Overt immediate hemolytic transfusion reaction attributable to anti-Wr(a).

Wr(a) is a low-prevalence antigen. Anti-Wr(a) is a relatively common antibody present in approximately 1 in 100 healthy blood donors. Anti-Wr(a) is reported to cause different degrees of hemolysis in transfusion and in HDN, ranging from benign to severe. This report describes an acute overt hemolytic transfusion reaction in a patient whose serum contained anti-Wr(a) and who received a Wr(a+) RBC component.

Successful perinatal management of hydrops fetalis due to hemolytic disease associated with D-- maternal phenotype.

We report the successful management of a case of hemolytic disease and hydrops fetalis secondary to anti Rh 17 antibodies in a woman with the rare D-- phenotype. We discuss the efficacy of intravenous immunoglobulins in treating hemolytic disease of the newborn infant.

Exchange transfusion with red blood cells preserved in adenine clears a child of severe falciparum malaria.

Falciparum malaria may be associated with significant morbidity and mortality. The degree of mortality and morbidity usually corresponds to the degree of parasitemia. Quinine and other antimalarial drugs are relatively slow acting and not always effective owing to the presence of drug resistance falciparum. Rapid reduction of the number of circulating parasites may be required. Exchange transfusion has been used as a safe and quick approach to decreasing the parasitemia and antimalaria drugs used to eradicate the rest of the Plasmodium. In the present report, a case is described of a child with severe falciparum malaria who was successfully treated with exchange transfusion using the new adenine and mannitol enriched preservative media, Adsol.

Serum and CSF levels of IL-2, sIL-2R, TNF-alpha, and IL-1 beta in chronic progressive multiple sclerosis: expected lack of clinical utility.

We measured interleukin-2 (IL-2), soluble IL-2 receptor (sIL-2R), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) by ELISA in paired sera and CSF from 50 chronic progressive multiple sclerosis (CPMS) patients during worsening disability, 19 patients with other neurologic diseases (OND), and in sera from 40 healthy volunteers. In the CPMS patients, 28% (14/50), 10% (5/50), 16% (8/50), and 6% (3/50) had elevated serum levels of IL-2, sIL-2R, TNF-alpha and IL-1 beta, respectively, compared with healthy controls. The only analyte we detected in the CSF was IL-2 in 1 CPMS patient (1/50, 2%). We also saw elevated serum sIL-2R in 16% (3/19) of OND patients. We found no significant difference in mean levels of serum sIL-2R between the 3 groups. Our study, the largest to date of CPMS patients, shows that serum and CSF levels of IL-2, sIL-2R, TNF-alpha, or IL-1 beta are not sensitive for, and the serum sIL-2R level is not specific for, CPMS. Therefore, measurement of these analytes will not be clinically useful for therapeutic or prognostic purposes in the majority of CPMS patients.

IgG subclasses in human chronic schistosomiasis: over-production of schistosome-specific and non-specific IgG4.

IgG subclasses were determined quantitatively in sera from 63 Egyptian men who were infected with Schistosoma mansoni. Total and antigen-specific IgG was measured pre- and post-treatment. Total IgG subclass antibodies were determined by immunoradiometric assay (IRMA) using monoclonal antibodies (MoAbs). The anti-worm and anti-egg specific S. mansoni IgG subclass antibodies were quantitatively measured by ELISA using specific MoAbs and standards obtained by affinity chromatography. Our data show that total IgG of the patients was elevated in the range of two to three times above normal. The magnitude of increase differed markedly among the four subclasses of IgG. The IgG1, IgG2 and IgG3 concentrations were approximately two to four times higher than normal, whereas the IgG4 concentrations was 20 times normal (9000 mg/l). IgG1 and IgG4 tended to dominate the IgG subclass distribution of anti-soluble worm antigen preparation (SWAP) antibodies followed by IgG2 and IgG3. On the other hand, IgG1 and IgG2 dominated the IgG subclass distribution of anti-soluble egg antigen (SEA) antibodies. As with IgG1, IgG2 and IgG3, most IgG4 was non-specific. The role of IgG subclasses in the pathogenesis of schistosomiasis is not clear. However, the high concentration of IgG4 might act as IgE blocking antibody, possibly as anti-idiotypes that may play a role in down-regulation of the immune system when it is challenged with an excess of antigen.

Dot-ELISA for serodiagnosis of human infections due to Western equine encephalitis virus.

