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Dengue: a review of the laboratory tests a clinician must know to achieve a correct diagnosis.

Dengue is the most important disease caused by an arbovirus (1, 2, 3 and 4 serotypes) worldwide, especially in the tropical and sub-tropical regions. Its clinical manifestations range from asymptomatic infections to a severe disease characterized by hemorrhage and shock. The incidence of dengue virus activity in the Americas has substantially increased from 1980 to 1994. In Brazil, the increase in the incidence of dengue is especially linked to the dissemination of Aedes aegypti. Thus, a rapid and accurate dengue diagnosis is of paramount importance for effective control of dengue outbreaks [8]. Five serological tests have been used for the diagnosis of dengue infection: hemagglutination-inhibition (HI), complement fixation (CF), neutralization test (NT), immunoglobulin M (IgM) capture enzyme linked immunosorbent assay (MAC-ELISA) and indirect immunoglobulin G ELISA. The limitations of these techniques are the high cross-reactivity observed with these tests. Four methods of viral isolation have been routinely used for dengue viruses: intracerebral inoculation of newborn mice, inoculation on mammalian cell cultures, intrathoracic inoculation of adult mosquitoes, and inoculation on mosquito cell cultures. In recent years, several new diagnostic techniques have been developed and have proven very useful in dengue diagnosis, such as: nucleic and acid hybridization, RT-PCR. Currently, dengue diagnosis is based on serology, viral isolation and RNA detection. Enzyme-linked immunosorbent assays (ELISA) are still the most widely used technique for serological diagnosis, but they do not identify the dengue virus serotype responsible for the current infection, so molecular techniques may soon assume a very important role in dengue diagnosis. RT-PCR is definitely the most satisfactory test that can be used on these infections, since it has been shown to be able to detect dengue viruses up to the 10th day after the onset of the symptoms.

Aedes↗

[Susceptibility of laboratory animals to the Chandipura and Isfahan viruses].

Pathogenicity and immunogenicity of Chandipura and Isfahan rhabdoviruses for laboratory animals were studied. Both viruses were found to be highly pathogenic for mice by the intracerebral route. Chandipura virus is highly pathogenic for mice of different ages by various routes of inoculation. The surviving animals were found to have antibodies demonstrable in different serological tests (agar gel diffusion and precipitation, complement-fixation, the neutralization test by plaque reduction in chick embryo cell culture). In the animals surviving the infection with Chandipura virus antibody could be found as early as 2 weeks, but after inoculation with Isfahan virus the antibody developed slowly and could be detected only at 4 weeks. Pathogenicity for mice of the T-227 and the prototype Isfahan virus strains differed slightly.

Animals↗

Single inoculation immune hamster sera for typing California group arboviruses by the complement-fixation test.

Eight reference California group viruses of North America were typed using sera of immune hamsters bled 21 days after a single inoculation. The complement-fixation test reactions were relatively specific, although only 2-fold differences were observed reciprocally with the closely-related La Crosse and snowshoe hare viruses. Hamster serum taken 10 days post inoculation was more specific than a 21-day serum. Sepcificity after second inoculation was lost with some antigens. Jamestown Canyon and South River viruses were identical by complement-fixation test and showed minor differences in the plaque reduction neutralization test.

Animals↗

Prediction models for eye irritation potential based on endpoints of the HETCAM and neutral red uptake tests.

The aim of this study was to explore the possibility of distinguishing between eye irritants (I; EU risk phrases R36 and R41) and nonirritants (NI), by using in vitro endpoints of the hen's egg test on the chorioallantoic membrane (the HETCAM test) and the neutral red uptake (NRU) test. Prediction models were derived by applying binary logistic regression to the in vitro data for these endpoints, which were taken from the report of a German validation study on the use of the HETCAM and 3T3 NRU tests as alternatives to the Draize eye irritation test. Whereas the validation study led to the conclusion that the combined use of the two tests enables a satisfactory discrimination between severe (R41) and nonsevere (NI, R36) eye irritants, the results of the present study indicate that the two in vitro tests can also be used to discriminate between nonirritants (NI) and irritants (R36 and R41).

