Cytomegalovirus infection in low-birth-weight infants with acute respiratory tract disease

To determine a participation of cytomegalovirus (CMV) infection in acute respiratory tract disease (ARTD) of low-birth-weight (LBW) infants, specific antibodies against CMV antigens, IgG antibodies against early antigens of CMV (IgG EA) and IgM antibodies against membrane antigens of CMV (IgG MA) were analyzed. The frequency of IgG EA in patients with ARTD was higher than that in controls (46% vs. 32%), and the geometrical mean titer (GMT) of IgG EA in the patients was also higher than that in controls (50.2 vs. 20.1). Five of 15 ARTD patients had IgM MA, and the frequency was significantly higher than that of controls (33% vs. 1.3%, p less than 0.01). Eleven of 15 LBW patients with ARTD had a history of blood transfusions during the neonatal period, and 5 of them had significant IgM MA indicating active CMV infection. All 4 LBW patients without blood transfusion were negative for IgM MA. These results suggest a close relationship of CMV infection to ARTD of LBW infants, but it remains for further studies whether blood transfusion is a primary source of CMV infection in LBW infants.     

肝炎病毒对肾移植术后巨细胞病毒感染的影响

目的：探讨肝炎病毒对肾移植术后巨细胞病毒(CMV)感染的影响。方法：对384例肾移植患术后CMV—IgM进行检测．比较肝炎病毒感染组与非病毒感染组术后CMV感染率。结果：肝炎病毒感染组术后CMV感染率(30．5％)明显高于无病毒感染组(11．3％)(P＜0．05)，若患术前已有CMV感染．肝炎病毒感染组术后CMV感染率更高(47．4％)。结论：肝炎病毒感染能够增加肾移植术后CMV感染率．对术前已有CMV感染的肝炎病毒感染更应注意术后CMV的监测．以便及时发现病毒活动．避免病情进展。     

Evaluation of quaternary aminoethyl-Sephadex A50 column chromatography for detection of anti-cytomegalovirus immunoglobulin M

The sensitivity of an indirect fluorescent antibody (IFA) test (screening test) for the detection of antibodies to cytomegalovirus (CMV) was examined by using 128 serum specimens and quaternary aminoethyl (QAE)-Sephadex A50 column chromatography to separate IgM from IgG class antibodies. Of these 128 rheumatoid factor-negative serum samples, only 54 (42%) continued to produce fluorescence after the IgG was removed by the Sephadex column (yielding a theoretical 1:10 dilution) and the samples were retested for IgM (confirming test). Of the 54 specimens that were positive on both the screening and confirming IgM IFA assays, 53 (98%) had titers of 1:80 or more. Of the 74 sera that were negative on the confirming test, only 10 (14%) had titers of 1:80 on the initial screening test, and none was greater than 1:80. Immunoglobulin measurements of eight serum samples before and after column treatment indicated excellent IgG removal but poor IgM recovery (a mean loss of 85% of the total IgM). Comparison of the time needed to detect IgM in CMV culture-positive patients demonstrated an increase from 17.1 to 28.3 days (serum tested by IFA before and after column separation, respectively). Therefore, confirmation of anti-CMV IgM in serum specimens by QAE-Sephadex A50 column chromatography seems to be of low sensitivity.     

Anticardiolipin Antibodies in Patients with Type 2 Diabetes Mellitus

Background: There is controversy about an increased prevalence of antiphospholipid antibodies in diabetic patients. The possible implications are little known.Methods: We prospectively studied all consecutive outpatients with type 2 diabetes mellitus (DM) attended to in an Internal Medicine office. IgM and IgG anticardiolipin antibodies (ACA) were determined by standardized enzyme-linked immunoassay.Results: Fifty-six patients were included. Only one patient (1.8%) had a titer of IgM ACA higher than 15 MPL units and no patient had a titer of IgG ACA higher than 15 GPL units. Six patients (10.7%) had low IgM ACA titers (4–15 MPL units) and 18 patients (32.1%) had low IgG ACA titers (4–15 GPL units). There were no differences in the frequencies of a low IgM or IgG ACA titer or in the means of IgM and IgG ACA titers in patients with complicated and uncomplicated DM, with and without cardiovascular disease, with and without nephropathy, or with and without retinopathy.Conclusions: Moderate to high ACA titers must be exceptional in patients with type 2 DM. Low ACA titers may occur in patients with type 2 DM. These low titers do not seem to be associated with complicated DM, cardiovascular disease, nephropathy or retinopathy.     

