Smooth-muscle antibodies and other tissue antibodies in cytomegalovirus infection.

Smooth-muscle antibodies (SMA) were present in 16% of sixty-three patients with cytomegalovirus (CMV) antibodies in serum and absent in forty CMV antibody-negative blood donors (P = 0-005). The SMA were of the IgG and IgM class, while no IgA antibodies were found. In patients with CMV infection, SMA, mainly of the IgM class, were present in the early stages of the disease, and the titre decreased faster than the complement-fixing CMV antibody titre. Anti-nuclear antibodies (ANA) were also found more often in CMV antibody-positive sera than in CMV antibody-negative sera, and ANA were usually present in sera which also contained SMA. Parietal cell antibodies, mitochondrial antibodies and other cytoplasmic antibodies did not occur more frequently in CMV antibody-positive than in CMV antibody-negative sera.     

Measurement of heterophil antibody and antibodies to EB viral capsid antigen IgG and IgM in suspected cases of infectious mononucleosis.

The EBV IgG titres in acute and convalescent specimens from 97 cases of infectious mononucleosis were compared with titres from acute and convalescent sera from 96 students with illnesses resembling infectious mononucleosis but without heterophil antibody, EB IgM or EB IgG seroconversion; and also with titres from 91 healthy students known to have had EB IgG antibody for at least six months. These titres were related to the titre of the Research Standard A.66/235 for infectious mononucleosis serum prepared by the National Institute for Biological Standards and Control. Serial sera were tested for heterophil antibody and EBVCA specific IgG and IgM from 61 university students with infectious mononucleosis. The period of persistence of heterophil antibody and EBV IgM after illness was outlined from the results of the tests. Single sera from 406 patients in hospital or general practice sent to the diagnostic laboratory for heterophil antibody tests were also tested for EBV antibodies without prior knowledge of the heterophil antibody result. The close agreement between heterophil antibody and EBV IgM results is shown. False positive EB IgM results were correlated with the presence of rheumatoid factor.     

Serological diagnosis of California (La Crosse) encephalitis by immunofluorescence.

A method of indirect immunofluorescence was developed and examined retrospectively as a serological test for the laboratory diagnosis of California encephalitis (CE). LaCrosse virus immunofluorescence immunoglobulin (Ig) G and IgM studies were done on paired sera from 50 patients with acute central nervous system infections. CE had been documented in 25 patients by hemagglutination inhibition, neutralizing, complement fixing, and/or precipitin tests. Five (20%) of the acute and 16 (64%) of the convalescent sera from CE patients had La Crosse IgM antibodies. Seven (28%) of the acute and all of the convalescent CE specimens had La Crosse IgG antibodies. Titers ranged from less than 4 to 256. IgG antibodies were present in all 11 sera collected 1 to 2 years after CE, but IgM antibodies were absent. The 25 serum pairs from patients who did not have CE were negative for IgM and IgG antibodies. This study indicated that La Crosse immunofluorescence antibody tests were as sensitive and specific for CE as conventional hemagglutination-inhibition tests, and would detect at least 20% of patients during their acute illness.     

Occurrence and cross-reactivity of heterophile antibodies and anti-kidney antibodies in kidney transplanted patients and patients with renal disease

Increased titres of heterophile antibodies to rat erythrocytes occurred in twelve of twenty-seven patients after renal transplantation. In seven of these twelve patients the titre rise appeared to be associated with rejection. Heterophile antibody formation showed no consistent kinetic pattern after transplantation and no definite relationship between rise in antibody titre and rejection can be claimed. Patients with very high heterophile antibody titres were however prone to rejection.Heterophile antibodies to rat erythrocytes cross-reacted with human and monkey kidney cells and a subpopulation of these antibodies also with human B erythrocytes. The antibodies were not of the Forssman or Paul-Bunnel-type and their appearance could not be related to ABO or HL-A incompatibility. The heterophile antibodies, primarily of IgM class, are suggested to be produced in response to B-substance related antigens in Gram-negative bacteria and non-HL-A isoantigens.Approximately 35% of transplantation sera or sera from patients with kidney disease had IgG antibodies reacting with human and monkey kidney cells, human thyroid cells and A and B erythrocytes. Anti-kidney IgG antibodies in certain sera cross-reacted with rat erythrocytes. One-third of the patients with renal disorders had increased heterophile antibody titres.     

