be subject (by way of example, general population of western Africa, or aid workers of one or more relief organizations, whether localized or scattered, or inhabitants of one or more temporary or semi-permanent shelter or housing systems, including shelter or housing established by the United Nations or another relief aid organization), and/or those febrile illnesses which are potentially borne by travelers at a point of entry at a geographical location (e.g., air travelers at an airport or sea travelers at a sea port), and/or those febrile illnesses that may be potentially the subject to of a bioterror attack (e.g., can be transmitted in an aerosolized manner). For each of the potential groups identified above, an assay test may be designed to test for febrile illnesses that are appropriate for the circumstance. In accord with the invention, the febrile illnesses are unrelated illnesses, each having a different causative factor. In accord with the invention, it is possible that the unrelated febrile illnesses selected for a test may have a non-causal logical relationship.
• By way of example, as shown in the key72 on theassay test10 ofFIG. 1, the assay test can be designed to test for the Ebola Virus (which is a viral infection and can be animal borne),Plasmodiumparasites (Malaria)(which is a parasitic infection and is animal borne by mosquito), Dengue virus (which is a viral infection and is animal borne by mosquito, as well as most common in tropical/subtropical geographical regions),Yersinia pestis(Plague)(which is a bacterial infection, is animal borne by rodent and their fleas, is specific to identified endemic regions, and can be in aerosol form),Burkholderia pseudomallei(Melioidosis)(which is a bacterial infection, a tropical illness, and can be in aerosol form or in contaminated soil). These febrile illnesses have no etiological relationship. A subset thereof are commonly bacterial infections: Pague and Medioidosis, though caused by different bacteria. A subset thereof are tropical: Dengue virus and Melioidosis, through caused by different agents. A subset thereof are animal borne: Ebola, Malaria, Dengue, and Plague, through borne by different animals (mosquito, rodent and fleas). A subset are distinguished as transmitted by different means: virus (Ebola, Dengue), bacteria (Plague, Melioidosis), and parasite (Malaria). From the foregoing, it appreciated that the febrile illnesses under test are unrelated. It is appreciated that another combination of unrelated febrile illnesses may be tested together, including a subset of the illnesses discussed above together with one or more of, by way of example, Anthrax, Lassa fever, Tularemia, Leptospirosis, Marburg hemorrhagic Fever, Rickettsial disease, Thyphoid, Chikungunya, Coxiella burnetii bacteria (Q-fever), Meningococcal, Pneomococcus, and Crimean-Congo haemorrhagic fever (CCHF).
• In accord with embodiments of the assay, and not by way of limitation, the assay is adapted to detect for at least three of, or all of, Ebola Virus,Plasmodiumparasites (Malaria), Dengue virus, as well as the bacteriaYersinia pestis(Plague) andBurkholderia pseudomallei(Melioidosis) in a bodily fluid. In accord with the preferred assay test, the assay is preferably adapted to use the bodily fluid of fingerstick whole blood, venous whole blood, serum and/or plasma.
• Turning now toFIGS. 2A through 2E, anothertest cell110 substantially similar to thetest cell10 is shown with like parts having related reference numerals.Test cell10′ includes a housing including atop shell21′. The sorbent strips are preferably substantially arranged as described above inFIG. 1. Thetop shell21′ defines afirst hole24′ in the form of a well for receiving a buffer (B) solution onto thefirst sorbent strip30′, and asecond hole26′ in the form of a well for receiving a mixture of the sample and buffer solution (S+B) onto thesecond sorbent strip32′. Thefirst sorbent strip30′ is marked with five test lines (marked “12345” on theshell21′), each test line corresponding to one of the antigens (or antibodies) for one of the unrelated febrile illnesses under test.Strip30′ also includes another line functioning as a control line (marked C). The test lines are provided with a color dye (e.g., blue) so that they are visible. The control line is provided with a color dye (e.g., green) so that it is visible. Afirst window35a′ is provided in the housing over the test lines and a second window35b′ is provided in the housing over the control line; however such window may be combined in a communal opening.
• In operation, fingerstick whole blood or other suitable bodily fluid sample is obtained and mixed with buffer solution. Then, referring toFIG. 2B, approximately100 of blood and buffer mixture is added to the same sample well (marked S+B). Migration of the sample (typically with the help of the buffer) to the test zone will cause the dye at all the test lines and as well as the control line to dissipate. Disappearance of the dye from the lines confirms that the sample has reached the test area. Once the lines have completely disappeared, as shown atFIG. 2B, approximately 120 μl of buffer is added to the buffer opening (marked B) in order to cause migration of a conjugate marker to the test area. After a period of time, typically 20 minutes, results may be read. InFIG. 2C, only the control line C is seen, thereby indicating a valid result and that the sample tested negatively for each of the febrile illnesses for which the sample was tested; in this case Ebola, Malaria, Dengue, Plague, and Melioidosis. InFIG. 2D, the control line andline5 are seen, thereby indicating a valid result that the sample tested positively for Melioidosis antibodies, but negatively for the antibodies for Ebola, Malaria, Dengue, and Plague. InFIG. 2E, the control line andlines1 and3 are seen, thereby indicating a presumed unusual but nonetheless valid result: the sample tested positive for Ebola and Dengue antibodies, but negatively for the antibodies for Malaria, Plague, and Melioidosis. It is noted that if the control line C is not seen, the test results are not interpreted as being valid.
