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Antibodies in malarial sera to parasite antigens in the membrane of erythrocytes infected with early asexual stages of Plasmodium falciparum.

Monolayers of human erythrocytes (E) infected with Plasmodium falciparum were briefly fixed with 1% glutaraldehyde and air dried. They were then exposed to sera from patients with P. falciparum malaria or from donors immune to this parasite and tested in an indirect immunofluorescence assay (IFA). Parasites in infected E were made visible by counterstaining with ethidium bromide. Immunofluorescence (IF) was restricted to the surface of infected E. No antibody binding was detected unless the E were dried, suggesting that the relevant antigens were not available on the outer layers of the E surface. Staining over large parts of the E surface was seen already when the merozoite penetrated noninfected cells and was strong in E containing early stages of the parasite (rings, trophozoites). It was weak or absent from E containing schizonts. Antibodies in sera from different parts of Africa, Colombia, or Sweden reacted similarly with E infected with a Tanzanian P. falciparum strain kept in culture for many years and with parasitized E freshly drawn from African, Swedish, or Colombian patients. All sera from residents of a holoendemic area (Liberia) were IFA positive. In contrast, some sera from Colombian or Swedish patients with primary infection gave negative results. The results of the IFA and of an enzyme-linked immunosorbent assay in which fixed and dried E were the targets were well-correlated, suggesting that the same antibodies were detected by these assays. The antigens involved in the IFA were susceptible to pronase but not to trypsin or neuraminidase. E surface IF was inhibited by lysates of infected E, merozoite extracts, or soluble antigens present in P. falciparum culture supernatants but not by lysates of normal E or ghost extracts. The inhibitory antigens were heat stable (100 degrees C, 5 min). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by immunoblotting of either antigen-enriched preparations from culture supernatants or merozoite extracts showed that antibodies eluted from monolayers of infected E reacted consistently with a predominant polypeptide of Mr 155,000 and two to four minor polypeptides of lower molecular weights. Metabolic labeling of the parasites with 75Se-methionine indicated that these antigens were parasite derived. We conclude that the antigens involved in these reactions are released from bursting schizonts or merozoites and are deposited in the E membrane in the course of invasion.(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies↗

Development of immunity against Plasmodium falciparum malaria: clinical and parasitologic immunity cannot be separated.

A total of 1622 individuals of all ages living under conditions of continuous malarial transmission in Liberia were enrolled in a cross-sectional study of parasite rates, positive parasite densities, and body temperatures. The age-specific Plasmodium falciparum-positive parasite densities were greatest at ages 0.5-1.0 year, then slowly declined into adulthood. The age-specific mean body temperature at parasite isodensity showed a steady decline even in the oldest age group. The results do not support the hypothesis that adults have higher body temperatures at a given parasite density than do children with the same parasite density. The age-specific P. falciparum parasite density for specific isotemperatures showed that a subgroup of children in the age group 0.5-1.0 year had low temperatures (less than 36.5 degrees C) despite high parasite densities. This indicates that low body temperature should be investigated further as a possible indicator of serious malaria in young children. Parasitologic and clinical immunity develops concomitantly and cannot be separated. The findings do not support the hypothesis that a special "anti-disease" immunity exists independently of parasitologic immunity.

Adolescent↗

Failure to detect MHC class II associations of the human immune response induced by repeated malaria infections to the Plasmodium falciparum antigen Pf155/RESA.