Comparison of three serological methods for diagnosing Mycoplasma pneumoniae infection.

AIMS--To compare the novel Serofast latex agglutination test (International Mycoplasma, Toulon-Cedex, France) with the complement fixation test and enzyme immunoassay (EIA) for diagnosing acute Mycoplasma pneumoniae infection. METHODS--Paired sera from 60 patients with respiratory infection who had tested positive for M pneumoniae by complement fixation test were analysed with Serofast and indirect EIA for specific IgG and IgM antibodies. RESULTS--Serofast was less sensitive than the two other tests. Only 30 (50%) out of 60 paired sera which showed a diagnostic seroconversion or had high positive, unchanged antibody titres by complement fixation test or EIA, or both, tested positive with Serofast. Positive test results with Serofast were associated with the presence of a complement fixation test titre of > or = 512 and high positive IgM antibody titres measurable by EIA; virtually all patients with a complement fixation test titre of < 256 or those responding primarily in the IgG class tested negative with Serofast. Based on analysis of sera taken at the acute phase of infection, 10 (17%) of the 60 patients tested positive by complement fixation test, 10 (17%) by EIA, and only four (7%) by Serofast. CONCLUSIONS--Serofast was less sensitive than complement fixation test and EIA and it cannot be recommended as a replacement for either test in routine diagnostic use. It might prove useful in laboratories where non-specific tests, such as the determination of cold agglutinins, are still used for the diagnosis of M pneumoniae infection. Testing paired sera is, however, a prerequisite for obtaining acceptable sensitivity by Serofast as well as other serological methods currently available.     

Evaluation of a simplified sucrose gradient method for the detection of rubella-specific IgM in routine diagnostic practice

Rubella-specific IgM was measured in a single fraction of serum from a sucrose density gradient. Haemagglutination inhibition (HAI) tests were performed on paired aliquots of the fraction untreated and after treatment with 2- mercaptoethanol, dilutions of the aliquots being incubated over night with rubella antigen before the addition of red cells. Of 822 sera tested, specific IgM was found in 249, but not in 492. When first tested, the remaining 81 sera gave unsatisfactory results because of contamination of the IgM fraction with IgG (6.0%), probable aggregation of IgG (3.5%), or the persistence of chick red cell agglutinins (0.4%). Tests were performed on 134 patients with rubella confirmed by a rise of HAI antibodies. Rubella-specific IgM was found at a titre of more than eight in the sera taken from 62 of 64 patients between 10 and 29 days after the onset of the rash but in only one of the sera taken between 80 and 119 days, and in none taken later. However, specific IgM was still to be found at lower titre in the sera of 13 patients collected between 80 and 162 days after the onset of the illness. In routine diagnostic tests over three years on the serum from 479 patients with suspected acquired rubella, specific IgM was found at a titre of more than eight in 51 patients and in only 10 instances (2.1%) did a lower level pose a problem in interpretation.     

Proportions of Ig Classes and Subclasses in Mumps Antibodies

Mumps antibodies of 34 human beings were studied, 12 patients with natural mumps infection, 15 subjects vaccinated with a live mumps vaccine, and seven subjects vaccinated with an inactivated vaccine. Small amounts of antibodies reacting with mumps antigen were found in the prevaccination sera. An immunization with either the live or the killed vaccine caused an increase in the mumps antibodies (range, from 1.1-fold to more than 50-fold; geometric mean, approximately sevenfold). IgG1 was the major isotype in all post-vaccination sera; the average share was 61%. Next came IgM (28%), followed by IgA (9%), and IgG3 (2% of total). The patient samples had 10 (acute phase) or 20 times (convalescent phase) more mumps antibodies than the prevaccination samples. IgG1 was the predominant isotype in the acute phase sera (average 42% of all antibodies). Next came IgM (41%) followed by IgA (13%), and IgG3 (4%). In convalescent sera IgG1 was also the predominant isotype (average 67%), followed by IgM (19%). The minor isotypes in the second samples were IgA (12%) and IgG3 (3%). Small amounts of IgG2 antibodies were found in 1 patient and 1 vaccine. IgG4 antibodies were not detected.     

