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Brucellosis: an unusual diagnosis for a seronegative patient with abscesses, osteomyelitis, and ulcerative colitis.

A 16-year-old girl developed multiple subcutaneous abscesses, osteomyelitis, and severe colitis. On the patient's second admission, a single blood culture--and, subsequently, a specimen of pus--yielded Brucella melitensis biovar 1. A second set of serologic tests, including the rose bengal test, the standard tube agglutination test, the CF test, and Coombs' test, were all negative for Brucella on the patient's second admission and 1 month later. However, a lymphocyte proliferation assay with extracted antigen of Brucella was markedly positive. Thus, this case illustrates that patients with B. melitensis infection may have a unique clinical presentation and that the lymphocyte proliferation assay is an important diagnostic tool for patients whose serologic test results are negative but for whom brucellosis is suspected.

Abscess↗

Serological diagnosis of neurobrucellosis.

The presence of antibodies was determined in the serum and cerebrospinal fluid in six patients with neurobrucellosis using the Rose Bengal test, the microdilution agglutination test, and the Coombs' test. Four of the patients were followed up for more than three months. The Rose Bengal test and the microagglutination test were positive in cerebrospinal fluid in five of the six cases at some stage. The Coombs' test was positive in cerebrospinal fluid in every patient and in one was the only positive serological test. Cerebrospinal fluid positivity is not excluded by low titres or negative results of antibodies in the serum for any of the three methods. A Coombs' test or some equivalent must always be made on the cerebrospinal fluid to diagnose neurobrucellosis.

Adolescent↗

Substitution of anti-human globulin by protein A-bearing staphylococci in the detection of Brucella antibodies.

A coagglutination test using protein A-bearing staphylococci has been developed for the detection of Brucella antibodies. Comparing the results of a random sample of 57 sera collected from Malta fever patients, suggestive titers of 1: greater than or equal to 160 were found in 8 sera (14%) with the standard agglutination test, in 22 sera (39%) with the Coombs test, and in 23 sera (40%) with the coagglutination test. The titers in the Coombs test and the coagglutination test coincided in 54 (95%) of the 57 sera, in 3 sera (5%) the difference was no more than one dilution step. Sera from healthy subjects and patients with infections other than brucellosis showed titers up to 1:40 in all three tests. Because of its sensitivity and specificity in detecting non-agglutinating antibodies, the Brucella-antibody coagglutination test may replace the Coombs test as a complementary assay to the standard agglutination. Native sera from Malta fever patients frequently show a prozone phenomenon in the standard agglutination test and a reduced agglutinate formation in both the Coombs test and the coagglutination test. The inhibitors of agglutination lattice formation are apparently serum beta-lipoproteins which become attached to the Brucella antigen and can be removed from the serum by treatment with MnCl2-heparin.

Antibodies, Bacterial↗

Haematolytic disease due to ABO incompatibility: incidence and value of screening in an Asian population.

The population in Singapore is predominantly Asian, with Chinese forming the major ethnic group. The incidence of haemolytic disease of the newborn (HDN) due to Rh incompatibility is very low. The true incidence of HDN due to ABO incompatibility is unknown. Early discharge is practised in Singapore making it important to predict severe HDN due to ABO incompatibility as this would constitute the main cause of haemolysis next to G6PD deficiency. One thousand, six hundred and eight baby-maternal pairs were typed for ABO, Rh, and tested for direct Coombs' test, maternal titre, cord bilirubin and haptoglobin levels. Two hundred and fifty-one were found to be ABO incompatible, with 141 group A and 110 group B babies. The incidence of HDN due to ABO incompatibility was 3.7% of all group O mothers. Coombs' test, maternal antibody titre, cord bilirubin and haptoglobin levels were of low predictive value for severe HDN due to ABO incompatibility. The data further support the notion that it is not cost effective to screen for ABO incompatibility.

ABO Blood-Group System↗

Immune thrombocytopenia. Use of a Coombs antiglobulin test to detect IgG and C3 on platelets.

