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PubMed1983

Immunological studies of post-streptococcal sequelae: serological studies with an extracellular protein associated with nephritogenic streptococci.

Using the Ouchterlony double diffusion and the crossed-immunoelectrophoresis techniques the reactivity to a purified extracellular product of nephritogenic group A streptococci (NASP) was examined with both acute and convalescent sera obtained from patients with documented post-streptococcal glomerulonephritis and patients with documented acute rheumatic fever. The streptococcal antigen utilized in these studies was first purified on SDS gels and then eluted from the gel, resulting in a single protein band on SDS electrophoresis. Double diffusion studies revealed that only nephritis patients reacted to this extracellular product associated with nephritogenic strains, whereas rheumatic fever sera produced no line of precipitation. An assay of serial bleedings from nephritis patients suggested that the antibody reactive to the NASP was in higher titre in the acute phase of the disease and decreased with convalescence. In confirmation of these findings, crossed-immunoelectrophoresis experiments were conducted with a battery of sera from acute nephritic and non-nephritic patients against the NASP antigen. A striking increase was detected in the reactivity of nephritis patients (96%) compared to non-nephritis sera (15-20%). Comparison between acute and convalescent sera using this technique confirmed the finding of decreasing antibody titre with resolution of disease. These findings of a specific humoral response in patients with acute post-streptococcal nephritis to the NASP of nephritogenic strains further implicates an aetiological function to this protein.

Adolescent↗
PubMedDate not supplied

Patients' and spouses' causal explanations of a myocardial infarction.

This study examined lay explanations of an illness episode, myocardial infarction, at acute and convalescent phases of illness. Data were collected by interviews, using a structured questionnaire during the acute phase of illness (in hospital) and convalescent phase (at home) after discharge, from 50 first-time MI patients and 50 spouses or significant others. Tension (at work, in the home situation, and in general) was the most frequent cause given for the heart attack by both patients and spouses at both phases. Half the patients and half the spouses changed their mind regarding the cause of the heart attack between the acute and the convalescent phases. Further, over 50 percent of the patient/spouse pairs disagreed regarding the cause of illness at both phases. A high percentage of patients changed their smoking, diet, and exercise behavior, even when they did not list these factors as causes of the heart attack. Findings also suggested spouses should be included in discharge planning and special problems which spouses may face after patients' discharge should be addressed.

Adult↗
PubMed1982

Immunity to herpes simplex virus type 2. IV. Impaired lymphokine production during recrudescence correlates with an imbalance in T lymphocyte subsets.

Cell-mediated immunity (CMI) to herpes simplex virus type 2 (HSV-2) was studied in patients with recurrent disease. Peripheral blood lymphocytes (PBL) obtained during recrudescence (0 to 3 days post-onset of lesion), convalescence (4 to 14 days), and quiescence (greater than 14 days), which were cultured in vitro in the presence of UV-inactivated HSV-2 (G) antigen, demonstrated similar, virus-specific lymphoproliferative responses. However, the production of the lymphokine, leukocyte migration-inhibition factor (LIF), was completely suppressed during recrudescence. During convalescence, LIF production returned to levels similar to those of PBL from seropositive controls (without a history of recurrent subsets revealed a significant increase in the proportion of T8+ and Ia+ cells during recrudescence and at prodrome (24 to 48 hr before onset of lesions). Glass adherence reduced the proportion of both T8+ and Ia+ cells and restored early (1 day) LIF activity, and recrudescent PBL suppressed the proliferation of autologous T cells in presence of UV-HSV-2 (G) antigen. The expression of both phenotypes and LIF production returned to control levels during convalescence.

Antibodies, Monoclonal↗
PubMed1982

Primary hemostasis after massive transfusion for injury.

Primary hemostasis, the formation of a platelet plug, was studied in 22 injured patients receiving an average of 21 transfusions during the operation for control of bleeding. The storage age of the blood averaged 15 days; no platelet transfusions were given. Platelet counts (PLT) and bleeding time (BT) were studied intraoperatively; postoperatively at 6 hours, 25 hours, day 2, day 4; and during convalescence (8 days to 3 months). Serial PLT and BT levels were correlated with the number of transfusions and age of blood. During operation, the PLT fell to 109,000/mm3 and the BT was greater than 15 minutes. Thrombocytopenia did not correlate with the number of transfusions or age of blood. The PLT averaged 106,000/mm3 at 6 hours and then fell significantly to 73,000/mm3 at 15 hours and to 76,000/mm3 on day 2. The PLT rose significantly to 110,000/mm3 by day four and increased to supernormal levels by convalescence. The BT remained elevated at 6 hours, 15 hours, day 2, and day 4, and declined to normal by convalescence. Thrombocytopenia and prolonged BT after massive transfusion for injury indicate platelet dysfunction which may protect against disseminated intravascular coagulation. Correction of the thrombocytopenia should be reserved for patients with bleeding.