Age-related interference with Chlamydia pneumoniae microimmunofluorescence serology due to circulating rheumatoid factor.

Microimmunofluorescence (MIF) serology is commonly used in the diagnosis of chlamydial infections. In the MIF assay, Chlamydia pneumoniae elementary bodies were used to detect C. pneumoniae immunoglobulin G (IgG) and IgM antibodies in paired serum samples from 286 patients with respiratory illnesses. In 69 patients, MIF serology was compared with C. pneumoniae cultures. All C. pneumoniae cultures remained negative. However, 205 (71%) of 286 patients were C. pneumoniae antibody positive and 64 (22%) had MIF test results indicating recent infection; 11 showed a fourfold increase in IgG titer, 18 had IgG titers of greater than or equal to 1:512, and 41 had IgM titers of greater than or equal to 1:16. In 35 (55%) of 64 patients, a recent-infection diagnosis was based on C. pneumoniae IgM antibodies only. However, 78% of C. pneumoniae IgM-positive patients had circulating rheumatoid factor (RF) by rheumatoid arthritis latex assay. RF positivity increased with age. After absorption with anti-human IgG, all C. pneumoniae IgM-positive sera became C. pneumoniae IgM negative in the MIF assay. Twenty-five patients with active rheumatoid arthritis but without respiratory illness were also tested; 14 were C. pneumoniae IgG positive and C. pneumoniae IgM positive as well. Absorption of IgG from these RF-containing sera invariably resulted in disappearance of reactivity in the MIF IgM assay. We conclude that with age the serologic diagnosis of recent C. pneumoniae infection becomes increasingly prone to false-positive results unless sera are routinely absorbed prior to MIF IgM testing.     

Immunoglobulin class-specific antibody response in respiratory syncytial virus infection measured by enzyme immunoassay

Immunoglobulin class-specific enzyme immunoassay (EIA) was used for determination of antibody responses in sera collected from 26 children with acute primary respiratory syncytial virus (RSV) infections. All 26 patients had IgG antibody responses with a significant titer increase in 24 (92%); an IgM antibody response was detected in 19 of the 26 (73%). From patients aged 6 months or less only 5 of 8 produced detectable IgM antibodies, whereas all patients aged 1–2 years did so. IgM antibodies appeared within 1 week after onset of illness and persisted from 20 days to 2–3 months. An IgA antibody response was observed in 20 of 26 (77%) patients with a significant titer increase detected in 17 of 26 (65%) patients. In some patients the persistence of IgA antibodies followed that of the IgM antibodies, but in others the IgA antibody titers remained stable up to the end of the follow-up. The most sensitive assay system for serological diagnosis of acute RSV infection in children was the determination of titer increases by IgG antibody.     

Rheumatoid factor as a cause of positive reactions in tests for Epstein–Barr virus-specific IgM antibodies

Sera from twenty-eight patients with rheumatoid arthritis (RA) were titrated in indirect immunofluorescence tests for Epstein–Barr virus (EBV) specific antibodies. All had IgG antibodies to viral capsid antigen (VCA), 64% at titres [unk] 320, and 71% reacted also in tests for VCA-specific IgM antibodies at titres ranging from 20 to 640. The reactions observed in the IgM test were not due to VCA-specific IgM antibodies, however, but rather to rheumatoid factor (RF) usually an IgM antibody to the Fc regions of IgG. The titres recorded in the anti-VCA IgM test correlated significantly with the RF titres and both reactivities were abolished by adsorption onto IgG coated latex particles. In addition, they clearly depended upon the height of the IgG antibody titre to VCA, indicating that the more VCA-specific IgG molecules are present the more likely it is that RF will combine with them in sufficient quantity before or after their attachment to VCA-positive test cells so as to become detectable by the fluorescent antibodies to human IgM. Results comparable in every aspect were obtained with those sera from patients with Hodgkin's disease, nasopharyngeal or cervical carcinomas which reacted in the anti-VCA IgM test. Sera from patients with infectious mononucleosis may also contain RF, but in such cases its removal by adsorption onto IgG-coated latex particles did not generally reduce the VCA-specific IgM antibody titre. Removal of RF from any of the sera studied did not affect the titres of VCA-specific IgG and, where applicable, IgA or heterophil antibody titres. These results re-emphasize the pitfall created by RF noted previously in tests for virus-specific IgM antibodies.     