Available evidence suggests that human T and B cell responses to a major Plasmodium falciparum malaria antigen (Pf155/RESA) in individuals primed by repeated infections are genetically regulated. In the present study we have attempted to establish whether these regulations reflect genetic restrictions imposed on the immune response by class II molecules of the donor's MHC system. T cell activation (proliferation and IFN-gamma release in vitro) and antibody activity (ELISA) were assayed with synthetic peptides corresponding to major Pf155/RESA epitopes. To associate T cell and antibody responses with the donors' MHC class II genotypes, leukocytes from 145 donors living in holo- or hyperendemic regions of Africa (Liberia, Gambia, Madagascar) were used for genomic HLA class II typing of their DRB-DQA and DQB genes by means of restriction fragment length analysis (RFLP). No associations between T cell responses and HLA-DR or -DQ alleles or DRB-DQA-DQB haplotypes were seen among the West Africans even when the donors were divided into high, medium or low responders. This was also true for a small group of HLA class II identical Malagasy donors including three pairs of twins. However, while the T cell responses between the twin pairs varied, those within the pairs were similar. Very similar findings were made with antibodies binding to Pf155/RESA peptides. Our data imply that the impact of MHC class II gene products on specific immune responses to Pf155/RESA epitopes is weak and hard to demonstrate in outbred human populations naturally primed by infection. This may be due to genetic regulations by other, non-HLA class II coded factors superimposed on possible HLA class II restrictions.

Adult↗

Duration of larval development of Simulium yahense (Diptera: Simuliidae) under natural conditions.

The duration of Simulium yahense Vajime & Dunbar larval development on a dam spillway in Harbel, Liberia, was observed to make accurate decisions regarding the frequency of larvicide treatments against this onchocerciasis vector. Larval development required a minimum of 10-12 d from eclosion to first pupation. Initial larvicidal treatment for S. yahense control would require a treatment cycle of 7 d. Once suppression of adult and larval populations is achieved, a 9-12-9-12 day treatment cycle could be adopted.

Animals↗

Morphometric multivariate analysis of field samples of adult Anopheles arabiensis and An. gambiae s.s. (Diptera: Culicidae).

The Afrotropical complex of sibling species Anopheles gambiae Giles includes the most efficient vectors of human malaria south of the Sahara. Anopheles arabiensis Patton and An. gambiae s.s. Giles are the members of the complex more adapted to the human environment. They are sympatric and synchronic over most of their distribution range; however, they show a different involvement in malaria transmission, with An. gambiae being more anthropophilic and endophilic than An. arabiensis. Discriminating between them is essential for a correct assessment of epidemiological parameters. The identification is currently achieved through recognition of species-specific chromosomal inversions or by molecular biology techniques. Both methods require considerable technical resources, not always available in the field. We carried out a morphometric analysis of field and laboratory samples of An. arabiensis and An. gambiae s.s. from sites in Madagascar, Burkina Faso, Mali, and Liberia to evaluate the degree of morphological differentiation. We examined 17 morphometric characters in samples representing each of the geographic sites. All of the measures were significantly larger for An. arabiensis (regardless of the collection site), demonstrating an intrinsic greater body size of this species. To assess the reliability associated with the multivariate statistic, we applied the discriminant function analysis, which provided a method for predicting to which group a new case will most likely be assigned. In a blind experiment, the morphometric method correctly identified approximately 85% of field-collected An. arabiensis and An. gambiae s.s., which provided a relatively simple method to approximate the relative frequencies of the 2 species in areas in which their concurrent presence was already known. The influence of laboratory conditions on the morphometrics of the 2 species was also analyzed.

Animals↗

Seroepidemiologic studies of acute hemorrhagic conjunctivitis virus (enterovirus type 70) in West Africa. II. Studies with human sera collected in West African countries other than Ghana.

Human sera were collected in Senegal, Nigeria, Ivory Coast, Dahomey, Liberia, Gabon and Togo during the pre-epidemic period of acute hemorrhagic conjunctivitis (AHC) from 1965 to 1969, and tested for virus neutralizing (VN) antibody to enterovirus type 70 (EV70). Of these, 1109 (91%) were antibody negative (less than equal to 1:4), 116 (9%) neutralized at a dilution of 1:8 or over, and 45 (4%) at dilutions of at least 1:16. The distribution pattern is not significantly different from that of sera collected from Kenya in 1967 or from army recruits in the United States, Argentina, Brazil and Colombia in the 1960s. Sera collected during the post-epidemic period (1970 to 1977) in Senegal, Sierra Leone, Mali, Upper Volta, Chad, Niger and Gabon were also examined; 1573 (68%) were VN antibody negative (less than or equal to 1:4), while 733 (32%) and 433 (19%) had titers of 1:8 or greater and 1:16 or over, respectively. There is a significant difference in distribution between pre- and post-epidemic antibody titers (p less than 0.001), although the incidence of AHC was lower in these countries than in Ghana and Southeast Asia. The prevalence of VN antibodies tends to be lower in the dry, hot inland areas and thus humid coastal monsoonal climates and dense populations seem to favor the spread of AHC.