A standard dot-ELISA (enzyme-linked immunosorbent assay) was modified for use in detecting IgM and IgG class antibodies to Western equine encephalitis (WEE) virus in serum samples from humans infected with this virus. Nitrocellulose membranes were soaked in supernatant fluid from WEE virus-infected cell cultures, air dried, and blocked with bovine protein. Serum samples were pipetted onto sections of the nitrocellulose, incubated, and washed. Addition of antibody to human immunoglobulin conjugated to alkaline phosphatase and enzyme substrate were used to detect the antibodies. Of 13 samples positive for IgM antibody to WEE virus by IgM antibody capture ELISA, 12 were positive by IgM dot-ELISA. IgG antibody to WEE virus was detected by dot-ELISA in 7/8, 10/14 and 7/10 samples with neutralizing, hemagglutination-inhibiting, or complement-fixing antibodies, respectively.

Dot-enzyme-linked immunosorbent assay (dot-ELISA) for the rapid diagnosis of human fascioliasis.

A dot-enzyme-linked immunosorbent assay (dot-ELISA) was developed as a fast and field applicable antibody detection tool for the diagnosis of human fascioliasis. The assay is performed using partially purified antigens from a species of Fasciola at 180 ng protein/dot (2 microliters) and serum samples at 1:20 dilution (1 microliter). Dot-ELISA results completely agreed with those of micro-ELISA. Antigen-coated nitrocellulose sheets stored for 3 mo at -20 C showed results identical to fresh sheets. Sera from patients with fascioliasis (n = 30) and other parasitic or viral infections (n = 120) were compared with sera from healthy controls (n = 14). Ninety samples can be tested within 90 min. The sensitivity, specificity, and speed of the assay may justify its use in laboratory and field studies.

Seasonal differences in the rhythmicity of human male and female lymphocyte blastogenic responses.

To test the hypothesis that there are circannual differences in mitotic activity in males and females, normal human peripheral blood lymphocytes were stimulated with suboptimal concentrations of Phytohemagglutinin (PHA), Concanavalin A (Con A) and Poke weed mitogen (PWM) over two summer/winter cycles. Lymphocyte responses for the entire population were significantly higher in the summer than in the winter. The same results were observed when responses were compared between a summer and a successive winter. However, when male and child-bearing age female responses were compared, females showed a higher significant difference for PHA and Con A between summer and winter, but not for PWM. These different responses due to season may reflect a relationship between the neuroendocrine and immune systems. At the cell level, these results suggest that an inherent difference exists between female and male lymphocytes and that these lymphocytes are sensitive to seasonal changes.

Quantitation of IgG antibody to Streptococcus pneumoniae vaccine by ELISA and FAST-ELISA using tyraminated antigen.

We examined two ELISA methods for measuring antibodies to Streptococcus pneumoniae using tyraminated S. pneumoniae polysaccharide types 3, 7N, 9F and 14 as antigens. The ELISA has the usual format with a relatively long incubation time whereas the FAST-ELISA has a short incubation time and employs a different solid-phase configuration. We showed that both techniques can be used for the detection of antibodies to S. pneumoniae polysaccharides. Although its analytical sensitivity is about 1/10 of that of the ELISA, the FAST-ELISA is sufficiently sensitive to distinguish protective from unprotective levels of antibodies to the types of S. pneumoniae studied. In studying pre- and post-immunization response, we showed that type 3 is the most immunogenic.

Simplification and standardization of dot-ELISA for human schistosomiasis mansoni.

Dot-ELISA, a technique that shares the same principles as the enzyme immunoassay, is useful for detection of anti-Schistosoma mansoni antibodies in the sera of patients with Schistosoma mansoni infections. The antigens were fixed to the nitrocellulose strips, blocked with 1% bovine serum albumin in 0.05% Tween 20. Patient sera (40) and normal laboratory personnel sera (9) were applied to the sheet directly, without cutting the strips into small discs. The nitrocellulose sheets are kept in a humid chamber for 30 min and then washed. After incubation with peroxidase-conjugated goat anti-human antibody, washing, and addition of substrate, positive reactions appear as brown dots against the white background. The room temperature assay takes about 2 hr. The optimum antigen concentration is 20-80 ng per dot and the optimum serum dilution is 1:100-1:400. The sensitivity and specificity of the assay are 90-95% and 90%, respectively. The level of positivity of the dot-ELISA by an arbitrary scale compares with standard micro-ELISA. The single positive reaction in a normal serum sample in dot-ELISA is also positive in micro-ELISA. Cross-reactivity between the S. mansoni antigen and human fascioliasis sera was noticed in 2 out of 8 patient sera. Good correlation between the arbitrary level of dot-ELISA and the absorbance of standardized micro-ELISA shows that the dot-ELISA is useful both for laboratory and field studies.