20例SARS患者特异性抗体变化规律

目的：了解严重急性呼吸道综合征(SARS)特异性IgM和IgG抗体的变化规律。方法：采用间接酶联免疫吸附试验(ELISA)检测20例SARS患者系列血清中特异性IgM和IgG抗体，系列血清包括患者发病后1周，2周，3周，4周，8周，12周所采集的样本。结果：20例患者发病后第1周IgM和IgM抗体均为阴性；第2周时16例IgM抗体阳性，17例IgM抗体阳性；第3周后所有患者IgG抗体阳性并持续至第12周，而IgM抗体阳性患者逐渐减少，至第12周时所有患者均为阴性。结论：SARS特异性IgG抗体消失较早，其存在是近期感染的标志；IgG抗体的持续存在可能是获得病后免疫力的标志。     

散发性戊型肝炎病毒感染的诊断

用基因工程重组的戊型肝炎病毒基因结构区第二码框架和第二读码框架具有免疫表位的嵌合抗原，建立了间接酶联免疫法，检测散发性急性肝炎病人血清中抗－ＨＥＶＩｇＧ和ＩｇＭ抗体。在４６例急性肝炎病人中出抗－ＨＥＶＩｇＧ抗体阳性７例，阳性率为１５．２２％，７例ＩｇＧ抗体阳性中，有５例ＩｇＭ抗体也阳性，占７１．４％。     

Immunoglobulin M antibodies against hepatitis B core antigen in patients with chronic hepatitis B infection

A batch of sera obtained from subjects with acute hepatitis B virus (HBV) infection, chronic carriers of hepatitis B surface antigen (HBsAg) who were either asymptomatic or who had chronic active hepatitis, and 32 sera from patients with HBsAg negative chronic active hepatitis were examined for the presence of antibodies against hepatitis B core antigen (anti-HBc) by radioimmunoassay (RIA). Sera containing anti-HBc were fractionated on sucrose density gradients to separate immunoglobulin M (IgM) and the titre of anti-HBc IgM was determined. In patients with acute HBV infection, anti-HBc IgM was detected during the acute phase of the illness with titres ranging from 1:128 to 1:4,096 (geometric mean titre 1:709). The titre of anti-HBc IgM fell rapidly over the following months and in most patients persisted at low levels for several years. Anti-HBc IgM was also detected in subjects with chronic HBV infection but with significantly lower titres. In asymptomatic carriers, anti-HBc IgM titres ranged from 1:4 to 1:32 (geometric mean titre 1:12), whilst carriers with chronic active hepatitis had titres ranging from 1:4 to 1:128 (geometric mean titre 1:35). By using a standardized assay procedure, the titre of anti-HBc IgM in a patient's serum may be of value in differentiating between acute and chronic HBV infection.     

Mumps-specific immunoglobulin M and G antibodies in natural mumps infection as measured by enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay for the demonstration of mumps immunoglobulin G (IgG ELISA) and immunoglobulin M antibodies (IgM ELISA) in serum was compared with complement fixation (CF), hemagglutination inhibition (HI), and hemolysis-in-gel (HIG) tests. The antibody levels measured by IgG ELISA had a high positive correlation with the CF and HIG tests, whereas only a moderate correlation was found between IgG ELISA and HI. Similar patterns of antibody response were observed with IgG ELISA, CF, and HIG: the antibody titres increased rapidly after the onset of symptoms and reached the maximal values in about three weeks. The HI antibodies developed more slowly during the first week of disease, after which the titres increased rapidly up to the fourth week. IgM antibodies measured by ELISA developed soon after onset of symptoms; most patients had IgM antibodies from the second day, and the highest titres were reached within the first week. The antibody response in mumps parotitis did not differ from that in mumps meningitis/encephalitis, while relatively higher antibody titres were found in patients with orchitis/epididymitis. The diagnostic efficiencies of the methods were compared with serum specimens from 33 patients who had a serologically verified mumps infection by at least one of the five methods used (rising antibody titres in paired sera or detectable IgM): IgM ELISA detected all 33 cases, IgG ELISA 29, HIG 28, HI 23, and CF 13. In 27 cases, IgM antibodies were already present in the acute phase serum specimens. It was concluded that mumps IgM ELISA is a more rapid and sensitive means for the serological diagnosis of mumps infection than the conventional tests.     