Serological response to plasmid-encoded antigens in children and adults with shigellosis

The immunological response to plasmid-encoded antigens of virulent Shigella was determined in Thai children less than 4 yr of age and in Thai adults by immunoblot analysis and ELISA. Forty-two percent (8/19) of Thai children and 4% (1/22) of Thai adults with shigellosis developed a greater than or equal to 4-fold rise in IgG antibody titer to water-extracted antigens of Shigella flexneri M90T by ELISA (p = 0.006). Two children and one lactating mother with shigellosis developed a 4-fold rise in serum IgA antibody titers to water-extracted antigens of M90T. The results of the ELISA were confirmed by immunoblot analysis in all of the 41 paired sera examined. Five patients developed IgA, and four developed IgM, antibodies as detected by immunoblot analysis, that were not detected by ELISA. The reciprocal log2 geometric mean titers of antibodies to plasmid-encoded antigens in acute sera was higher in Thai adults than Thai children: IgG 7,265 versus 1,659; IgM 879 versus 480; and IgA 662 versus 60 (p less than 0.001). Thai adults had high titers of antibodies to plasmid-encoded antigens in their acute sera, but were susceptible to Shigella infections, although they were historically less susceptible than Thai children.     

Viral infections in transfusion-dependent patients with beta- thalassemia major: the predominant role of cytomegalovirus

For 9 months, 38 transfusion-dependent patients with beta-thalassemia, ranging in age from 3.4 to 19.1 years, were observed for serologic evidence of viral infections, by the collection of serial serum samples. Seventy-six age-matched healthy subjects, two for each patient, were followed as controls. Samples taken at the beginning, middle, and end of the study were tested against 18 viral antigens by complement fixation (CF). In addition, tests for antibodies to HIV, Epstein-Barr virus, hepatitis A virus, and markers for hepatitis B virus were performed. When changes in the antibody titer on CF tests (greater than or equal to 2-fold increase or decrease) or persistently high titers (greater than or equal to 64) were revealed, specific enzyme immunoassays (EIAs) for IgM and IgA antibodies were performed concomitant with CF tests in all sera. When symptomatic infections occurred, viral cultures and/or direct detection of antigens were carried out by immunofluorescence methods, EIA, or latex agglutination tests. Thalassemic patients and controls had similar (p greater than 0.05) overall rates of serologically confirmed viral infections (53 versus 132), but the former group had a higher (p less than 0.01) incidence of cytomegalovirus (CMV) infections (9 versus 4). CMV infections were associated in the thalassemic patients with hepatitis (2 cases), lymphadenitis (2 cases), and upper respiratory tract infection (1 case), while the remaining cases of CMV had a subclinical course. Moreover, the thalassemic patients had a lower (p less than 0.01) incidence of symptomatic infections (27 versus 110) than controls. Therefore, this study showed that both symptomatic and subclinical CMV infections may occur often in thalassemic patients, who otherwise have subclinical viral infections at an overall rate similar to that in healthy subjects.     