We applied a radiolabeled Coombs antiglobulin test to the diagnosis and management of immune thrombocytopenia in adults and children. This assay substantiated that the majority of patients with idiopathic thrombocytopenic purpura have increased levels of IgG on their platelets. Platelet-associated C3 was elevated in a subset of these patients, some of whom had normal levels oet-associated IgG, thus suggesting a role for C3 in the pathogenesis of the thrombocytopenia. The assay enabled us to anticipate a change in clinical status, establish the presence of immunologic remission after splenectomy and propose several mechanisms by which corticosteroids act. Platelets from a patient with the post-transfusion-purpura syndrome also carried increased IgG, indicating a role for IgG antibody or IgG-containing immune complexes in the destruction of host platelets in this disease. The radiolabeled Coombs test provides a general means to help diagnose, manage and study immune platelet disorders.

Adolescent↗

Corrected end-tidal carbon monoxide closely correlates with the corrected reticulocyte count in coombs' test-positive term neonates.

OBJECTIVE: To evaluate clinical usefulness of corrected end-tidal carbon monoxide (ETCOc) measurements in healthy, term, Coombs' test-positive neonates and correlate it to the corrected reticulocyte count (RC). METHODS: ETCOc and RC were determined (at 36 +/- 12 hours of age) in 50 Coombs' test-positive neonates and compared with the ETCOc values of 50 Coombs' test-negative neonates. RESULTS: Fifty percent of Coombs' test-positive infants had RCs <5% (within a normal range for a healthy newborn) and ETCOc = 1.8 +/- 0.34 parts per million (ppm) and likely did not exhibit hemolysis. Among infants with elevated RCs, 72% had RCs between 5% and 8% and ETCOc = 2.77 +/- 0.68 ppm, and 28% had RCs >8% and ETCOc = 4.52 +/- 0.83 ppm. There was an almost linear correlation (r = 0.86) between the RC and the ETCOc among Coombs' test-positive infants. The 50 Coombs' test-negative infants had ETCOc = 1.6 +/- 0.45 ppm. Serial ETCOc measurements were performed in 14 Coombs' test-positive infants: in all but 1 infant ETCOc values declined over time. CONCLUSIONS: There is a good correlation between ETCOc and RC in Coombs' test-positive infants. ETCOc >2.5 ppm predicts a significant elevation of RC in 90% of Coombs' test-positive infants.

Blood Group Incompatibility↗

Brucellosis in man. I. Serological diagnosis.

50 Blood samples were collected from in-patients with febrile splenomegaly suspected to be Malta fever, in Sharkia fever hospitals; Egypt. The samples were subjected to serological tests (tube agglutination, Widal & Coombs) for diagnosis of brucellosis. The results of tube agglutination (TAT) revealed that 5 (10%) were positive; the titre ranging from 1/80-1/320, 3 doubtful (1/40) and 42 negative (1/20, 1/10 and no agglutination). Results of the Coombs test on negative and doubtful of TAT showed that out of 45 patients; 3 (6.66%) were positive; the titre ranging from 1/80-1/160, one doubtful and 41 negative. Coombs test improved the titre of one positive case of TAT from 1/320-1/640. Results of serological tests (TAT & Coombs) for MALTA fever were 8 (16%); the titre ranging from 1/80-1/640, one doubtful (1/40) and 41 negative. Results of the Widal test to detect Enteric fever in the way of differential diagnosis were 7 (14%) positive out of 50 patients examined; the titre ranging from 1/80-1/160. Five of them agglutinated typhoid (O&M) suspensions. One of the sera agglutinated paratyphi A (H) suspension, the remaining one serum agglutinated paratyphi. B(H) suspension and none of the sera agglutinated paratyphi. C(H) suspension. All the positive Coombs and negative Widal cases were obtained against typhoid (O) suspension and none against any of the (H) suspensions; Coombs test was positive in two (4.65) of 43 patients negative to Widal; no improvement of titre in the positive Widal. Results of Widal & Coombs to detect Enterica were 9 (18%) positive and 41 negative.