Bleeding Time↗
PubMed1995

Clinical features and viral excretion in an infant with primary human herpesvirus 7 infection.

OBJECTIVE: To find clinical features of a virologically-confirmed patient with primary human herpesvirus 7 (HHV-7) infection and a relationship of the excretion of viruses between HHV-7 and human herpes-virus 6 (HHV-6). PATIENT AND METHODS: A 13-month-old boy who had a known prior history of exanthem subitum at 6 months of age developed fever for 3 days and a skin rash appeared as the fever was resolving. The course was accompanying with nonspecific signs and symptoms such as anorexia, irritability, mild diarrhea, palpebral edema, mild inflammation of pharynx, and mild occipital and cervical lymphadenopathy. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction (PCR) amplification. Samples from other body sites were also tested for their DNA sequences using the PCR. Both virus antibody activity was measured by an indirect immunofluorescent assay or a neutralization test. RESULTS: Cultured mononuclear cells from the patient at the acute stage of the disease produced morphologic changes, which reacted only with the monoclonal antibody to HHV-7 but not with the antibody to HHV-6. Both viruses were not isolated from blood obtained at the convalescent stage. An antibody response of the patient indicated a seroconversion to HHV-7 but not to other microbial agents including HHV-6 and Mycoplasma pneumoniae. Both virus DNA sequences were detected in peripheral blood mononuclear cells at acute and convalescent stages. HHV-7 DNA was excreted into saliva and transiently into stool at an early convalescent stage followed by HHV-6 excretion into saliva. No HHV-7 and HHV-6 was excreted into urine. CONCLUSIONS: Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection and HHV-7 infection may reactivate HHV-6.

Antibodies, Viral↗
PubMed1994

Gonadotropin-releasing hormone agonist use before hysterectomy.

OBJECTIVE: Our purpose was to compare the effects of leuprolide acetate in patients with symptomatic uterine leiomyoma before hysterectomy. STUDY DESIGN: Group I (n = 90) included patients with a pretreatment uterine size of 14 to 18 gestational weeks and group II (n = 60) included patients with uteri > 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotropin-releasing hormone agonist. RESULTS: All patients in the two groups with a pretreatment hemoglobin < 11.0 gm/dl randomized to agonist had a significant (p < 0.05) increase (> or = 1.5 gm/dl) in hemoglobin level. Patients in group I who received preoperative agonist were more likely to undergo vaginal hysterectomy (80% vs 13%, p < 0.05) than were patients who did not receive preoperative agonist. Patients undergoing vaginal hysterectomy had a shorter hospital stay, decreased operative blood loss, and a shorter convalescence period than did those undergoing abdominal hysterectomy. In group II, in spite of a mean uterine volume reduction of 51.3%, intraoperative morbidity, operative blood loss, hospital stay, and postoperative convalescence period did not differ between treatment arms. CONCLUSION: The preoperative administration of gonadotropin-releasing hormone agonist in patients with a uterus of 14 to 18 weeks' size increases the use of vaginal hysterectomy, decreases intraoperative blood loss, and shortens hospital stay and convalescence. Preoperative gonadotropin-releasing hormone agonist for patients with a preoperative hemoglobin < 11.0 gm/dl reduces the risk of preoperative transfusion. Preoperative gonadotropin-releasing hormone use in the nonanemic patient with a uterine size > or = 18 weeks' gestational size doses not appear to lower operative morbidity.

Adult↗
PubMed1993

Adherence of Mycoplasma hyopneumoniae to porcine ciliated respiratory tract cells.