腰椎间盘突出症影像学表现与免疫学的相关研究

目的:探讨腰椎间盘突出症的免疫状态及其影像学表现与免疫水平的关系。方法:分析了52例腰椎间盘突出症的影像学表现,检测了其血清IgG、IgM、IgA、C3和C4水平,并与40例正常组行对照研究。结果:(1)影像学表现分突出型(12例,占23.1％);破裂型(28例,占53.8％)和游离型(12例,占23.1％)。(2)腰椎间盘突出症血清IgM、IgG较对照组高。(3)破裂型组较对照组血清IgG、IgM水平增高,此外,游离型组血清IgA水平亦同时增高,而突出型组无意义。结论:腰椎间盘突出症存在体液免疫反应的异常,提示临床上腰腿痛病人,若血清IgG、IgM升高或IgG、IgM、IgA同时升高,对辅助诊断腰椎间盘突出破裂型或游离型能提供更多有价值的信息。     

Immunoglobulin levels and specific viral antibodies in relation to smooth-muscle antibodies in cytomegalovirus infection.

Among 17 patients with cytomegalovirus (CMV) infection smooth-muscle antibodies (SMA) of the IgM class were detected in 9 (53%) and IgG-SMA in 6 (35%), while no IgA-SMA were found. IgM-SMA were present most often and in the highest titres (10-160) in the beginning of the disease, while IgG-SMA were found both early and late during the course of infection. SMA occurred most frequently in patients with specific CMV antibodies of the IgM class and in patients with elevated serum alanine aminotransferase values, but these relationships were not significant. Elevated levels of serum IgG, IgA and IgM were found in CMV infection, and a correlation between serum IgM values and IgM-SMA titres was demonstrated (alpha less than 0.01). A similar correlation between serum IgG and IgG-SMA could not be established. These findings are in support of the assumption that IgM-SMA account for a minor part of the elevated serum IgM levels in CMV infection, but not of the hypothesis that the stimulus for antibody production is the release of antigens from liver cells.     

Immunoglobulin G subclass responses to cytomegalovirus in seropositive patients after transfusion

The immunoglobulin G subclass responses to cytomegalovirus (CMV) after red cell (RBC) transfusion were studied in 26 seropositive surgery patients and 34 transfused seropositive oncology patients. Also included as controls were 18 surgical patients who received no RBCs during surgery. None of the 78 patients studied had IgG2 to CMV before or after transfusion. The absence of a total IgG response to CMV after transfusion could not be attributed to preexisting deficiencies in one or more subclasses, because all 78 patients had similar levels of IgG1, IgG3, and IgG4 to CMV before transfusion. Discriminant analysis was used for statistical evaluation of the combined CMV subclass responses in each patient and the individual subclass responses. Individual patients responded to CMV antigens with an increase in concentration in any of the three subclasses or any combination of the subclasses, excluding IgG2. IgG subclass analysis showed that 10 of 27 patients who did not respond with at least a fourfold total IgG titer rise had a significant increase in IgG subclass antibodies to CMV. Three of 33 patients with at least a fourfold total IgG titer rise lacked a subclass response. These results suggest that the measurement of IgG subclasses may be a sensitive indicator of immune response to CMV.     

Comparison of the Brucella Standard Agglutination Test with the ELISA IgG and IgM in patients with Brucella bacteremia

The presumptive diagnosis of Brucellosis is based on a high or rising antibody titer measured by the Brucella Standard Agglutination Test (SAT). This tests does not discriminate between the immunoglobulin classes (IgG and IgM). The purpose of this study was to compare the diagnostic value of SAT with Brucella Enzyme Linked Immunosorbent Assay (ELISA) IgG and IgM tests in patients with Brucella bacteremia. Over a one-year period, we had 68 patients with clinical features suggestive of Brucellosis who had positive blood cultures for Brucella species. Sera were obtained from all of the patients as well as a control group of 70 healthy military personnel who were blood donors and had no symptoms of Brucellosis. Patients and blood donors originated from the same referral population. All the sera were tested by SAT and ELISA. All the 70 controls had a negative SAT. The sensitivity and specificity of the SAT test for the bacteremic patients were 95.6% and 100.0% respectively, while that of the ELISA IgG were 45.6% and 97.1%, and that of the ELISA IgM were 79.1% and 100.0% respectively. The sensitivity and specificity of either IgG or IgM positivity were 94.1% and 97.1% respectively. Assuming that the population prevalence of active Brucellosis in Saudi Arabia (SAT >or=1:320) is 5%, the positive and negative predictive values of SAT were 100% and 99.7% respectively; of ELISA IgG they were 45.2% and 97.1%; and of ELISA IgM they were 100% and 98.9%. When both the ELISA IgG and IgM were combined, the positive and negative predictive values were 63% and 99.6% respectively. In patients with Brucella bactremia, the sensitivity of either ELISA IgM or IgG were lower than SAT, however, combining IgM and IgG had similar sensitivity and specificity to SAT. The positive predictive value of SAT and IgM is satisfactory.     