Immune response to extracellular and somatic antigens in streptococcal infection and sequelae

The aim of the present study is to define the temporal relationships of the IgM and IgG responses to Streptococcal group A carbohydrate (CHO) in rabbits and in man. Rabbits were immunized with group A streptococci and the development of anti-group A carbohydrate (ACHO) was studied. ACHO which appeared one week after the beginning of immunization belonged to the 19S class of immunoglobulins (IgM). A two- to four-fold rise in ACHO titers and immunoglobulins of the 7S class (IgG) were observed after two weeks. Three weeks after the beginning of immunization, the ACHO titer was at a maximum. In the following months no further rises in titer were seen, and the antibodies belonged mostly to the IgG class. IgM and IgG responses to streptococcal CHO and to extracellular antigens in patients with pharyngitis, acute rheumatic fever (ARF), and acute glomerulonephritis (AGN) were studied. Higher values of IgM were found in pharyngitis and AGN sera than in ARF sera, probably reflecting the interval between streprococcal infection and time of bleeding. ACHO antibodies persisted in patients' sera for long periods and belonged to IgG and IgM. This suggests a continuous, rather than a persistent, production of ACHO.     

Mycoplasma pneumoniae is a frequent cause of exacerbation of bronchial asthma in adults

The possible role of infection with Mycoplasma pneumoniae (MP) in exacerbation of bronchial asthma in adults was studied in 95 patients hospitalized due to acute asthma. Twenty (21%) of these patients had evidence of a recent MP infection as determined by the presence of high levels of MP-specific IgM antibodies. In addition, high levels of both IgM and IgG but not IgA serum immunoglobulins were observed in the MP-infected group as compared to a control group of 20 non-MP-infected asthmatics. Five out of 20 MP-infected asthmatics exhibited rheumatoid factor (RF) in their sera while patients in the control group were all negative for RF. It is concluded that MP infection may be significant in exacerbation of asthma in adults.     

Rapid diagnosis of acute mumps infection by a direct immunoglobulin M antibody capture enzyme immunoassay with labeled antigen

A new immunoglobulin M (IgM) antibody capture enzyme immunoassay with peroxidase-labeled mumps antigen (dMACEIA) is described, and its suitability for practical diagnosis of acute mumps infection is evaluated. All 54 patients with proven mumps infection that were tested showed mumps-specific IgM antibodies. On the other hand, no specific IgM antibodies were present in 16 cases of suspected mumps that could not be confirmed by classical complement fixation serology, and IgM mumps virus antibodies could be detected neither in the sera of 100 healthy individuals nor in those of 16 patients positive for rheumatoid factor. In all, 22 children with acute respiratory illness caused by parainfluenza virus and 44 patients with infections due to other viruses showed no IgM response in mumps dMACEIA. The particular characteristic in which complement fixation antibodies against mumps nucleocapsids appear before and disappear earlier than antibodies to the enveloped mumps virus could not be demonstrated in the dMACEIA. In an extensive epidemic of mumps virus infection, the dMACEIA gave a clear diagnosis of mumps infection in 200 out of 371 suspected cases. By day 2 of the illness, 71% of the patients had detectable IgM, and by day 3, all of them had detectable IgM. In 99% of the cases, dMACEIA gave a positive result in the first available serum specimens, most of which were negative for complement fixation antibodies. A positive but only moderate correlation was thus observed between the two serological procedures. IgM antibodies persisted for at least 6 weeks. The dMACEIA, performed in 3 h, offers a reliable, simple, and rapid alternative to routine methods for detection of acute mumps infection.     