Adolescent↗

Initial clinical assessment of the comatose patient: cerebral malaria vs. meningitis.

One hundred twenty-one Liberian children were admitted in coma to the ELWA Hospital, Monrovia, Liberia. Admitting diagnoses, before lumbar puncture, were compared with discharge diagnoses. Ninety-four children were discharged with a final diagnosis of cerebral malaria and 27 with a diagnosis of meningitis. The admitting diagnosis was correct in 76.6% (72 of 94) of patients with cerebral malaria and 59.3% (16 of 27) of patients with meningitis. The cerebrospinal fluid leukocyte count was the single most significant factor in determining the correct diagnosis. Without the cerebrospinal fluid analysis, the discriminant accuracy (77%), i.e. definitive separation of the two illnesses, was comparable to the physician's admission diagnosis (73%). Other data contributing to the differential diagnosis of cerebral malaria and meningitis included the number of days of fever before admission, the presence or absence of nuchal rigidity, fontanelle fullness and peripheral blood malaria smear. Mortality rates for cerebral malaria and meningitis were 14.9 and 29.6%, respectively. These data suggest that physicians cannot reliably discriminate between cerebral malaria and meningitis without cerebrospinal fluid analysis.

Adolescent↗

Mycobacterium tuberculosis presenting as chronic red eye.

PURPOSE: To report a case of tuberculosis of the conjunctiva. METHODS: Case report with pathologic correlation. A 17-year-old man who had relocated to Australia from Liberia presented with chronic unilateral conjunctivitis. RESULTS: The diagnosis was not initially evident, despite 2 separate biopsy specimens, conjunctival cultures, and polymerase chain reaction testing. Definitive diagnosis was made after repeated histologic examination. Antituberculous treatment resulted in prompt resolution of all ocular signs. CONCLUSION: Tuberculous conjunctivitis is now a very rare condition in the developed world. Definitive diagnosis requires the identification of Mycobacterium tuberculosis organisms in conjunctival biopsy specimens-either through microscopic detection of acid-fast bacilli or more sensitive culture techniques.

Adolescent↗

Antigenic relatedness between arenaviruses defined at the epitope level by monoclonal antibodies.

Monoclonal antibodies (MAbs) were produced against two African arenaviruses, Lassa virus and Mopeia virus. Competitive binding analysis of MAbs identified four antigenic sites on the nucleoprotein (NP), two on glycoprotein 1 (GP1) and six on glycoprotein 2 (GP2) of the Josiah strain of Lassa virus. 64 virus isolates from western, central and southern Africa were all consistently distinguishable by MAbs to certain epitopic sites on GP1, GP2 and NP viral proteins. Furthermore, MAbs to Lassa virus GP1 and NP uniformly distinguished viruses from the West African countries of Sierra Leone, Liberia and Guinea from those of Nigeria. GP2-directed MAbs to two African arenaviruses reacted broadly with South American arenaviruses demonstrating that an epitopic site on GP2 may be the most highly conserved antigen in the arenavirus group.

Africa↗

Evidence for recent genetic variation in monkeypox viruses.