Adherence of Mycoplasma hyopneumoniae to the mucosa of the distal portion of the respiratory tract of swine is an important initial event in development of mycoplasmal pneumonia. A suitable in vitro model of adherence would be useful for investigation of mycoplasmal and host cell factors involved in this process. We have developed an adherence assay, using suspensions of porcine respiratory tract ciliated epithelial cells and M hyopneumoniae. Tracheal epithelial cells, collected by use of cytologic brushes, were mixed with broth cultures of M hyopneumoniae and the mixtures were incubated, diluted, vortexed, and sedimented. Pellets were spread on glass slides, stained with a fluorescent antibody against M hyopneumoniae, and evaluated by fluorescent microscopy. Fluorescence was observed principally among cilia on the ciliated tufts of epithelial cells. Only a few organisms were observed adhering on the nonciliated parts of ciliated cells or on other cell types. When mycoplasmas were preincubated with low dilutions of serum from swine convalescing from M hyopneumoniae disease, attachment was partially inhibited (P < 0.05). Significant inhibition of attachment was not observed when organisms were preincubated with higher dilutions of convalescent serum, with purified IgG from hyperimmune serum against M hyopneumoniae, or with low dilutions of lung lavage fluids (from convalescent swine) that contained specific IgA antibodies against M hyopneumoniae. Preincubation of the organisms with periodate and trypsin abolished attachment and formaldehyde decreased it (P < 0.05), whereas a variety of carbohydrates had no effect on attachment. Preincubation with dextran sulfate, ammonium sulfate, magnesium sulfate, and methionine reduced attachment (P < 0.05). Treatment of cell-Mycoplasma mixtures with the hydrophobic bond-breaking agent tetramethylurea, or incubation in absence of salt, or at low temperature also reduced attachment (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Expression of LFA-1 and ICAM-1 on peripheral blood T-cells and soluble CD2 levels in serum during acute Kawasaki disease].

To clarify the activation of peripheral blood T-cells in Kawasaki Disease (KD) patients, we investigated whether the expression of lymphocyte function-associated antigen-1 (LFA-1) and/or intercellular adhesion molecule-1 (ICAM-1) on peripheral blood T-cells and serum levels of soluble CD2 (sCD2) increase during the acute stage. Expression of cellular adhesion molecules was analyzed using flow cytometry. sCD2 levels in serum were measured by a sandwich enzyme immunoassay. There was a decrease in the number of CD3+ T-cells in the bright LFA-1 alpha and LFA-1 beta population and a concomitant increase in the dim population of LFA-1 alpha and LFA-1 beta during the acute stage, in comparison with the convalescent stage. In addition, we observed no significant differences in ICAM-1 expression between the acute stage and the convalescent stage. There were no significant differences in sCD2 levels among the acute stage, the convalescent stage and the control subjects. In our view the present data, in conjunction with previous reports on T-cell function during acute KD, suggest that sequestration of activated peripheral blood T-cells may be a feature of this disease.

Antigens, CD↗
PubMed1996

Experimentally induced Bartonella henselae infections followed by challenge exposure and antimicrobial therapy in cats.

OBJECTIVES: To elucidate kinetics of Bartonella henselae bacteremia and IgG response, evaluate antibiotic therapy, and investigate challenge exposure in cats. ANIMALS: Specific-pathogen-free cats. PROCEDURE: Cats were inoculated with B henselae or B quintana and monitored. Convalescent cats were challenge exposed with B henselae. Amoxicillin, enrofloxacin, erythromycin, and tetracycline HCl were evaluated for effect on B henselae bacteremia. RESULTS: Cats developed B henselae bacteremia within 1 week; bacteremia persisted for longer than 2 months before subsiding spontaneously. IgG antibody titer developed shortly after onset of bacteremia; antibody co-existed with bacteremia for several weeks and remained detectable after bacteremia subsided. Cats inoculated with B quintana remained abacteremic. On challenge exposure to B henselae, cats previously infected with B henselae remained abacteremic; cats previously inoculated with B quintana supported B henselae infection. Tetracycline HCl and erythromycin depressed B henselae bacteremia; however, duration of bacteremia remained similar to that in untreated cats. Obvious signs of illness were not observed. CONCLUSIONS: Long-duration, high-titer B henselae infections were highly reproducible in cats. Convalescent cats were immune to reinfection. B quintana-inoculated cats did not have evidence of infection and were susceptible to B henselae challenge exposure. Antibiotic therapy was incompletely efficacious in terminating cat bacteremia. CLINICAL RELEVANCE: A cat with an inapparent B henselae infection must provisionally be regarded as a possible reservoir for infection for a minimum of 2 to 3 months. Convalescent cats are resistant to reinfection. Usual antibiotic therapy was not completely efficacious. Measurement of IgG antibody can be used to detect past or current infection.