Human parvovirus B19 specific IgG, IgA, and IgM antibodies and DNA in serum specimens from persons with erythema infectiosum.

To determine the diagnostic use of different markers of acute parvovirus B19 infection, serum specimens obtained from 128 persons with erythema infectiosum were tested for specific immunoglobulin G (IgG), IgA, and IgM antibodies by capture enzyme immunoassay (EIA) using Chinese hamster ovary (CHO) cell-expressed B19 antigen, and tested for circulating B19 DNA by polymerase chain reaction (PCR). A significant rise in specific IgG and IgA antibodies was detected in 87% and 77%, respectively, of persons from whom acute- and convalescent-phase serum specimens were available. Specific IgA antibodies were detected in single serum specimens from 90% of cases and were present in 22 (18%) of 120 persons from a control group without a history of recent exposure to B19. Specific IgM antibodies were detected in 97% of cases and one person (1%) from the control group. B19 DNA was detected in 94% of cases and was absent in 20 persons from the control group positive for both IgG and IgA antibodies. Serum specimens obtained between 4 and 6 months after onset of illness from six additional persons were also tested. All had specific IgG antibodies, four (67%) had IgA, five (83%) had IgM, and none had detectable B19 DNA. Our data indicate that 1) specific IgA antibodies are too persistent to be a useful indicator of recent B19 infection; 2) specific IgM antibodies are the most sensitive indicator of acute B19 infection in immunologically normal persons but can persist up to 6 months; and 3) B19 DNA can often be detected up to 2 months after onset of illness even in immunologically normal hosts and might be a useful adjunct test for diagnosis of acute B19 infection.     

Antibody response to Epstein-Barr virus in infectious mononucleosis.

Altogether 171 serum specimens from 58 patients with heterophil antibody-positive infectious monomucleosis were studied for antibody response to Epstein-Barr virus (EBV). The sera were tested for fluorescent immunoglobulin G (IgG) and IgM gel-precipitating (GP) and complement-fixing (CF) antibodies to EBV. All 58 patients had IgG and IgM antibodies to EBV. Both IgG and IgM antibodies developed rapidly; the IgM antibodies disappeared within 8 to 10 weeks, whereas the IgG antibodies remained at an almost constant level. The development of IgG antibodies was so rapid that a fourfold or greater rise in titers was noted only in 22% of the patients. Both GP and CF antibodies to EBV (crude P3HR-1 Burkitt cell antigen) developed slowly; the mean titers kept rising for more than 12 weeks. The micro GP technique seemed to be more sensitive than the CF method, because 86% of the patients with infectious mononucleosis had GP antibodies compared with 72% having CF antibodies. In patients with infectious mononucleosis, a seroconversion or significant rise in GP antibodies was noted in 57%, whereas only 19% had a similar change in CF antibodies. The most promising of these antibody assays in the diagnosis of recent infections was the EBV-specific IgM antibody technique, which enables one to make the diagnosis on the basis of only one serum specimen. In cases where the acute-phase serum specimen is missing, the diagnosis can be made later by using the GP and CF techniques.     

Contribution to laboratory diagnosis of mumps and parainfluenza

Specific IgM and IgG antibodies to mumps virus (MV) were detected in sera of mumps-patients by ELISA in agreement with the results obtained by indirect immunofluorescence (IF). Of given sera 37.5% contained IgM reacting in indirect ELISA also with the antigens of parainfluenza virus (PiV) T3. In all patients with respiratory illness over 2 years of age, the significant increase of antibodies to PiV in haemagglutination inhibition (HI) test was in good correlation with serum IgM and IgG antibody levels to PiV T3 determined by ELISA; but, in addition, 30.7% of these sera cross-reacted with MV antigens. The cross-reactions were eliminated by using MV-nucleocapsid antigen in indirect ELISA, or in direct ELISA using the peroxidase-labelled whole virion antigen. In some children under two years of age a discrepancy was observed between the significant increase of serum antibodies in HI and the inability to detect specific IgM antibodies by means of ELISA in their sera. The low-avidity antibodies appearing after primary PiV infection were probably washed off during the ELISA procedure.