Cytomegalovirus infections in seropositive patients after transfusion. The effect of red cell storage and volume

Antibody responses to cytomegalovirus (CMV) after red cell (RBC) transfusion were studied in 84 seropositive surgery patients and 82 seropositive oncology patients. The surgery patients were randomized to receive RBCs stored either 3 to 8 or 20 to 42 days after donation. Of 38 patients receiving RBCs stored 8 days or less, 3 developed a rise in titer (4-fold increase) of IgG antibody to CMV 8 to 12 weeks after transfusion. This rate of response (8%) did not differ significantly (p = 0.23) from that (16%) in the 46 patients receiving RBCs stored 20 to 42 days. Seropositive oncology patients were randomized to receive RBCs from seronegative or random donors. Five (19%) of 27 oncology patients receiving seronegative RBCs and 13 (23%) of 55 patients receiving random RBCs (mean, 2 seropositive RBC units/patient) developed a rise in titer of antibody to CMV. No CMV morbidity occurred in either patient group. For both patient groups, a rise in titer of antibody to CMV was associated with the number of transfused RBC units. These results confirm that CMV-seronegative RBCs are unnecessary for infrequently transfused seropositive patients. They also suggest that multiple transfusions of stored RBCs are as immunosuppressive as multiple transfusions of RBCs used within a few days after donation.     

Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy

The role of the sexual transmission of human cytomegalovirus (CMV) as a cause of congenital infection was investigated. Serum samples were collected from 756 pregnant women at 10 to 12 weeks of gestation and at 32 to 36 weeks of gestation. Serum samples were also obtained from the husbands of women who seroconverted and women who were seronegative during pregnancy. Commercially available enzyme immunoassay kits were used to detect serum IgG, IgM, and IgA antibodies against CMV. CMV from neonatal urinary specimens was isolated according to a standard tissue culture technique, using MRC-5 cells. At 10 to 12 weeks of gestation, 634 of the 756 pregnant women (83.9%) had IgG antibody to CMV. At 32 to 36 weeks of gestation, 642 of the 756 women (84.9%) had IgG antibody to CMV. A meaningful rise of serum IgG-antibody titer (seroconversion) occurred in 8 women (1.1%). CMV was isolated from the urine of an infant born to a seroconverted woman within a week after birth. The prevalence of IgG antibody to CMV was significantly higher in the husbands of women who seroconverted during pregnancy than in the husbands of the women who were seronegative during pregnancy (P < 0.01). Understanding the epidemiology of CMV is a key element in the development of strategies for the prevention of infection. The transmission of CMV by sexual contact may be important in the pathogenesis of congenital infection. Entirely new approaches to the prevention and treatment of congenital CMV infection are necessary, including antiviral interventions and the development of a vaccine strategy. Received: December 14, 1999 / Accepted: April 10, 2000     

The diagnostic problems in cytomegalovirus infection in patients with a transplanted kidney]