3T3 Cells↗

Immunofluorescent study of the replication of infectious pancreatic necrosis virus in trout and Atlantic salmon cell cultures.

Cell cultures of trout gonad tissue (RTG-2) and Atlantic salmon heart, kidney, liver, and spleen tissue were inoculated with 50 50% tissue culture infective doses (TCID(50)) of infectious pancreatic necrosis (IPN) virus per cell, and the titer of cell-associated and released virus was determined from 2 to 16 h postinoculation (PI). Cover slips were collected over the same period and stained for IPN viral antigen by the direct immunofluorescent (FA) technique. Viral replication was detected after a latent period of approximately 2 to 4 h and reached a peak titer of 10(8.2) to 10(8.4) TCID(50) per ml at 8 to 10 h PI. The release of virus was more rapid in Atlantic salmon cells than in RTG-2 cells. Viral antigen was first detected by FA from 3 to 4 h PI. Approximately 75 to 80% of the cells contained antigen in the cytoplasm 9 to 11 h PI. The direct FA technique was found to be a sensitive method for detecting IPN virus in infected cells. Three strains of IPN virus were tested for serological cross reactions by FA and virus neutralization tests.

Animals↗

Cross-neutralization between vesicular stomatitis virus type Indiana and Chandipura virus.

Using highly potent immune sheep sera, it was possible to demonstrate that: (1) Two rhabdoviruses, classified in the Vesiculovirus genus on morphological grounds but previously considered unrelated, viz., the vesicular stomatitis virus type Indiana (VSV), and Chandipura virus (ChV), show a low-level, but distinct cross-neutralization. This was, in most combinations, considerably increased by complement. (2) The species of cells used for growing the viruses for immunization and for neutralization tests, influenced the level of cross-neutralization. (3) No cross-reaction between VSV and ChV could be detected in the immunodiffusion reaction. (4) Immune sera, raised in sheep by immunization with the two purified rhabdoviruses contained complement-dependent cytotoxic antibodies specifically reacting with the cell species used for growing the viruses.

Antigens, Viral↗

Preparation and efficacy of antiherpes type 1 and 2 subunit vaccines.

DNA free antiherpes subunit vaccines were prepared from diploid human embryonic lung cells infected either with type 1 or type 2 herpes simplex viruses (HSV). Virion and membrane-bound virus-specific glycoproteins were solubilized with Nonidet P-40 and separated by ultracentrifugation. The antigenic properties of the vaccine were tested in guinea pigs. Antibody response was followed by virus neutralization and complement fixation. The vaccine itself was low-immunogenic, however its immunogenicity has considerably increased by usage of suitable adjuvants. In virus neutralization test higher antibody titre was found against homologous virus. The antibody response was related to protein content and to the frequency of vaccination.

Adjuvants, Immunologic↗

Development of a gelatin particle agglutination reagent for measles antibody assay.

A new agglutination test that utilizes gelatin particles as the carrier of measles antigen was developed and used to evaluate immune status to measles virus infection. The particle agglutination (PA) reagent reacted with monoclonal antibodies against two major proteins of measles virus, the hemagglutinin (H) and fusion (F) proteins. Children were followed individually for ten years for measles antibody. Results showed that the PA test was as sensitive and specific as the plaque neutralization test. The procedure is simple and rapid. No prior treatment of specimens is needed, and the test is completed in a single reaction. The PA test therefore can be used for diagnoses and epidemiologic surveys of measles virus infection.

Agglutination Tests↗

[Production of an diagnostic erythrocyte agent from Pseudomonas aeruginosa exotoxin A].