Antibodies, Bacterial↗

Further implication of murine leukemia-like virs in the disorders of NZB mice.

Further evidence implicating murine leukemia-like virus in the disorders of NZB mice was afforded by a study of antigens associated with murine leukemia virus (MuLV). MuLV group antigens were prevalent in extracts of spleen, kidney, and, to a lesser extent, thymus throughout a substantial portion of the life span of NZB mice as well as in extracts of lymphomas and sarcomas indigenous to the strain. G (Gross) soluble antigen, type-specific antigen, was first detected in plasma of untreated NZB mice at 3 months of age. G soluble antigen production increased thereafter in line with age, with 50% of reactions becoming positive at 5.3 months and 100% at 7 to 9 months. From months 3 to 9, the time-response curve for positive conversion of direct antiglobulin (Coombs) tests in untreated NZB mice corresponded closely to that for G soluble antigen production. Beyond the 9th month, G soluble antigen underwent elimination from the plasma of NZB mice, with positive reactions reduced to 50% at 13.3 months and to 0% at 18 months. G natural antibody was first detected in the serum of NZB mice at about 10 months of age and increased thereafter in line with age. The curves for G antibody production and G soluble antigen elimination bore a reciprocal relation to each other with crossover at 50% response occurring at 13.3 months. Significant proteinuria, a functional manifestation of membranous glomerulonephritis, became increasingly prevalent in female NZB mice as G soluble antigen was eliminated from plasma. Cumulative mortality of female NZB mice, mainly attributable to renal glomerular disease, increased in phase with G antibody production. MuLV group antigens were identified in the glomerular lesions by the immunofluorescence method. Positive conversion of direct antiglobulin tests was significantly delayed by vaccinating baby NZB mice with formaldehyde-inactivated cell-free filtrates of older NZB mouse spleens. The plasmas of vaccinated NZB mice with negative direct antiglobulin reactions at 4 to 7 months were likewise negative when tested for G soluble antigen. The 50% response time for G antibody production in the vaccinated NZB mice occurred at 7.3 months, that is, 6 months earlier than in untreated NZB mice. The collective findings implicate murine leukemia-like virus in the etiology of autoimmune hemolytic disease and membranous glomerulonephritis, as well as malignant lymphoma, of NZB mice and suggest that virus-specified cell-surface and soluble antigen is a factor in the immunopathogenesis of the renal disease and possibly also the autoimmune hemolytic disease.

Animals↗

Posttransfusional immunologic thrombocytopenia. A case report.

A case of posttransfusional immunologic thrombocytopenia is reported in a 75-year-od PlA1-negative woman. This was the second episode of postoperative and posttransfusion thrombocytopenia in the same patient who had had only one pregnancy. Both thrombocytopenic episodes were subclinical and discovered by systematical hematologic study. A potent anti-PlA1-antibody (titer 1/128) was demonstrated by the platelet-indirect radioactive Coombs test which appeared more sensitive than other platelet immunological assays used. The very long duration of the thrombocytopenia is discussed as well as the therapeutic possibilities in such cases.

Aged↗

The tranfer of Brucella abortus antibodies from dam to calf.

The higher sensitivity of the ABGT (Coombs Test) makes it the most useful test for comparison of total specific immunoglobulins for Brucella abortus in different secretions. Using it in the present study it was found that in 85 cows the mean selective concentration of immunoglobulins in colostrum was six to eight fold, whether the cows were infected or not. In the non-infected group calves acquired mean levels of immunoglobulins of about one third those in colostrum whereas in the infected group this ratio reduced to about one seventh. There were wide individual variations. However, mean values indicate that in both groups the calf acquires a level of antibodies up to twice the level of the dam's pre-partum serum, again with individual wide variations. Titres to the SAT and CFT are also given for all animals.