Several methods of cytomegaloviral (CMV) infection diagnosis were studied in patients with a transplanted kidney. EIA was used to examine clinically normal subjects and patients with CMV infection symptoms for the presence of anti-CMV IgM and IgG. Pulmonary cells of the human embryo were infected with the patients' blood and urine, followed by examination for the presence of antigen. After 7 to 14 days part of the infected cultures were examined for virus isolation. The cytological specimens prepared from the saliva and urinary sediment were investigated for the presence of cells containing characteristic CMV inclusions. Altogether 87 patients were examined. Of these, 27 had evident signs of the disease. As for the patients, virus from the blood was isolated in 60, that from the urine in 90% of cases. Viral antigen was found in the cells infected with material from the urine (in 70% of cases) and blood (in 80% of cases). It the group of the clinically normal subjects, the same parameters turned out much lower: virus from the blood was isolated in 12, that from the urine in 11% of cases. In the clinically normal subjects, anti-CMV IgG and IgM were demonstrated in 80 and 21% of cases, respectively. As for the patients, anti-CMV IgG was discovered in 100 and anti-CMV IgM in 70% of cases. All the patients with a transplanted kidney exhibited markers of CMV infection.     

乙型、丙型肝炎病毒对肾移植术后巨细胞病毒感染的影响

目的 :探讨肝炎病毒对肾移植术后CMV感染的影响。方法 :对 384例肾移植患者术后CMV -IgM进行检测 ,比较肝炎病毒感染组与非病毒感染组术后CMV感染率。结果 :肝炎病毒感染组术后CMV感染率 (30 .5 % )明显高于无病毒感染组(11.3% ) (P <0 .0 5 ) ,若患者术前已有CMV感染 ,肝炎病毒感染组术后CMV感染率更高 (4 7.4 % )。结论 :肝炎病毒感染能够增加肾移植术后CMV感染率 ,对术前已有CMV感染的肝炎病毒感染者更应注意术后CMV的监测 ,以便及时发现病毒活动 ,避免病情进展。     

Prevention of primary cytomegalovirus infection in patients with hematologic malignancies by intensive white cell depletion of blood products

The effect of white cell depletion of red cells and platelet concentrates on the transmission of cytomegalovirus (CMV) was studied retrospectively in 150 patients treated intensively for acute leukemia or non-Hodgkin's lymphoma. CMV infection was diagnosed on the basis of IgM and IgG antibody responses to CMV late antigen (CMV-LA). Before cytoreductive therapy for their underlying disease, 59 patients were CMV seronegative and 91 were CMV seropositive. None of the 59 CMV-seronegative patients showed persistent seroconversion 2 months after the cytoreductive treatment. The comparison group, consisting of 312 cardiac surgery patients, showed a significantly higher incidence of primary CMV infections: 10 of 86 (11.6%, p = 0.004). Twenty-five percent of the CMV-seronegative patients and controls had transient IgG antibodies to CMV-LA without IgM antibodies, which is indicative of antibodies passively acquired via blood products. These results indicate that white cell-poor blood products carry a very low risk, if any, of CMV transmission. The policy of transfusing white cell-poor blood products provides a useful alternative to the selection of CMV-seronegative donors.     

Monoclonal and oligoclonal gammopathies in heart-transplant recipients

Immunoglobulin abnormalities in serum from 76 heart-transplant recipients were examined by cellulose acetate and agarose gel electrophoresis. Monoclonal components were typed by immunofixation. IgG, IgA, and IgM and total kappa and lambda light chains were quantified by immunonephelometry. We confirm that both monoclonal and oligoclonal immunoglobulin banding are common in serum from these patients. Of the 149 serum samples examined, 21 (15%) had one monoclonal component and 53 (35%) had two or more. These monoclonal immunoglobulins were generally present at a low concentration and were transient. The class of immunoglobulins most commonly involved was IgG (about sevenfold more numerous than IgM); monoclonal IgA components and free light chains were not detected. The nephelometric kappa/lambda and heavy chain/light chain ratios were poor indicators of these abnormalities. Immunoglobulin abnormalities were not correlated with the sex and age of recipients, the pre-existing cardiopathy, the time since transplantation, or plasma concentrations of cyclosporine, but did correlate with plasma immunoglobulin concentration, biopsy findings, and viral infections, especially cytomegalovirus (CMV). A monoclonal IgG purified from a patient with a high titer of anti-CMV antibodies did not react with CMV antigens. The origin of these immunoglobulin abnormalities is unclear. Our data suggest that the presence of monoclonal or oligoclonal banding in heart-transplant recipients is of limited prognostic significance.     