The sensitization of formolized sheep red blood cells with exotoxin A by means of chromium chloride or glutaraldehyde is more effective with respect to their sensitivity in the passive hemagglutination test than loading by means of amidol, tannin and rivanol. The use of chromium chloride decreases the consumption of exotoxin A 2, 8, 16 and 16 times in comparison with the use of amidol, tannin, rivanol or glutaraldehyde respectively. The high specificity of erythrocyte diagnosticum obtained from exotoxin A by means of chromium chloride is indicated in the study of hyperimmune sera to 22 different antigens of enteric bacteria and staphylococci in the passive hemagglutination test and to 10 different enterobacterial and staphylococcal antigens in the antibody neutralization test.

ADP Ribose Transferases↗

[Humoral immunity in subjects with a history of tick-borne encephalitis].

A total of 137 patients with a history of focal and meningeal forms of tick-borne encephalitis (TBE) were examined in the period from 1 to 7 years after the acute stage of the disease. In their examination the authors used hemagglutination inhibition test in the acute and the long-term periods and neutralization test in the late periods. Antibodies to the TBE virus were detected in individuals living in the western region of TBE prevalence (Latvian SSR). The results of the clinical and immunological investigation help to obtain a more comprehensive understanding of the peculiarities of TBE pathogenesis, the stability of the post-disease immunity, as well as to solve more successfully the questions of immunoprophylaxis and medical expert examination of the patients.

Adolescent↗

Development of a simplified assay for the detection of neutralizing antibodies to Japanese encephalitis virus.

Japanese encephalitis virus is a common cause of viral encephalitis in Asia with an estimated 45,000 cases annually. It causes significant morbidity and mortality. It is transmitted primarily by Culex mosquitoes between birds and animals, while man is thought to be an accidental, dead-end host. Since dengue is also prevalent usually in Japanese encephalitis-endemic areas, all Japanese encephalitis positive sera must be confirmed by detecting Japanese encephalitis specific neutralizing antibodies. The plaque reduction neutralization test is the gold standard for detecting and quantifying Japanese encephalitis neutralizing antibodies. This test, however, takes about a week and is carried out in 6 or 24-well plates, which limits its usage for large-scale screening. A simplified assay was developed for the detection and quantification of Japanese encephalitis neutralizing antibodies. The assay, which is carried out in 96-well plates, would be suitable for use in the mass screening of the population's immunity level as well as for use in vaccine efficacy studies.

Animals↗

Human recombinant neutralizing antibodies against hantaan virus G2 protein.

Old world hantaviruses, causing hemorrhagic fever with renal syndrome (HFRS), still present a public health problem in Asia and Eastern Europe. The majority of cases has been recorded in China. The aim of our study was to generate human recombinant neutralizing antibodies to a hantavirus by phage display technology. To preserve the structural identity of viral protein, the panning procedure was performed on native Hantaan (HTN) (76-118) virus propagated in Vero-E6 cells. In total, five complete human recombinant IgG antibodies were produced in a baculovirus expression system. All of them were able to completely neutralize HTN, and Seoul (SEO) virus in a plaque reduction neutralization test (PRNT). Three of these antibodies could also completely neutralize Dobrava (DOB) virus but not Puumala (PUU) virus. All antibodies bind to Hantaan virus G2 protein localized in the virus envelope. The sequence areas within the HTN (76-118)-G2 protein detected by five selected antibodies were mapped using peptide scans. Two partial epitopes, 916-KVMATIDSF-924 and 954-LVTKDIDFD-963, were recognized, which presumably are of paramount importance for docking of the virus to host cell receptors. A consensus motif 916-KVXATIXSF-924 could be identified by mutational analysis. The neutralizing antibodies to the most widely distributed hantaviruses causing HFRS might be promising candidates for the development of an agent for prevention and treatment of HFRS in patients.

Amino Acid Sequence↗

The purification of four respiratory syncytial virus proteins and their evaluation as protective agents against experimental infection in BALB/c mice.