Amoxicillin↗
PubMed1997

Humoral immune response to functional regions of human cytomegalovirus glycoprotein B.

Sera from patients with primary human cytomegalovirus (HCMV) infections, both acute and convalescent phase, and from HCMV-seropositive healthy subjects were analyzed to determine whether the sera would recognize antigenic domains on HCMV glycoprotein B (gB) that function in virion infectivity and spread of virus from cell to cell. The intact gB molecule, amino-terminal derivatives of different lengths, and internal deletion derivatives were expressed in eukaryotic cells and reacted by immunofluorescence with the sera. All convalescent-phase sera and most sera from healthy seropositive individuals reacted with full-length gB and with an amino-terminal derivative containing 687 amino acids (aa), gB-(1-687); approximately half of the sera recognized an amino-terminal derivative of 447 aa, gB-(1-447), and one-third reacted with the shortest deletion derivative of 258 aa, gB-(1-258). Of the acute-phase sera, 77% recognized intact gB and gB-(1-687), 32% recognized gB-(1-447), and 14% recognized gB-(1-258). Deletion of aa 548 to 618 dramatically reduced the percentage of reactive sera, whereas deletion of aa 411 to 447 had a minor impact on reactivity of sera. To investigate the epitope specificity of human antibodies to gB, we carried out competition experiments between human sera with neutralizing activity and selected monoclonal antibodies (mAbs) to conformational epitopes on gB. We found that antibodies in human sera preclude syncytium formation in UB15-11 glioblastoma cells constitutively expressing gB and compete with certain murine mAbs that block virus entry into cells and transmission of infection from cell to cell. Our results show that HCMV-immune human sera contain antibodies to functional regions on gB, and the abundance of these antibodies in convalescent-phase sera suggests that they may play a central role in limiting dissemination of virus in the host.

Acute Disease↗
PubMed1998

[Virus-specific serum and fecal antibodies response in children with acute rotavirus gastroenteritis].

BACKGROUND: The analysis of the immune response to rotavirus infection and the characterization of the viral antigens recognized by specific antibodies are of great concern in evaluating the protection against rotavirus. MATERIAL AND METHODS: The levels of rotavirus-specific fecal (sIgA) and serum antibodies (IgM, IgG and IgA) were evaluated by ELISA in 25 children with acute gastroenteritis for rotavirus, in 11 of them during the acute and convalescent phases. The specificity of serum antibodies to viral polypeptides was characterized by immunoblotting. RESULTS: Serum IgM antibodies with a geometric mean titer (GMT) of 1/3,973 were the predominant antibodies detected during the acute phase. In comparison, IgG and IgA serum antibodies and sIgA coproantibodies levels were higher in the convalescent phase (GMT = 1/5,799, 1/257 and 1/137 respectively). Significant differences were observed for all the isotypes of immunoglobulins evaluated during the infection and in the convalescence (p < 0.01). Rotavirus-specific serum antibodies recognized mainly the structural VP6, VP7 and VP3/VP4 proteins. Other polypeptides also detected were VP1, VP5 and the non-structural NS34 protein. CONCLUSIONS: Rotavirus infection produce an intense humoral immune response both in serum and in the gut. Specific antibodies react against structural proteins of the internal (VP6) and external (VP7) capsids of rotavirus.

Antibodies, Viral↗
PubMed1998

Filariasis and erisipela in Santo Domingo.