乙肝大三阳患者肝细胞损伤与6项免疫指标相关性探讨

目的探讨乙型肝炎大三阳患者肝细胞损伤与血清IgM、IgG、IgA、C3、C4及C反应蛋白(CRP)变化的关系。方法选择乙肝大三阳患者80例,根据丙氨酸氨基转移酶(ALT)值(ALT>200IU/L和<40IU/L)分为甲、乙两组,各40例,采用速率散射比浊法测定血清IgM、IgG、IgA、C3、C4及CRP。结果甲组血清IgA、IgG、CRP均高于乙组,两组差异具有统计学意义(P<0.05);血清IgM、C3、C4两组差异无统计学意义(P>0.05)。结论血清IgA、IgG、CRP有助于评估肝细胞损伤程度。     

丙型肝炎和自身免疫性肝炎自身抗体的特点分析

目的分析自身抗体在丙型病毒性肝炎和自身免疫性肝炎中的特点方法应用间接免疫荧光法（IIF），检测233例丙型肝炎（HCV）患者和45例自身免疫性肝炎（AIH）患者血清中相关的自身抗体。结果233例HCV患者自身抗体检测阳性率分别为抗核抗体（ANA）44．6％（104／233）、抗平滑肌抗体（SMA）18．0％（42／233）、抗线粒体抗体（AMA）14．2％（33／233）、抗肝肾微粒体抗体（抗LKM-1）1．7％（4／233）、抗肝特异性蛋白抗体（LSP）10．7％（25／233）、抗细胞骨架抗体（CS）7．7％（18／233）、抗胃壁细胞抗体（APCA）6．0％（14／233）、抗心肌抗体（AHRA）6．9％（16／233）。HCV组和AIH组ANA和SMA检测结果比较，HCV组ANA、SMA抗体1：100滴度阳性率分别为69．2％、27．9％，ANA及SMA抗体以低滴度为主，AIH组ANA及SMA抗体则以高滴度为主（62．2％、28．9％）。ANA抗体高滴度（1：1000）的HCV患者ALT、ASr、Tbil、GGT、IgM的水平明显高于低滴度（1：100）患者（P〈0．05），而IgA和IgG两组间比较差异无统计学意义。AIH组抗LKM-1检测阳性率高于HCV组。结论丙型肝炎患者血清中存在多种自身抗体但滴度较低，自身免疫性肝炎患者自身抗体滴度较高，HCV引起的自身免疫紊乱是造成机体免疫损伤、加重丙肝病毒血症的一个极其重要因素。     

Evaluation of a rapid enzyme immunoassay system for serologic diagnosis of Mycoplasma pneumoniae infection

A 5-min qualitative membrane enzyme-linked immunoassay (EIA) from Remel (Mycoplasma pneumoniae immunoglobulin G (IgG)/IgM Antibody Test System) was evaluated for its ability to detect IgG and IgG at levels indicating active or recent infection. Specimens from 131 patients were evaluated using an immunofluorescent antibody assay (IFA) to determine IgG and IgM titers and the membrane EIA. An enzymelinked immunosorbent assay (ELISA) performed by a reference laboratory was used for discrepancy resolution. There were 34 IgM positive specimens (titer ⩾ 1:16), 19 IgG positive specimens (titer ⩾ 1:64), and 78 negative specimens. Compared with IFA and/or ELISA, the membrane EIA was 97% sensitive for the detection of IgM and 79% sensitive for the detection of IgG. Of the 78 specimens called negative, 17 specimens had IgG titers (⩽1:32) or an ELISA result indicating prior exposure, and the membrane EIA called seven of 17 (41%) positive. For the detection of both IgG and IgM, the membrane EIA had a sensitivity of 91 %, specificity of 91%, and positive and negative predictive values of 87 and 93%, respectively. The Remel membrane EIA is a rapid and reliable assay for the diagnosis of active or recent M. pneumoniae respiratory tract infections.