The fusion (F) glycoprotein, large glyco- (G) protein, phospho- (P) protein and 22K protein of respiratory syncytial (RS) virus A2 strain were purified by a combination of immunoaffinity adsorption and preparative SDS-PAGE. All four proteins elicited serum antibody in mice after repeated inoculation in adjuvant, although the magnitude of the response as measured by ELISA varied from mouse to mouse. The F protein generated neutralizing antibodies in only 50% of the mice determined to be seropositive by ELISA. The G protein also induced neutralizing antibodies but in this instance neutralization tests and ELISA titres were more closely correlated. No neutralizing activity was detected in mice immunized with the P or 22K proteins although all produced antibody detectable by ELISA. Mice immunized with either the F or the G protein were found to be protected against subsequent RS virus challenge, whether they had developed neutralizing antibody or not. Mice inoculated with the P or 22K proteins were not protected.

Animals↗

Genetic and antigenic properties of Dobrava virus: a unique member of the Hantavirus genus, family Bunyaviridae.

We examined the genetic and antigenic properties of Dobrava (DOB) virus, a hantavirus associated with severe haemorrhagic fever with renal syndrome in Europe. Cloning and sequence analyses revealed the DOB M segment to consist of 3644 nucleotides, with a coding capacity of 1134 amino acids in the virus complementary-sense RNA (cRNA). Seven potential asparagine-linked glycosylation sites were identified in the M segment gene product, one in the G2 and six in the G1 coding regions. The S segment is 1667 nucleotides long, and has a single ORF in the cRNA capable of encoding a protein of 428 amino acids. Phylogenetic comparisons of the M and S segments of DOB virus to those of other hantaviruses indicated that DOB virus is similar to, but clearly distinct from Hantaan (HTN) and Seoul (SEO) viruses. Certain G2-specific, but not G1-specific monoclonal antibodies to HTN virus reacted to the same titre with DOB and homologous viral antigen. Plaque-reduction neutralization tests indicated that, of the sera tested, only antisera to SEO virus were able to neutralize DOB virus to a titre greater than 1:10; however, this neutralization titre was eightfold lower than that observed with homologous SEO virus. The data reported here confirm that DOB virus is a unique species in the Hantavirus genus, family Bunyaviridae.

Animals↗

Reactivity of neutralizing antibodies with different specificities to H particles of poliovirus.

In order to elucidate the antigenic structure of poliovirus, the reactivity of antibody produced with H antigenic particles of Mahoney strain (polio type 1) was investigated. Injection of H particles of Mahoney strain into rabbits yielded neutralizing antibody as well as CF-N and CF-H antibodies. This result coincided with the report by Hinuma and coworkers. Neutralization tests with inhibitor resistant Mahoney mutants revealed that the neutralizing antibody produced with H particles was of HN31 type, one of the five different kinds of polio neutralizing antibodies reported previously (14). Absorption experiments with H particles on different neutralizing antibodies and analysis of antibody eluted by acid dissociation from antiserum-treated H particles also showed that the HN31 type antibody specifically combined with H particles of Mahoney strain. Since the H particle of poliovirus is known to be deficient in VP4, these results seems to indicate that the HN31 type antibody reacts with a structural part(s) of poliovirus other than VP4.

Absorption↗

Evaluation of serologic assays for diagnosis of whooping cough.