DNA from isolates of monkeypox virus, when digested with the endonuclease PstI, gave fragment-size profiles which correlated with the geographic area from which the isolate originated. Although some of the differences were located subterminally in the genome, others mapped to the central conserved region. Further differentiation of the viral genomes was sought by analysis of a short region within the central conserved part of the genome that appeared to be a partially deleted counterpart of an intact 1024 bp open reading frame (ORF) present in variola and vaccinia virus genomes. We reasoned that this region would not be conserved by functional selection and would therefore be likely to show more variation between isolates of monkeypox virus. The deletions found in monkeypox virus isolates from Liberia and from Benin were almost the same as that which we had previously found in the Denmark strain. A much shortened ORF, potentially coding for a product of 133 amino acids, was retained in all three West African isolates, but three Zairean isolates each showed an identical series of small insertions and deletions which effectively abolish the ORF. Three deletions, present in all isolates, must pre-date the geographical separation of monkeypox virus lineages; other, presumably more recent, changes differ between the Zairean and West African isolates. In contrast, the base similarity was found to be more than 99% when all the monkeypox virus sequences were appropriately aligned. This, in a disrupted and presumably nonfunctional gene also indicates that the changes described are recent. It is suggested that insertions and deletions occur regularly during poxvirus DNA replication, but are preserved only in sequences that are not required for continued transmission in the natural host.

Africa, Western↗

Seroreactivity with the Plasmodium falciparum blood stage antigen Pf332 in adults and children from malaria-endemic regions.

It has earlier been reported that the human monoclonal antibody (MoAb 33G2) and polyclonal antibodies reactive with Pf332 may interfere in vitro with the erythrocytic cycle of Plasmodium falciparum at two potential target sites for protective antibodies, indicating that the antigen may constitute an important target for immune responses during malaria infections. MoAb 33G2 shows its highest reactivity with repeated sequences in the antigen Pf332 and also cross-reacts with determinants in Pf155/RESA. This study was conducted in order to assess the prevalence of seroreactivity against Pf332 in individuals residing in areas of different malaria endemicity, and in children with different degrees of disease severity. We now report that individuals resident in malaria-endemic regions show a high prevalence of seroreactivity to antigen Pf332 repeat sequences. The mean antibody concentrations were significantly higher in donors from Liberia, Madagascar and Gambia compared with Thai and Colombian donors, probably reflecting the higher degree of exposure in the African regions. Although the levels of such antibodies in individual sera correlated well with the levels of antibodies to one Pf155/RESA repeat peptide, only a minor part of the peptide-reactive antibodies were cross-reactive between the two antigens. In Gambian children, the mean concentrations of antibodies reactive with Pf332 or Pf155/RESA peptides were significantly higher in children with severe than with mild malaria. Further longitudinal studies are needed to evaluate the capacity of Pf332 to induce potentially protective or harmful antibody responses.

Adult↗

Plasmodium falciparum-inhibitory monoclonal antibodies produced by human hybridomas.

Stable human hybridomas were generated that produced inhibitory anti-Plasmodium falciparum monoclonal antibodies. Peripheral blood lymphocytes, obtained from adults in Liberia, a malaria endemic area, were immortalized with Epstein-Barr virus and then fused with KR4, a human, lymphoblastoid cell line. Stable hybridomas that produced anti-P. falciparum monoclonal antibody were identified by an ELISA assay that used the trophozoite and schizont antigens of both the Honduras I and FCR3 parasite strains. Monoclonal antibodies produced by selected hybridomas derived from lymphocytes of two individuals were subsequently studied. The anti-parasite antibodies were produced at 1-3 micrograms/ml in culture supernatants. All of the monoclonal antibodies bound specifically to trophozoites and schizonts of both strains of parasite in an indirect immunofluorescence assay and inhibited production of ring stage parasites by more than 90% when added to trophozoite or schizont containing erythrocytes in culture. Western immunoblot analysis of antigens obtained from trophozoites and schizonts (parasite age span of 36 to 48 h) was performed using either affinity purified or ammonium sulfate-concentrated monoclonal antibody. Antibody from three hybridomas which bound primarily to antigens of the Honduras 1 strain had Mr of approximately 140,000, 130,000 and 123,000.