This study examined acute-convalescent changes in diagnostic anti-streptococcal antibodies by the anti-streptolysin O (ASO) and anti-DNAase B (ADAB) tests among patients (n 28) with lymphedema and recurrent erisipela of the lower limb, comparing them with endemic normal control residents (n=25). The study was based in Villa Francisca, an urban focus of Bancroftian filariasis in eastern Santo Domingo, capital of the Dominican Republic. The acute signs and symptoms of erisipela were consistent with a diagnosis of bacterial cellulitis. The ASO test was especially successful at demonstrating a rise in mean titer during convalescence, whereas the ADAB produced about the same frequency of significant increases (0.2 log titer) as did the ASO. When subjects were scored as responders if mounting a minimal titer increase by either test, patients were found more frequently positive than were controls (chi2=5.3, P=0.02). About half (54%) of all patients mounted at least a minimal antibody increase. Filaria-specific IgG4 antibodies were absent from all sera of 20 residents of a nonendemic Dominican mountain town but appeared in about two-thirds of the sampled residents of the endemic barrio. Notably however, levels did not change between the acute phase and convalescence. These findings are consistent with the hypothesis that recurrent streptococcal invasion of the lymphatics may be a significant factor triggering or amplifying lymphedema and elephantiasis in patients with chronic filariasis.

Adolescent↗
PubMed1998

Differentiating foot-and-mouth disease virus-infected from vaccinated animals with baculovirus-expressed specific proteins.

We had shown in preliminary studies with a small number of animals that antibodies against 2C could be detected in cattle and pigs which had been infected with FMDV but not in animals which had been vaccinated against the disease. To determine whether this test was generally applicable, sera from several hundred animals which had been vaccinated with different products in many countries have been tested in an ELISA using baculovirus expressed 2C. Our results show that only 1-2% of the sera gave a positive reaction by this method. In contrast, 100% of sera from convalescent animals gave a positive reaction. To be useful in differentiating between convalescent and vaccinated animals it is necessary to know how long these antibodies can be detected by our ELISA. We have determined the levels of antibodies against 2C and also other virus-specific proteins which are present in cattle and pigs following infection with FMDV. Our results show that levels of anti-3ABC antibodies could be detected by ELISA with baculovirus-expressed protein up to one year after infection. In contrast, the levels of anti-2C antibodies fell more rapidly than those against 3ABC indicating that the latter protein may be preferable for detecting convalescent animals. Nevertheless, we envisage that the final test format should include several virus-specific proteins to determine accurately the immune status of an animal.

Animals↗
PubMed1998

A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.

OBJECTIVE: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy. METHODS: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed. RESULTS: Sixty-five women at three institutions underwent laparoscopically assisted vaginal hysterectomy (n = 34) or abdominal hysterectomy (n = 31). Three patients in the laparoscopic group required conversion to abdominal hysterectomy. Mean operating time was significantly longer for laparoscopically assisted vaginal hysterectomy (179.8 versus 146.0 minutes). There were no differences in blood loss or incidence of intraoperative complications. There was a higher incidence of wound complications in the abdominal hysterectomy group, but no significant difference in the frequency of postoperative complications. Laparoscopically assisted vaginal hysterectomy required a significantly shorter mean hospital stay (2.1 days) and convalescence (28.0 days) than abdominal hysterectomy (4.1 days and 38.0 days, respectively). There were no significant differences in mean hospital charges between the study groups (laparoscopic $8161, abdominal $6974). CONCLUSION: Except for operating time, there are no differences between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy regarding intraoperative characteristics among abdominal hysterectomy candidates. Postoperatively, laparoscopically assisted vaginal hysterectomy requires a shorter hospital stay and convalescence. Hospital charges are similar between the procedures. A larger number of cases will help determine the indications for laparoscopically assisted vaginal hysterectomy.

Adult↗
PubMed1996

Serum concentrations of total bile acids in patients with acute Kawasaki syndrome.

OBJECTIVES: To investigate serum concentrations of total bile acids (TBAs) in patients with acute Kawasaki syndrome (KS) and correlate those concentrations with other liver function test results. PATIENTS AND METHODS: Seventy-one Japanese patients with KS (mean age, 1.6 years). Blood samples from 29 patients were obtained during the acute and convalescent phases of KS. RESULTS: Elevated serum TBA concentrations higher than 20 micromol/L were detected in 16 (22.5%) of the patients with acute KS. Serum concentrations of TBAs gradually returned to normal (P=.001, Pearson's correlation coefficient). The mean +/- SD serum concentration of TBAs of patients during the acute phase (37.9 +/- 63.9 micromol/L) was significantly higher than that of patients during the convalescent phase (7.2 +/- 7.5 micromol/L) (P=.02, Pearson's correlation coefficient). The data show a correlation between the serum concentrations of TBAs with those of alanine aminotransferase (P=.03, Pearson's correlation coefficient), total bilirubin (P<.001, Pearson's correlation coefficient), and C-reactive protein (P=.01, Pearson's correlation coefficient) measured during the acute phase. CONCLUSIONS: The cause of the elevated concentration of serum TBAs in patients with acute KS is unclear. Increased bile acid synthesis from cholesterol may occur, or patients with acute KS may suffer from damage to the bile duct cells of their biliary systems caused by cytokine activation. This damage may depress bile acid excretion, thereby increasing the serum concentrations of TBAs.

