IgG4-related disease involving the trachea and paratracheal soft tissue:a case report and literature review / 中华内科杂志

Objective To investigate the clinical data of a patient with IgG4-related disease involving the trachea and paratracheal soft tissue and review the literature so as to improve the understanding level of the disorder.Methods To analyze the clinical manifestation,laboratory examination,imaging,histopathology,treatment and prognosis of a patient with IgG4-related disease trachea and paratracheal soft tissue involved,who was admitted to the Department of Respiratory and Critical Care Medicine at Beijing Chaoyang Hospital.The relevant literatures were reviewed.Results A 18-year-old female was admitted with chief complaint of cough,dyspnea,and neck mass.Neck CT suggested that tracheal stenosis was caused by surrounded soft tissue.Paratracheal mass biopsy showed dense collagen fibers with infiltration of many lymphocytes and plasma cells.Immunohistochemical stain found that IgG4-positive plasma cells were ＞ 50/high power field (HPF) and a ratio of IgG4/IgG positive cells was over 40％.The level of serum IgG4 was significantly increased (2 930 mg/L).She was diagnosed as IgG4-related disease.The patient was treated with 80 mg intravenous methylprednisolone per day for three days,then prednisone 40 mg daily oral.Her dyspnea was significantly relieved.One month later,CT scan showed that the cervical tracheal stenosis was significantly improved.We identified 20 cases of IgG4-related disease involving the trachea and paratracheal soft tissue from databases,in which only 1 case was similar as this patient.The other 19 cases were of extratracheal involvement.Elevated serum IgG4 was detected in 11/12 patients.Most patients were treated with glucocorticoid,some combined with immunosuppressive agents and rituximab.The clinical outcome was good.Conclusion IgG4-related disease involving the trachea and paratracheal soft tissue is a rare condition.Serum IgG4 level and histopathology should be considered for diagnosis.Glucocorticoid is effective.

Seroprevalencia y detección de infección primaria por citomegalovirus mediante prueba de avidez IgG en el primer trimestre de embarazo / Seroprevalence and detection of primary infection by cytomegalovirus with IgG avidity test during the first quarter of pregnancy

Objetivo. Conocer la seroprevalencia y detección de infección primaria por citomegalovirus (CMV) mediante prueba de avidez de inmunoglobulina G (IgG) durante el primer trimestre del embarazo en el Hospital General de Morelia, Michoacán. Material y métodos. Se estudiaron 177 pacientes mediante prueba de Elisa modificada, la cual utiliza inmunoanálisis quimioluminiscente de micropartículas (CMIA) para detección de anti-CMV (IgG e inmunoglobulina M [IgM]) e IgG avidez. Resultados. Del total de pruebas, 90.4% resultaron positivas para IgG; de éstas, 2.3% resultaron reactivas a IgM. En este segundo grupo, la prueba de IgG avidez reportó avidez baja en 1.1% y alta en el mismo porcentaje; 9.6% fueron seronegativas. Conclusiones. Se encontró similitud con lo publicado en México. Los profesionales de la salud deben conocer los algoritmos para el diagnóstico y manejo oportuno de la infección por CMV mediante la prueba de avidez de IgG.

Objective. To determine the seroprevalence and detection of primary infection by cytomegalovirus (CMV) with immunoglobulin G (IgG) avidity test during the first quarter of pregnancy in the General Hospital in Morelia, Michoacan. Materials and methods. A total of 177 patients were studied employing a modified Elisa test using a chemiluminescent microparticle immunoassay (CMIA) for the detection of CMV antibodies (IgG and immunoglobulin M [IgM]), and IgG avidity. Results. 90.4% were positive for IgG, and of these, 2.3% were also reactive for IgM, and in this group the IgG avidity test reported low avidity for 1.1% and higher avidity in the same percentage. 9.6% were seronegative. Conclusions. Similarity was found with published studies in Mexico. Health professionals should know the clinical algorithms for diagnosis and proper management of CMV infection using the IgG avidity test.

Lactobacillus rhamnosus GG Protects Cells from Clostridium difficile Toxins.

Aims: To determine the anti-cytotoxic effects of Lactobacillus rhamnosus GG (LGG) against extracellular and intracellular Clostridium difficile toxins. Study Design: Co-culture system. Place and Duration of Study: Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health and Department of Pathobiological Sciences, School of Veterinary Medicine, Madison, Wisconsin, between April 2010 and August 2011. Methodology: In this study, we investigated the effects of a probiotic LGG (Culturelle®) against a toxigenic C. difficile strain (ATCC 9689) and a non-toxigenic C. difficile strain (ATCC 700057) in a co-culture system. Co-cultures were prepared with 3 ml of 1:10, 1:100 or 1:1000 dilution of an overnight culture of LGG and 2 ml of 1:100 dilution of either the toxigenic or the non-toxigenic strain. Cytotoxic effects of cell-free culture supernatants (CFS) and cell lysates of the toxigenic strain on Vero cells were evaluated after coculturing. The relative abundance of toxin A (TcdA) and Toxin B (TcdB) genes in 72 h cocultures were determined using real time PCR. Results: In co-cultures with 1:10 or 1:100 dilution of LGG, counts of the toxigenic C. difficile strain were about one log unit lower than control pure cultures after incubation for 48 h. In all co-cultures, counts of the non-toxigenic strain were two log units lower than those of controls. Accordingly, LGG resulted in a significant decrease (p < 0.05) in the relative abundance of TcdA and TcdB in target DNA prepared from co-cultures containing the 1:10 or the 1:100 dilution of the probiotic. Co-culturing the toxigenic strain with the probiotic (1:10 and 1:100) decreased (P < 0.05) the cytotoxic effect of both extracellular and intracellular clostridial toxins resulting in up to 30% increase in cell viability. Conclusion: LGG inhibits the growth of C. difficile in a dose-dependent manner and protects cells from C. difficile induced cytotoxicity.

