AUTOANTIBODY STUDIES IN BOVINE ANAPLASMOSIS.
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Allergy and Immunology↗
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THE RADIOISOTOPE PRECIPITATION TEST FOR STUDY OF Q FEVER ANTIBODIES IN HUMAN AND ANIMAL SERA.
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Alaska↗
[The "Coombs consumption test" with isolated pigeon erythrocyte nuclei in LE-serology].
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Animals↗
Direct Coombs test-negative autoimmune hemolytic anemia and low-affinity IgG class antibodies.
Autoimmune hemolytic anemia, in which the direct antiglobulin test (DAT) is negative or weakly positive, may be due to low-affinity autoantibodies. We describe two such cases. An 8-year-old male presented with weight loss, jaundice, a hemoglobin of 33 g/L, reticulocytes of 306 x 10(9)/L, and haptoglobin of < 0.1 g/L. The DAT was negative. After washing the red blood cells (RBCs) with saline at 4 degrees C, the DAT was positive for IgG and an eluate contained an IgG3 autoantibody, thus confirming a diagnosis of autoimmune hemolytic anemia (AIHA). Red cell transfusions and corticosteroids were given with eventual complete recovery. A 73-year-old male had a hemoglobin of 89 g/L and haptoglobin of < 0.1 g/L. The DAT was initially negative but was positive for IgG using cold-washed (4 degrees C) RBCs; it was also positive with unwashed cells in the DiaMed system and an eluate contained IgG1 autoantibody. AIHA was therefore confirmed and prednisolone started but continued hemolysis necessitated splenectomy before full recovery occurred. Although RBCs may be strongly sensitized with low-affinity autoantibodies in vivo, the IgG is easily removed when RBCs are washed at room temperature for a DAT. The DiaMed system that uses unwashed RBCs overcomes this problem, but cold washing the RBCs at 4 degrees C must be used when preparing eluates.
Journal Article↗
Haematological abnormalities in the acquired immunodeficiency syndrome.
Full haematological data were available on 22 of the first 30 patients with proven acquired immunodeficiency syndrome (AIDS) admitted to Johannesburg Hospital before July 1987. Reversal of the helper/suppressor T-cell ratio was present in all cases and polyclonal hypergammaglobulinaemia in 85% of cases. Sixty-eight per cent of patients were anaemic, 55% leucopenic, 77% lymphopenic and 23% thrombocytopenic. Four patients (out of 12 tested) exhibited a positive Coombs test (25%) and 2 patients (out of 13 tested) had a circulating lupus anticoagulant (15%). Bone marrow examination revealed all patients to be either normo- or hypercellular. Three patients exhibited haemophagocytosis. Given the increasing incidence of AIDS and the frequency of haematological abnormalities in this condition, the practising clinician should have a high index of suspicion when confronted by any unexplained haematological abnormality.
Acquired Immunodeficiency Syndrome↗
[On a fatal outcome of a penicillin medication in childhood with a positive Coomb's test].
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Child↗
Comparison of counter-immunoelectrophoresis with other serological tests in the diagnosis of human brucellosis.
Sera from 65 persons with clinical brucellosis were employed in a comparison of standard and rapid serological tests. The results obtained with the Rose Bengal test correlated very well with those of the standard tube agglutination test, whereas results with the rapid plate agglutination test and the Coombs (antiglobulin) test were inferior. Absorption of patients' sera with specific anti-human immunoglobulin sera showed that IgM was active in the Rose Bengal test but not in the Coombs test, whereas IgG and IgA were active in both tests. In addition to the A & M antigen, which plays the most important role in the agglutination, Rose Bengal, and Coombs tests, other antigenic fractions of Brucella were examined in precipitation tests. A protein antigen reacted with 94% of the sera in counter-immunoelectrophoresis. On the basis of the results with both groups of sera, the Rose Bengal test and counter-immunoelectrophoresis appear to be the most promising methods for diagnosing clinical brucellosis. The tests differ qualitatively since different Brucella antigens are employed.
Brucellosis↗
[A comparison of complete and incomplete antibodies by Middlebrook-Dubos, Boyden and Coombs hemagglutination tests in man].
The antibodies in the sera of 160 tuberculous persons and in a control group of 100 healthy persons were investigated by Middlebrook-Dubos (M-D), Boyden hemagglutination and modified M-D antiglobulin methods. By the M-D method 88% of the sera from 135 persons with lung tuberculosis, and 57.1% sera from 21 persons with other organ tuberculosis gave positive results. In the control group of 100 persons 11% were positive, while all of PPD negative persons remained negative. By Boyden method 90% of 135 lung tuberculosis, 57.1% of 21 with other organ tuberculosis and 4% of the control group gave positive results. In 91.2% of 80 persons with lung tuberculosis, tested with modified M-D antiglobulin method, found incomplete antibodies. The difference in control groups (11%, 4%), and in persons with active tuberculosis (88%, 90%) indicates that the serological tests are just as significant as other diagnostic methods.