Agglutination Tests↗

Prevalence and lack of clinical significance of blood group incompatibility in mothers with blood type A or B.

PURPOSE: To examine the prevalence and clinical significance of blood group incompatibility in infants whose mothers have blood type A or B. METHODS: We prospectively analyzed cord blood samples from 4996 consecutive love-born infants for blood type, hematocrit, and results of direct antiglobulin (Coombs) test (DAT) and indirect Coombs test (ICT). OUTCOME MEASURES: Erythrocyte sensitization was determined by positive DAT or ICT results. Significant hyperbilirubinemia (> or = 224 mumol/L (12.8 mg/dl) and mean cord hematocrits were compared between mother-infant pairs with ABO incompatibility and positive DAT or ICT results and those with negative Coombs test results. RESULTS: Of all births, 6.9% (343/4996) were of infants who had ABO incompatibility and had been born to mothers with blood type B or A; 44 (13%) of 343 infants had a positive antiglobulin test result, of whom 43 had a positive ICT result only. Type A or B mothers were 5.5 times less likely to have sensitization than type O mothers; A-B, B-A, A-AB, and B-AB mother-infant pairs with a positive antiglobulin test result had mean cord hematocrits and rates of significant hyperbilirubinemia similar to those of corresponding pairs whose antiglobulin tests both showed negative results. Infants with a positive DAT result had lower mean cord hematocrits than infants with negative results on both antiglobulin tests or on a positive ICT result only. Significant hyperbilirubinemia was more frequent in infants with a positive DAT result than in infants with negative results on both antiglobulin tests or a positive ICT result only. CONCLUSION: Sensitization is much rare when the mother has blood type A or B than when she has blood type O, as demonstrated by the antiglobulin test. The incidence of significant hyperbilirubinemia and lower cord hematocrit is not increased by sensitization when the mother has type A or B.

ABO Blood-Group System↗

Role of gel based technique for Coomb's test.

The direct (DAT) and indirect antiglobulin tests (IAT) are one of the most important diagnostic tools used in the investigation of immune mediated disorders. Recently, transfusion laboratories have seen the introduction of column technology in the form of the gel technology (GT). Aim of this study is to compare the conventional tube tests (CTT) and the GT for Coomb's test and to evaluate their sensitivity and specificity. 1656 samples were included in this study, in which 1054 samples were subjected to IAT and 602 samples were subjected to DAT Of the 602 samples tested for DAT, 587 (97.5%) showed concordant DAT results. DAT by the GT could detect 8.6% positivity as compared to 6.1% by CTT. The sensitivity and specificity of the GT was 100% and 97.3% respectively and its negative predictive value was 100%. Among the 1054 samples for IAT, 1041 (98. 8%) showed concordant results. The IAT by the GT showed 6.6% positivity as compared to 5.4% positivity by CTT The sensitivity, specificity and the positive and negative predictive value were 100%, 97.7%, 81.4% and 100% respectively. In conclusion, the GT is a better alternative to the CTT for both DAT and IAT. The GT is highly recommended to be implemented as a routine method of testing in all zonal / regional blood transfusion centers.

Anemia, Hemolytic, Autoimmune↗

[Importance of flow cytometry in the detection of anti-erythrocyte autoantibodies].

Coombs test and flow cytometry have been compared in terms of specificity and sensibility in a population of hospitalized patients, for whom a Coombs test had been required. The Coombs test seems more sensible than flow cytometry to detect red cell-bound IgG. For a given patient and over the time, flow cytometry seems better correlated with the severity of haemolysis if erythrocytes are strongly sensitized by IgG. The results of flow cytometric analysis, in percentage of sensitized erythrocytes, do not allow to define a sensibilization threshold for haemolysis prediction. Flow cytometric analysis would be more sensible than Coombs test in the detection of red cell-bound C3d, but these cases are not associated with autoimmune haemolytic anemia. Direct Coombs test should remain the diagnostic test of autoimmune haemolytic anemia.

Autoantibodies↗