• Turning now toFIGS. 3A-3D, another embodiment of a multiple unrelatedfebrile illness test110 is shown. The test cell includes afirst test strip130ahaving a fluid pathway along which atest site150aprinted. Thetest site150ahas multiple test lines (12345) and a control line (C). Thefirst strip130aalso has a liquidbuffer receiving portion124a, and immobilizedconjugates139athat are released to migrate along the fluid pathway and toward the test site when the liquid receiving portion receives a liquid solution, all such features substantially as described as with respect tosorbent material30 in the embodiment described inFIGS. 1, 1A and 1B. The test lines of thetest site150aon thefirst test strip130aare adapted to test for antibodies (or antigens) for an EARLY (first) stage of a plurality of febrile illnesses. As such, and by way of example, in an embodiment a test line is provided that detects IgM antibodies to the antigen of Ebola, which can be used to confirm early stages of Ebola; i.e., within a few days after the symptoms begin.
• Thetest110 also includes a second test strip130b, substantially similar to and displaced from the first test strip, and having a second test site150b. The test lines at the second test site150bare adapted to test for antibodies (or antigens) for a LATE (second) stage of the plurality of febrile illnesses. By way of example, in an embodiment, the LATE stage test strip is adapted to detect IgG antibodies to the antigen of Ebola which can be used to confirm a later course of the disease, or even indicate that recovery is occurring. The detection of IgG and IgM antibodies to the antigens of Ebola is described in U.S. Pat. No. 7,189,522, previously incorporated by reference herein.
• Athird sorbent strip170 extends between the first and second sorbent strips130a,130b, and contacts the first and second strips at therespective test sites150a,150bof the first and second strips. Thethird sorbent strip170 includes azone172 in which to receive a common sample and buffer (S+B) that feeds to thetest sites150a,150bof the first andsecond test strips130a,130b. It is appreciated that the first, second and third strips can be distinctly formed from each other, or alternatively may be constructed as unitary member.
• In use, fingerstick whole blood or other suitable bodily fluid sample is obtained and mixed with buffer solution. Then, referring toFIG. 3A, preferably approximately 100 μl of blood and buffer mixture is added to the same sample well zone172 (marked S+B) marked between the arrows. The sample, with the help of the buffer, migrates in opposite directions away from sample well toward the first andsecond test sites150a,150b. Referring toFIG. 3B, once the lines have completely disappeared, preferably approximately 120 μl of buffer is added to each of the bufferliquid receiving area124a,124bin order to cause migration of the conjugate markers on the first and second strips toward therespective test sites150a,150b. After a period of time, typically20 minutes, results may be read. InFIG. 3C, only the control line C is seen in each of the first andsecond test strips130a,130b, thereby indicating a valid result and that the sample tested negatively for each stage of each of the febrile illnesses for which the sample was tested; in this case Ebola, Malaria, Dengue, Plague, and Melioidosis. InFIG. 3D, along the EARLY stage detection first test strip, the control line andline1 are seen, thereby indicating a valid result that the sample tested positively for early stage of Ebola; along the LATE stage detection second test strip, the control line and no test line are seen, thereby indicating a valid result and no later stage illness state detectable for any of the illnesses. InFIG. 3E, along the EARLYdetection test strip130a, the control line and no test lines are seen, thereby indicating a valid result without detection of the early stage of any of the illnesses. InFIG. 3E, along the LATE stage detection test strip130b, the control line andline1 are seen, thereby indicating a valid result and detection of late stage, and possibly a recovery stage, of Ebola. The test is negative for the antibodies for Malaria, Dengue, Plague, and Melioidosis.
• Turning now toFIGS. 4 and 5, a lateral flow immunoassaydevice test cell210 is provided for the presumptive detection of infection with one or more selected unrelated febrile illnesses, to either verify or reject the respective illnesses individually. Thetest cell210 has ahousing220 having atop wall221 defining afirst hole224, a sorbent orbibulous material230 defining a horizontal flow path in the housing. Thesorbent material230 includes a plurality of zones preferably made of a plurality of materials. In one zone, conjugates239 having desired antigens or antibodies with attached colored markers are deposited and immobilized. The antigens are respectively associated with several independent and unrelated febrile illnesses, as previously described. Thefirst zone231 is adapted to receive a sample and buffer solution through thefirst hole224, to cause the sample and buffer solution to contact the conjugate239 thereby mobilizing the conjugate, and to wick the conjugate-carrying sample and buffer solution to thesecond zone233. The second (test)zone233 is preferably printed with a plurality of longitudinally displacedtest lines250A-E at which are immobilized