Circulating immune complex levels in patients with schistosomiasis and complications.

Circulating immune complexes (CIC), adult schistosome antibody, and total immunoglobulin concentrations were estimated in sera from 35 chronic Schistosoma mansoni patients with different infection intensities and different pathological complications. High CIC levels were present in about one-third (10/35) of the sera. Most of the patients (9/10) with elevated CIC levels also had hepatomegaly or hepatosplenomegaly. This finding is significant in the pathogenesis of schistosomal liver fibrosis and may also apply to other liver diseases, especially cirrhosis. No correlation was found between infection intensity as judged by stool egg counts and CIC levels. A reverse relationship was observed between the level of anti-adult worm IgG and CIC levels. CIC levels were elevated within 7 and 28 days after treatment in most patients. Hypergammaglobulinaemia was detected in most sera.

Immunoaffinity fractionation of Schistosoma mansoni worm antigens using human antibodies and its application for serodiagnosis.

A crude Schistosoma mansoni soluble worm antigen preparation (SWAP) was fractionated using an immunoaffinity column consisting of specific human anti-SWAP antibodies obtained from chronic S. mansoni-infected human sera and bound to CNBr-activated Sepharose 4B. The chromatographic separation resulted in three fractions: the unbound material (FW), and the eluted antigens with glycine-HCl (F1) and glycine-HCl-NaCl (F2). Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) showed that the purified antigens F1 and F2 consisted of several bands when stained with Coomassie blue and silver stain, with molecular weights between 20 X 10(3) and 200 X 10(3). The F1 and F2 fractions in addition to FW and SWAP were used in an enzyme-linked immunosorbent assay (ELISA) to measure antibody levels in sera from schistosomiasis patients. Each individual serum assessed with the purified F2 antigen gave 100% positivity and three to four times higher optical density in comparison to SWAP with only 88% positivity. No detectable cross-reactive antibodies against F2 were found when a limited number of sera from filariasis, fascioliasis and trichinellosis patients were screened. Furthermore, F2 was also used and found to be more sensitive generally in detecting anti-adult worm antibodies than SWAP in recently schistosomiasis-infected persons. Thus, F2 appears to be a highly sensitive and specific reagent for the serodiagnosis of schistosomiasis infection.

Use of a partially purified Fasciola gigantica worm antigen in the serological diagnosis of human fascioliasis in Egypt.

Crude extracts of Fasciola gigantica adult worms, when used as an antigen in indirect hemagglutination (IHA) and counterimmunoelectrophoresis (CIEP) tests, detected all independently diagnosed human F. gigantica and F. hepatica infections but cross-reacted with sera of patients with schistosomiasis and amebiasis. Fractionation of this crude worm extract using Sephadex G-200 chromatography demonstrated four major protein peaks. Antigen from the crest and descending portion of peak II (mol. wt. approximately 20 x 10(3)) and all of peak III (mol. wt. approximately 6 x 10(3)) were pooled and used as a source of partially purified antigen. This partially purified fraction, when used in the CIEP test, reacted with sera from patients with fascioliasis but not those from schistosomiasis or amebiasis patients, whether undiluted or concentrated fivefold, but failed to react by IHA with fascioliasis sera. It reacted with undiluted sera from all individuals passing F. gigantica eggs except one, a possibly spurious infection, and with eight of 20 sera from individuals passing F. hepatica eggs, while the remaining 12 sera became positive after fivefold concentration. It also reacted with two sera from individuals passing eggs of both Fasciola species and with five of 11 sera from individuals negative microscopically but positive serologically with the crude antigen.

Acute hepatitis non-A non-B in Cairo residents (a preliminary report).

Of 110 patients admitted with jaundice to the Abbassia Fever Hospital (AFH) in Cairo, 49 had acute hepatitis A infection (positive for anti-hepatitis A specific IgM), 28 had hepatitis B infection (positive for HBsAg) and seven had both markers. Of great interest, however, was the finding that 26 patients had no markers for either A or B virus infection. Clinically and biochemically, the non-A non-B hepatitis group resembled the other two infections. None of the 26 patients lacking both markers gave a history of previous blood transfusion or parenteral injections. Thus, the possibility of a faecal-oral or water-borne infection must be considered in these cases.