Antibodies, Bacterial↗
[Diagnostic possibilities in drug allergies].
Drug allergies can be subclassified into three subgroups, which differ in their pathophysiology and require different diagnostic steps: (1.) classical drug allergies, which are directed to the drug itself, a reactive compound of the drug, or some contamination of it; (2.) pseudo-allergic reactions, which are caused by non-immune mediated degranulation of mast cells and basophils, and (3.) autoimmune reactions, in which the drug elicits an immune reaction to autologous structures. A very detailed (criminalistic) history has the highest priority for clarification of a suspected drug allergy. In addition, skin tests, serological tests and the lymphocyte transformation test may be useful. It is necessary to differentiate between tests which imitate the drug elicited allergic reaction (i.e. Coombs test in drug induced hemolytic anemia) and tests which only indicate sensitization. The detection of IgG antibodies to drugs bound to various carriers (nitrocellulose, sepharose) is controversial and the meaning of a positive result is unclear. Therefore, this test cannot be recommended for the routine diagnosis of drug allergy. Special emphasis is placed on the value of the lymphocyte transformation test, which is more often positive than other test procedures and may sometimes strengthen the suspicion that a disease may be caused by a drug. Nevertheless, this test requires cautious interpretation as it may be falsely positive as well as falsely negative.
Basophils↗
Laboratory-based diagnosis of brucellosis--a review of the literature. Part II: serological tests for brucellosis.
Brucellosis is a common zoonotic disease transmittable to humans from infected animal reservoirs. Malta, Rock, Gibraltar, Cyprus or Mediterranean fever, Bang's disease, intermittent typhoid or typho-malarial fever, undulant fever, etc. are just various synonyms for brucellosis. Patients suffering from this disease show unspecific symptoms, e.g. fever, chills, malaise, arthralgia, headache, tiredness and weakness. Human brucellosis may be caused by four of totally six genetically and phenotypically closely related Brucella species, i.e. B. melitensis, B. abortus, B. suis and B. canis. Although many organ systems may be involved, brucellosis is rarely fatal. Therapeutic failure and relapses, chronic courses and severe complications like bone and joint involvement, neurobrucellosis and endocarditis are characteristic for the disease. A definite diagnosis requires the isolation of Brucellae from blood, bone marrow or other tissues. However, cultural examinations are time-consuming, hazardous and not sensitive. Thus, clinicians often rely on the indirect proof of infection. The detection of high or rising titers of specific antibodies in the serum allows a tentative diagnosis. A variety of serological tests has been applied, but at least two serological tests have to be combined to avoid false negative results. Usually, the serum agglutination test is used for a first screening and complement fixation or Coombs' test will confirm its results. As Brucella ELISAs are more sensitive and specific than other serological tests, they may replace them step by step. This review will summarize advantages and disadvantages of the serological techniques used in clinical laboratories for indirect verification of human brucellosis.
Agglutination Tests↗
[Drug allergies].
Drug allergies can be classified into three subgroups which differ in their pathophysiology and require different diagnostic steps: 1. classical drug allergies, which are directed against the drug itself, a reactive metabolite or some contaminant of the drug, 2. pseudoallergic reactions, which are caused by non-immune mediated degranulation of mast cells and basophils, and 3. autoimmune reactions, in which the drug elicits an immune reaction to autologous structures. A very detailed accurate history is of the greatest importance in the clarification of a suspected drug allergic reaction, as well as experience with the drug. In addition, skin tests, serological tests and the lymphocyte transformation test may be useful. One should differentiate between tests which imitate the drug-elicited allergic reaction (i.e., Coombs test in drug-induced hemolytic anemia) and tests which solely indicate a sensitization and the tests must be interpreted accordingly.
Antibody Formation↗
Enzyme-linked immunosorbent assay for diagnosis of brucellosis.
The performance of an ELISA for detection of total antibodies to Brucella spp. was compared with that of the Rose Bengal, standard agglutination and Coombs test in the diagnosis of brucellosis. Sera tested were from 208 patients from whom Brucella melitensis had been isolated, 177 patients with significant results in at least two conventional tests, and 107 patients with fever from whom no Brucella spp. had been isolated and in whom all conventional tests were negative. ELISA was the most sensitive test (97%), showing greater specificity (96%) and good predictive positive and negative values (98% and 94% respectively). ELISA was the only positive test in 6% of patients in whom brucellosis had been confirmed by culture.
Agglutination Tests↗
Detection of Salmonella typhimurium infection of chickens.
The serological response of two groups of chickens was followed by three techniques after experimental infection of one group with Salmonella typhimurium. Results obtained illustrate the greater sensitivity of the microantiglobulin (Coombs) test over more conventional methods for detecting salmonella agglutinins. The possibilities of the diagnostic use of the microantiglobulin test in the field are discussed.