Animals↗

Inhibition of in vitro growth of Plasmodium falciparum by purified antimalarial human IgG antibodies. Isolation of target antigens from culture supernatants.

In the search for candidate molecules for a malaria vaccine the in vitro inhibition of Plasmodium falciparum cultures by polyclonal or monoclonal antibodies has become a major tool. In the present study antigens identical to antigens circulating in plasma during attacks of malaria have been isolated from supernatants of P. falciparum cultures and used for immunoadsorbent purification of IgG antibodies from a pool of human immune serum collected in Liberia. Approximately 50% growth inhibition of three different P. falciparum isolates from Africa was obtained with the affinity-purified antibodies at a concentration of 25 micrograms ml-1 culture medium after 48 h of incubation. The target antigen/antigens for the protective antibodies have been partly characterized by radiolabelling, polyacrylamide gel electrophoresis and autoradiography but have not yet been identified unequivocally. However, the results indicate that one or more of the easily isolated antigens from the supernatant of P. falciparum cultures could be used in a malaria vaccine. The results also indicate that antigenic differences between strains from geographically disparate areas may not constrain the development of such a vaccine.

Adult↗

Malaria-induced immune thrombocytopenia.

On return from Liberia, a previously healthy 36-year-old man showed signs of malaria accompanied by severe haemolysis and slight thrombocytopenia. We found evidence of a platelet-associated IgG being responsible for the thrombocytopenia, inasmuch as the direct platelet suspension immunofluorescence test was strongly positive, the indirect immunofluorescence test and tests for drug-dependent antibodies at the same time being negative. We suggest that autoimmunity may be a contributing mechanism for platelet destruction in acute malaria.

Adult↗

Dissection of the human antibody response to the malaria antigen Pf155/RESA into epitope specific components.

The development of vaccines is presently receiving major attention in malaria research. As it is not possible to base malaria vaccines on the use of killed or attenuated organisms, the vaccines which are being developed are subunit vaccines in which the immunogens consist of defined parasite antigens or antigenic fragments. Since protective immunity to malaria involves both antibody-dependent and antibody-independent mechanisms, the immunogens in a subunit vaccine must have the capacity to induce relevant B- and T-cell responses in the majority of vaccinees. In turn, this requires good knowledge of these responses in humans who have acquired immunity through natural infection. In this paper we have summarized our recent work on the dissection into epitope-specific components of the human antibody response to the Plasmodium falciparum antigen Pf155/RESA, a recognized candidate for a vaccine against the asexual blood stages of this parasite. Epitope mapping of the antigen by means of short synthetic peptides led to the identification in several molecular regions of short amino acid sequences constituting linear and probably immunodominant B-cell epitopes. The antigenically most active region was located in the C-terminus of the molecule. This region, which consists of approximately 40 related, 4- or 8-amino acid long repeats, induced higher antibody concentrations in a larger number of malaria-immune donors than any of the other regions. A large fraction of these antibodies bound to short synthetic peptides representing the major repeat motifs of Pf155/RESA. Although these repeats are made up of closely related amino acid sequences, the antibody response to them was highly polyclonal, indicating the presence of several linear and probably also conformational epitopes which gave rise to a variety of cross-reacting as well as monospecific antibodies. Further analysis revealed that the levels of antibodies differing in specificity and/or avidity for different peptides varied independently of each other in individual donors. In an area (Liberia) where malaria transmission is holoendemic and perennial, these antibody profiles remained constant when individual donors were followed over several years. Since the C-terminal repeat region of Pf155/RESA is conserved in different P. falciparum strains, the results reflect differences in the genetic regulation of epitope-specific host responses rather than antigenic differences between infecting parasites. In donors living in an area with high but seasonal malaria transmission, antibody levels usually drop to lower levels when there is no transmission.(ABSTRACT TRUNCATED AT 400 WORDS)

Amino Acid Sequence↗

Detection of antibodies to malaria: comparison of results with ELISA, IFAT, and crossed immunoelectrophoresis.