antigens or antibodies (depending on whether the test cell is designed to test for the presence of antibodies or antigens) as is well known in the art. Awindow228 of clear plastic is preferably provided over thetest lines250A-E. Indicia270,272 are provide to associate thetest line250A-E with the respective illnesses under test. Additional zones may be provided to the test to aid in movement, binding, wicking, solution/fluid reception, solution/fluid storage, or viewing of the test lines. An optional third zone35 (sometimes called a control zone) may also be printed with acontrol line260 typically containing antibodies to the conjugate antigens (or in some cases antibodies which will bind to conjugate antibodies, or even antigens which will bind to conjugate antibodies) as is well known in the art. Where thethird zone235 is provided, thewindow228 of preferably extends above thecontrol line260. If desired, an optional fourth zone237 (sometimes called a reservoir zone) may be provided as a wicking reservoir as is also well known in the art. Thefourth zone237 includes a relatively thicker absorbent paper241d.
• As yet another alternative, test lines for both early and later stage forms of a febrile illness can be co-located on a common test strip or sorbent material, such that each of the early and later stage forms can be presumptively confirmed on a single test strip. By way of example, early and later stage forms of three unrelated febrile illness can be tested with a test zone having six test lines, and early and later stage forms of five unrelated febrile illness can be tested with a test zone having ten test lines on a single strip.
• The antigens are respectively associated with unrelated, epidemiologically independent febrile illnesses. The febrile illnesses share a common condition of a high grade fever, and potentially additional considerations. The febrile illnesses are epidemiologically independent as each illness does not share a common biological factor in its cause. However, it may be advisable to test for the febrile illnesses together to confirm one of a potential identity of febrile illnesses, or alternatively collectively rule out all such febrile illnesses, at one time.
• There have been described and illustrated herein several embodiments of immunoassays and methods of their use. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while the specification discusses ligand binding using antigen/antibody reactions, other ligand binding mechanisms such as aptamer binding, nucleic acid binding, enzymatic binding, etc. may also be used. Also, while the test cells are described as having various numbers of lines for testing for a corresponding number of ligands, it will be appreciated that different numbers of lines may be utilized for testing for different numbers of ligands. In such a case, a single housing may be utilized with a single hole for the sample, or alternatively, multiple holes could be utilized if desired. Where multiple holes are utilized, multiple strips may be used for one or more samples provided. Preferably, the multiple strips would touch (e.g., overlie or underlie) a single strip providing a migration path for the conjugate. It may also be possible to provide a single hole which sits over or leads to two adjacent strips adapted for sample migration. Further, while the test cells are described as having holes in the top wall of a housing for receiving the sample and the buffer-solution or buffer-conjugate subsystem, it will be appreciated that one or both holes may be provided in the end wall or side wall of the housing. Moreover, while it is preferred that the test utilized a lateral flow format with a bibulous material as a carrier, it is appreciated that other test constructs, including those using a different solid state carrier or even a liquid carrier, can be utilized to perform the tests described herein as well.
• Also, while the test cell is described is being utilized in conjunction with a sample of fingerstick whole blood, it is appreciated that other bodily fluid can be used as well in the test cell, including venous whole blood, serum and/or plasma. Additionally, the assay test can be adapted for saliva, vomit, urine, fecal matter, or other bodily discharge, each of which is considered a bodily fluid for purposes herein. It is appreciated that depending upon the sample an appropriate diluent or other additive may need to be combined with the bodily fluid to allow the bodily fluid to properly migrate on the sorbent material and otherwise be reactant within the test.
• Those skilled in the art will also appreciate that the housing may be modified in additional ways to include separate windows for each test line. Also, while the invention was described in conjunction with the use of a buffer solution which is added to the migration path of the conjugate and optionally to the migration path of the sample, it will be appreciated that that one or more buffers may be chosen as desired to be added to the migration paths depending upon the test or tests to be conducted. Thus, buffers such as phosphate buffers or TRIS (tris hydroxymethylaminomethane) buffers are often utilized. However, the invention is intended to encompass the use of any diluent including water. In addition, the diluent may, if needed, may be added to and mixed with the sample prior to adding the sample to the sorbent material or the sample may be deposited first and the diluent may be added thereafter. Likewise, any diluent capable of causing conjugate to migrate may be utilized, and may be premixed with the conjugate in a liquid conjugate system, or provided to the migration path for the conjugate in a dry conjugate system. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.