Agglutination Tests↗
Spherocytosis associated with anaplasmosis in two cows.
Spherocytes were detected on blood smears of 2 Angus cows. The RBC from both cows had increased fragility in hypotonic saline solution, supporting the presence of spherocytes. Other laboratory tests revealed a macrocytic, regenerative anemia with anisocytosis, polychromasia, basophilic stippling, Howell-Jolly bodies, nucleated RBC, and Anaplasma marginale organisms. A complement-fixation test was positive for anaplasmosis in cow 1 and a direct Coombs' test was positive for immunoglobulin G in both cows.
Anaplasmosis↗
[Paroxysmal cold hemoglobinuria complicated with acute hemolysis in a child].
An 8 year-old girl with paroxsmal cold hemoglogunuria (PCH) is reported. She was referred to our clinic because of acute anemia, and found to have PCH after clinical and laboratory examination. Anti-P1 antibody and Donath-Landsteiner (D-L) antibody were detected. In Coombs' test with variable incubation temperatures, positive IgG on her erythrocytes changed to negative as temperature of incubation was elevated. Also activation of complement was detected on the surface of her erythrocytes. Clinical improvement was obtained by blood transfusion, and positive Coomb's test and D-L test turned to negative.
Acute Disease↗
Detection and quantitation of fetomaternal hemorrhage.
Failure to administer additional doses of Rh immune globulin (RhIG) to patients with excessive fetomaternal hemorrhage (FMH) is one of the causes of continued Rh isoimmunization. We compared the fetal cell ratio (FCR) with the other laboratory methods currently used at our hospital to quantitate FMH, ie, fetal cell preparation (FCP), RhIG cross-match with maternal serum, and indirect Coombs' testing 24 to 48 hours after administration of RhIG. The incidence of excessive FMH as detected by the various methods was 3.6% (cross-match), 9.6% (Coombs'), 18% (FCP), and 66% (FCR). The methods currently used do not accurately quantify FMH. The FCR is the most sensitive test but it has a high false-positive rate and thus does not appear to be clinically useful. We suggest that repeating the indirect Coombs' test may provide a practical alternative for determining the need for additional doses of RhIG.
Adolescent↗
Laboratory-based diagnosis of brucellosis--a review of the literature. Part I: Techniques for direct detection and identification of Brucella spp.
Brucellosis is a world-wide re-emerging zoonosis and the most frequent laboratory-acquired bacterial infection, causing severe disease in humans with unspecific clinical signs affecting numerous organs. Contact with infected animals, ingestion of contaminated animal products and handling of Brucella isolates in laboratories are risk factors. Various other febrile illnesses, e.g. malaria, tuberculosis, typhoid fever and tularemia may present with the same symptoms. Therefore, clinical diagnosis is difficult to establish but effective therapy requires an early diagnosis. Vaccines for humans are still not commercially available. Blood culturing of Brucella is time-consuming and not reliable. Thus diagnosis is usually based on indirect serological tests, i.e. serum agglutination test, complement fixation or the Coombs test. However, these 'conventional' serological tests lack sensitivity and specificity. Hence, a combination of various tests is mandatory for a definite diagnosis. Enzyme-linked immunosorbent assays can be used for screening and confirmation of brucellosis in one step. Molecular techniques like the polymerase chain reaction and restriction fragment length polymorphism are needed to differentiate species and strains within the genus Brucella. This review will summarize advantages and disadvantages of the techniques used in clinical laboratories for direct detection and identification of Brucella spp.
Animals↗
[Severe complications following intermittent administration of rifampicin].
In the last two years the authors have noted the cases of five patients with pulmonary tuberculosis to which intermittent treatment with Rifampicin was administered (twice weekly, 600-900 mg/day), in association with Ethambutol. Between 2 and 6 months after the treatment was started, 24-72 hours after the last administration of Rifampicin acute renal failure developed in all five cases. Two of the patients also had signs of liver failure (increased serum transaminase, lowered pseudo-cholinesterase, increased BSP retention), and in one of them there was also a hematological syndrome consisting in hemolytic anemia and thrombocytopenia. Four of the patients benefited from application of diuretics, hydroelectrolytic re-equilibration and/or hemodialysis. One of the subjects died 12 hours after being hospitalized, with acute pulmonary oedema, refractory to treatment. From the histopathological viewpoint glomerular lesions were found in the kidney (non-uniform thickening of the basal membranes by PAS-positive deposits). In two of the patients various immunological tests have been carried out (Coombs test, lymphocyte-migration inhibition, serum and urine immunelectrophoresis) that, by their alterations, provide some elements indicating the immunological origin of the phenomena.
Acute Kidney Injury↗