Acute Disease↗
PubMed1975

Acute viral hepatitis in adults. Comparison of the radioimmunoassay and counterimmunoelectrophoresis methods of detecting HbsAg.

We compared the radioimmunoassay (RIA) and counterimmunoelectrophoretic (CIE) methods in detecting hepatitis B antigen (HBsAG) in 407 acute and 336 convalescent sera of adults with viral hepatitis. The CIE method demonstrated that 41% of acute and 28% of 14-to 17-day serum specimens were HBsAg-positive. The RIA method demonstrated seropositivity in 60% of acute and 56% of convalescent specimens (P less than .001). Eighty-four percent of coded specimens initially positive for HBsAg by RIA were found to have subtype antigenic determinants d or y; 92% of the HBsAg-negative controls were negative for subtype antigens, confirming the specificity of the RIA test. RIA subtyping data corroborated earlier work with immunodiffusion techniques.

Acute Disease↗
PubMed1989

Platelet activation during pain crisis in sickle cell anemia patients.

Platelet activation at sites of enmeshed sickled red cells in the microcirculation may contribute to platelet plug formation and microinfarction in sickle cell anemia. To test this hypothesis platelets from 116 sickle cell anemia patients free of crisis, 32 patients with crisis, 16 convalescents within 1 week of crisis, and 180 normal controls were studied. Platelets store 90% of their ADP in dense secretory granules. During activation ADP is secreted and permanently lost from the cell. This leads to a decrease in cellular ADP concentration and a sharp rise in the ATP/ADP ratio. ATP and ADP were ethanol-extracted from platelet-rich plasma, measured in the luciferase-luciferin assay and expressed in nmoles per 10(8) cells. No adenine nucleotide differences were found in platelets from patients free of crisis compared with normal controls. The ADP concentration of platelets from patients in crisis was significantly lowered, indicating that in vivo platelet secretion of ADP had occurred. Total and released ADP was decreased from 2.69 to 1.66, and from 1.90 to 1.21 respectively, and the total ATP/ADP ratio was increased from 1.85 to 2.84 (P less than 0.001). ADP stores in platelets from convalescents were significantly different from sickle controls (P less than 0.001) but were less abnormal than ADP stores in platelets from crisis patients (P less than 0.01), indicating recovery. Total and released ADP was decreased to 1.97 and 1.31 respectively, and the ATP/ADP ratio was increased to 2.38. Platelets from patients in crisis were able to release their remaining granular ADP in response to thrombin as effectively as normal platelets. Thus significant platelet activation with ADP release occurs during acute sickle pain crisis. This might contribute to platelet plug formation and microvascular obstruction.

Acute Disease↗
PubMed1980

New bacterial absorption method for determination of hepatitis A IgM and IgA antibodies.

Antibodies against hepatitis A virus (anti-HAV) can be determined by a commercially available radioimmunoassay (RIA) (HavabTM, Abbott). To discriminate between recent and past hepatitis A infection this RIA was used in combination with absorption with protein A-containing staphylococci. However, nonabsorbable anti-HAV was repeatedly detected in late-convalescent sera using this methods. The nature of these antibodies was studied in serum samples from 12 such patients. In all patients, the late-convalescent sera contained no IgM class anti-HAV as judged by sucrose density gradient centrifugation. The restricted specificity of staphylococcal protein A explains the lack of absorption. Some recently described streptococcal strains capable of binding all IgG subclasses (including IgG3) as well as both IgA subclasses were, therefore, added to the staphylococci. Absorption studies using these strains indicated that the previously nonabsorbable anti-HAV in these 12 patients was mainly of the IgA class. A bacterial mixture including IgA-binding streptococci seems preferable to routine determination of IgM anti-HAV in acute hepatitis A diagnosis. The results also indicate that IgA anti-HAV in serum can persist for more than two years after a hepatitis A infection.

Absorption↗