Claims (23)

What is claimed is:

1. A test device for the qualitative detection of one febrile illness from a plurality of pathogenically unrelated febrile illnesses, the test device for use with a solution and for use with a conjugate having a marker, the test device for determining the presence of one of a plurality of ligands respectively associated with one of the plurality of pathogenically unrelated febrile illnesses in a liquid sample so as to identify which, if any, of the pathogenically unrelated febrile illnesses is detected in the test sample, comprising:

a) a sorbent material having a first width and a first length substantially longer than said first width, and a first location for receiving the solution and defining a first migration path for the solution and conjugate; and

b) a test site located on or in the sorbent material having a plurality of separately located immobilized ligand-binding mechanisms for receiving the liquid sample, at least one ligand-binding mechanism associated with each of the plurality of ligands for the pathogenically unrelated febrile illnesses.

2. A test device according toclaim 1, wherein:

at least two of the febrile illnesses are prevalent within a geographical proximity.

3. A test device according toclaim 1, wherein:

at least one of the febrile illnesses is a viral infection and at least one of the febrile illnesses is a bacterial infection.

4. A test device according toclaim 1, wherein:

each of febrile illnesses is caused by a different type of bacteria, virus, or parasite.

5. A test device according toclaim 1, wherein:

at least a plurality of the febrile illnesses are animal borne by different animals.

6. A test device according toclaim 5, wherein:

at least one of the febrile illnesses is borne by at least one of a bat, a rodent, a mosquito, and a flea, and at least another of the febrile illnesses is borne by a different animal.

7. A test device according toclaim 1, wherein:

at least one of the febrile illnesses can be transmitted by an aerosolized pathogenic agent.