Lactobacillus rhamnosus GG Supplementation for Preventing Respiratory Infections in Children: A Meta-analysis of Randomized, Placebo-controlled Trials.

Objective: To systematically review the effectiveness of administering Lactobacillus rhamnosus GG (LGG) for preventing respiratory infections in children. Design: Systematic Review and Meta-analysis. Data sources: Electronic databases and trial registries. Results: Four RCTs involving 1805 participants met the inclusion criteria. Compared with placebo, LGG administration was associated with a reduced incidence of acute otitis media (four RCTs, n=1805, RR 0.76, 95% CI 0.64-0.91, fixed effects model, NNT 17, 95% CI 11-46), a reduced risk of upper respiratory infections (one RCT, n=281, RR 0.62, 95% CI 0.50-0.78, NNT 4, 95% CI 3-8) and antibiotic treatments (four RCTs, n=1805, RR 0.80, 95% CI 0.71-0.91, fixed effects model). There was no significant difference between the LGG and the control groups in the risk of overall respiratory infections and the incidence of lower respiratory infections. However, subgroup analysis of two studies on children older than 1 year showed significant reduction in the risk of overall respiratory infections (two RCTs, n=794, RR 0.73, 95% CI 0.57-0.92, random effects model, NNT 8, 95% CI 5-14). Adverse effects were similar in both groups. No serious adverse events were reported. Conclusion: The administration of Lactobacillus rhamnosus GG compared with placebo has the potential to reduce the incidence of acute otitis media, the upper respiratory infections and antibiotic use in children.

Avaliação da ação neutralizante e da reatividade de anticorpos IgA e IgG anti-rotavírus SA-11 em soro de adultos saudáveis / Evaluation of neutralizing ability and reactivity of anti-rotavirus SA-11 IgA and IgG antibodies in serum samples from healthy adults

O rotavírus é a principal causa de diarréia em crianças em todo o mundo. Infecta também adultos, mas não há dados completos sobre a sua incidência nesse grupo nem sobre o papel de anticorpos preexistentes na proteção contra o vírus. O objetivo do trabalho foi avaliar a presença de anticorpos IgA e IgG anti-rotavírus SA-11, por ELISA, em amostras de soro de adultos saudáveis e sua ação neutralizante frente ao vírus, em ensaios de neutralização. Por Immunoblotting foi avaliado o reconhecimento de proteínas virais pelos anticorpos séricos. Observou-se que os títulos das amostras foram muito variáveis, sendo os de IgG superiores aos de IgA. Todas as amostras mostraram-se capazes de neutralizar o vírus em diferentes níveis, porém não foi possível estabelecer uma correlação com os títulos de anticorpos. Foi observado que anticorpos da classe IgG reconhecem mais proteínas virais que os da classe IgA. Este trabalho pode ser considerado mais um passo na elucidação do papel dos anticorpos séricos IgA e IgG anti-rotavírus na infecção em adultos.

Rotavirus has been considered the leading cause of diarrhea in children worldwide. The virus also infects adults but there is no conclusive data neither on the incidence of infection on this group nor on the role of pre-existing antibodies. The aim of the work was to evaluate the presence of anti-rotavirus SA-11 IgA and IgG by ELISA in serum samples of healthy adults and the serum neutralizing ability against the virus by neutralization assays. Immunoblotting was used to evaluate viral proteins recognition by serum antibodies. The antibody titers were extremely variable where IgG titers are greater than IgA ones. All samples were able to neutralize the virus in different levels but it was not possible to establish a correlation between antibody titers and neutralization ones. Immunoblotting assays revealed that IgG antibodies recognize more viral proteins than IgA did. This work can be considered a valuable step for elucidating the role of serum anti-rotavirus IgG and IgA antibodies in adults infection.

Specific IgG1 and IgG4 antibodies to citrus red mite in citrus farmers: a study of their relationship to respiratory symptoms

Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.

Specific IgG1 and IgG4 antibodies to citrus red mite in citrus farmers: a study of their relationship to respiratory symptoms

Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.

The prevalence of specific IgE and IgG to reactive dye-human serum albumin conjugate in workers of a dye factory and neighboring factories

Previous studies suggest that reactive dyes can induce IgE mediated bronchoconstrictions. To evaluate the significance of specific IgE and IgG antibodies in workers exposed to reactive dyes, we studied the prevalence of Black GR-specific IgG by enzyme linked immunosorbent assay, as well as Black GR-specific IgE by RAST, in 176 workers employed in 1 reactive dye factory and 4 neighboring factories. Six employees of reactive dye asthma who were working in factories near the reactive dye factories were noted. The prevalence of specific IgE antibodies in the neighboring factories was higher than in that of the reactive dye factory. The prevalence of specific IgG was highest in the reactive dye factory, and those of the neighboring factories were markedly lower. It was suggested that IgE mediated sensitization to reactive dye could have occurred in employees who were working in neighboring factories, and the prevalence of reactive dye-specific IgG antibody could be used as an in direct method of assessing the exposure of workers to reactive dye.