An enzyme-linked immunosorbent assay (ELISA) for the immunoglobulin G (IgG), IgM, and IgA response to Bordetella pertussis filamentous hemagglutinin (FHA) and pertussis toxin (PT) and a neutralization test (NT) in a microplate tissue culture assay for neutralizing antibodies to PT were evaluated in paired sera from 90 patients with culture-confirmed pertussis. Eighty patients were children (age, less than 15 years), and 6 of 80 children had been immunized with three doses of diphtheria-tetanus-pertussis vaccine as infants. A significant titer rise (greater than or equal to twofold), determined by ELISA, of IgG, IgM, and IgA to FHA was recorded in 75 (83%), 28 (31%), and 47 (52%) of the patients, respectively. A significant titer rise to PT in IgG was found in 83 (92%), IgM in 29 (32%), and IgA in 44 (49%) of the patients. A significant titer rise to FHA or PT in IgG was found in 88 (98%) of the patients, in combination with a significant rise in the titer of IgA to FHA. These data were obtained in a single serum dilution of 1:500. Titrations performed later showed that the titer rise to FHA in IgG was a mean of 6.5-fold, which was significantly lower than the mean 67.0-fold rise in IgG to PT (P less than 0.001). The mean titer of IgG to FHA in convalescent-phase serum was 270, which was also significantly lower than the mean PT titer of 2,943 (P less than 0.001). A significant rise (greater than or equal to fourfold) in PT titer by NT was found in 58 of 83 (70%) of the patients. The NT was significantly less sensitive than the ELISA for the determination of the IgG titer to PT ( P< 0.001). Results showed that a 100% (90 of 90) sensitivity in terms of titer rises was achieved in the serologic diagnosis of pertussis by ELISA in a single-point determination of the IgG and IgA responses to FHA and of the IgG response to PT.

Adolescent↗

Heterologous flavivirus infection-enhancing antibodies in sera of Nigerians.

Human sera collected from Nigerians were examined for plaque reduction neutralizing and infection-enhancing antibodies against dengue 2, yellow fever, and West Nile viruses. Neutralization tests showed that 17 of 19 sera contained flavivirus neutralizing antibody; 11 were positive to all 3 viruses, 5 to dengue and yellow fever, and 1 to dengue virus only. Two sera had no detectable neutralizing antibody to any of the flaviviruses. Enhancement assays showed that 17 flavivirus neutralizing antibody-positive sera contained infection-enhancing antibodies to dengue 2, and 16 had antibody to yellow fever. Although 11 sera were positive for West Nile neutralizing antibody, 17 enhanced this virus. Heterologous infection-enhancing antibody titers were lower than the homologous ones. Broadly reacting sera and those with high neutralizing antibody titers produced the highest infection-enhancing antibody titers.

Antibodies, Viral↗

Humoral immune responses in rabbits induced by an experimental inactivated severe acute respiratory syndrome coronavirus vaccine prepared from F69 strain.

BACKGROUND: The etiologic agent of severe acute respiratory syndrome (SARS) has been confirmed to be a novel coronavirus (CoV), namely SARS-CoV. Developing safe and effective SARS-CoV vaccines is essential for us to prevent the possible reemergence of its epidemic. Previous experiences indicate that inactivated vaccine is conventional and more hopeful to be successfully developed. Immunogenicity evaluation of an experimental inactivated SARS-CoV vaccine in rabbits was conducted and reported in this paper. METHODS: The large-scale cultured SARS-CoV F69 strain was inactivated with 0.4% formaldehyde and purified, then used as the immunogen combined with Freund's adjuvant. Eight adult New Zealand rabbits were immunized four times with this experimental inactivated vaccine. Twelve sets of rabbit serum were sampled from the third day to the seventy-fourth day after the first vaccination. The titers of specific anti-SARS-CoV IgG antibody were determined by indirect enzyme-linked immunosorbent assay, and the neutralizing antibody titers were detected with micro-cytopathic effect neutralization test. RESULTS: Rapid and potent humoral immune responses were induced by the inactivated SARS-CoV vaccine in all the eight test rabbits. Titers of both specific IgG antibody and neutralizing antibody peaked at about six weeks after first vaccination, with the maximum value of 1:81 920 and 1:20 480, respectively. After that, serum antibody levels remained at a plateau or had a slight decrease, though two boosters were given in the succedent 4 to 5 weeks. Cross neutralization response existed between SARS-CoV F69 strain and Z2-Y3 strain. CONCLUSIONS: The inactivated SARS-CoV vaccine made from F69 strain owns strong immunogenicity, and the cross neutralization response between the two different SARS-CoV strains gives a hint of the similar neutralizing epitopes, which provide stable bases for the development of inactivated SARS-CoV vaccines.

Animals↗