194 sera from Vietnamese refugees and 100 pairs of corresponding maternal and cord sera from Liberia were examined for malaria-IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence microscopy (IFAT). For both tests the antigen was prepared from P. falciparum cultures. 44% of the Vietnamese sera were positive in the ELISA and 36% in the IFAT, but results were discordant in 36% of cases. The Liberian sera were all reactive in the IFAT and 95% were reactive in the ELISA. Overall, there was a significant correlation (p less than 0.001) between reciprocal IFAT titer and ELISA extinction value. With both tests, cord serum was generally slightly less reactive than corresponding maternal serum. Results of the two tests on 19 pairs of maternal and cord sera were compared with the number of anti-malaria precipitins detected by crossed immunoelectrophoresis. A positive correlation (p less than 0.01) between ELISA extinction values and numbers of precipitating antibodies was found. It is concluded that ELISA is at least as useful as IFAT for epidemiology and blood donor screening.

Antibodies↗

Psychological and Readjustment Problems Associated with Emergency Evacuation of Peace Corps Volunteers.

Background: To assess the psychological impact of emergency evacuation on individuals temporarily residing in foreign countries, we surveyed two groups of recently returned Peace Corps Volunteers. Methods: Cases were individuals (n = 265) who had been evacuated under emergency circumstances from their countries of service: Liberia, the Philippines, and Yemen. The control group (n = 90) consisted of the immediate predecessors of cases from the same countries who had completed their service under regular circumstances. Results: There were no significant age or gender differences between cases and controls. The median length of service in the foreign country was 14 months for evacuees and 24 months for regular returnees. Feelings of depression were self-reported by 60% of evacuees while 29% of controls reported this. For feelings of disorientation, 55% of cases versus 33% of regular returnees reported such symptoms. Other symptoms identified by more than 40% of evacuees included: difficulty making decisions (49% versus 26% of controls); anxiety (46% versus 27% of controls); numbness of feelings (43% versus 14% of controls); and periods of crying (43% versus 12% of controls). Conclusion: Temporary residence in a foreign culture may be associated with significant psychological symptoms upon return to one's home country. When forced to depart from one's host country under emergency conditions, the likelihood of individuals reporting these symptoms markedly increases.

Journal Article↗

Passive immunization of Aotus monkeys with human antibodies to the Plasmodium falciparum antigen Pf155/RESA.

In order to assess the protective effects of anti-Pf155/RESA antibodies of different specificities in vivo, passive immunizations of Aotus monkeys were performed. Antibodies reactive with the Pf155/RESA repeat sequences (EENV)2 and EENVEHDA were isolated from the immunoglobulin G (IgG) fraction of a pool of plasmas from Liberia by affinity chromatography on synthetic peptides. The two fractions of antibodies differed in specificity but displayed similar capacities to inhibit merozoite invasion in Plasmodium falciparum in vitro cultures. Four groups of monkeys (named groups I to IV) were injected with (i) 160 mg of total control IgG, (ii) 2 mg of IgG affinity purified on (EENV)2, (iii) 2 mg of IgG affinity purified on EENVEHDA, and (iv) 160 mg of total immune IgG, respectively. The monkeys were then challenged with P. falciparum-infected erythrocytes, and the levels of parasitemia and hematocrits as well as other serological parameters were determined daily. Although all groups developed parasitemia, groups II and IV tended to show lower mean daily levels. Three monkeys of group II and two monkeys (each) of groups III and IV self cured the infections, but so did one monkey from the group treated with control IgG (group I). The serum levels of transfused antibodies were low at the peak of parasitemia, suggesting that clearance of parasites was mediated by immune responses mounted by the monkeys. The results indicate that antibodies to epitopes formed by repeats of Pf155/RESA may depress P. falciparum parasitemias and thus that immunogens based on such repeats should be suitable components in a subunit vaccine against asexual stages of P. falciparum.

Adult↗