8. A test device according toclaim 1, wherein:

at least one of the febrile illnesses can be transmitted by direct contact.

9. A test device according toclaim 1, wherein:

at least one of the febrile illnesses is a tropical and/or subtropical illness.

10. A test device according toclaim 1, wherein:

each of the febrile illnesses is caused by a different type of bacteria, virus, or parasite,

at least a plurality of the febrile illnesses are animal borne by different animals, and

at least a plurality of the febrile illnesses are tropical and/or subtropical illnesses.

11. A test device according toclaim 10, wherein:

at least two of the febrile illnesses are prevalent in a common geographical region.

12. A test device according toclaim 10, wherein:

at least one of the febrile illnesses can be transmitted through air and at least one of the febrile illnesses can be transmitted by direct contact.

13. A test device according toclaim 1, wherein:

the ligand binding-mechanism are adapted to bind with at least three of Ebola Virus, Malaria, Dengue virus, Plague, Melioidosis, Anthrax, Lassa fever, Tularemia, Leptospirosis, Rickettsial disease, Thyphoid, Chikungunya, Marburg hemorrhagic Fever Q-fever, Meningococcal, Pneomococcus, and Crimean-Congo haemorrhagic fever (CCHF).

14. A test device according toclaim 1, wherein:

the plurality of ligand binding-mechanism are respectively adapted to bind with antigens or antibodies for at least three of Ebola Virus, Malaria, Dengue virus, Plague, and Melioidosis.

15. A test device according toclaim 1, wherein:

time is required for the liquid sample to laterally flow from the first location to the test site such that the liquid sample does not immediately wet the test site upon application.

16. A test device according toclaim 1, wherein:

said separately located immobilized ligand-binding mechanisms are related to bioterrorism pathogens.

17. A test device according toclaim 1, further comprising:

c) a second sorbent material having a second width and a second length substantially longer than said second width, the second sorbent material distinct from the first sorbent material and defining a second migration path distinct from the first migration path, the second sorbent material intersecting the first sorbent material at or adjacent the test site, the second sorbent material having a second location for receiving the liquid sample,

wherein time is required for the liquid sample to laterally flow from the second location to the test site such that the liquid sample does not immediately wet the test site upon application.

18. A test device for the qualitative detection of one febrile illness from a plurality of pathogenically unrelated febrile illnesses, the test device for use with a solution and for use with a conjugate having a marker, the test device for determining the presence of one of a plurality of ligands respectively associated with one of the plurality of febrile illnesses in a liquid sample so as to identify which, if any, of the unrelated febrile illnesses is detected in the test sample, comprising:

a) a first sorbent material having a first width and a first length substantially longer than said first width, and a first location for receiving the solution and defining a first migration path for the solution and conjugate;

b) a test site located on or in the first sorbent material having a plurality of immobilized ligand-binding mechanisms, at least one ligand-binding mechanism associated with each of the plurality of ligands for the febrile illnesses, wherein the febrile illness are related by having prevalence within a geographical proximity; and

c) a second sorbent material having a second width and a second length substantially longer than said second width, the second sorbent material distinct from the first sorbent material and defining a second migration path distinct from the first migration path, the second sorbent material intersecting the first sorbent material at or adjacent the test site, the second sorbent material having a second location for receiving the liquid sample,

wherein time is required for the liquid sample to laterally flow from the second location to the test site such that the liquid sample does not immediately wet the test site upon application.

19. A test device according toclaim 18, wherein:

the febrile illnesses are related by having prevalence within a common country.

20. A test device according toclaim 17, wherein:

the febrile illnesses are related by having prevalence within neighboring countries.

21. A test device according toclaim 17, wherein:

the febrile illnesses are related by having prevalence within a continent.

22. A test device according toclaim 17, wherein:

the febrile illnesses are related by having prevalence within a ±20° of latitude.

23. A test device according toclaim 17, wherein:

the febrile illnesses are related to are related to bioterrorism pathogens.

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