Genetic response to an environmental pathogenic agent: HLA-DQ and onchocerciasis in northwestern Ecuador.

The aim of this study is to explore human leukocyte antigen (HLA)-DQ variability in two populations (Cayapas Amerindians and Afro-Ecuadorians) who live near one another along the Cayapa River and who are exposed to the same environmental stresses, such as infection by Onchocerca volvulus. HLA-DQA1 and HLA-DQB1 of 149 unrelated individuals (74 Cayapas and 75 Afro-Ecuadorians) have been analyzed. HLA high-resolution molecular typing was performed by sequence-based typing, sequence-specific oligonucleotides hybridization and sequence-specific primer (SSP) amplification. The comparison between affected (cases) and unaffected people (controls) in both populations shows the key role of several HLA-DQA1 alleles in susceptibility and protection against onchocerciasis. In both populations, there is strong evidence related to the protective role of DQA1*0401 against onchocerciasis. Alleles HLA-DQA1*0102 and *0103 seem to represent risk factors in Afro-Ecuadorians, while HLA-DQA1*0301 is only a suggestive susceptibility allele in Cayapas. These findings represent new positive/negative associations with onchocerciasis in South America, whereas previous findings pertained only to African populations.

Strongyloides stercoralis: characterization of immunodiagnostic larval antigens

Forty-one-, 31-, and 28-kDa proteins of strongyloides stercoralis filariform larvae have previously been demonstrated to be sensitively and specifically recognized by serum IgG in individuals with strongyloidiasis. Characteristics of these proteins, their immunodominant epitopes, and reactive antibodies are described here. The proteins are soluble is aqueous as well as detergent extracts. The immunodominant epitopes are present in S. stercoralis but not in S. cebus or S. ratti. Epitopes on the three proteins are not shared, as determined by cross-absorption of serum with each of the size components on nitrocellulose. In most sera from strongyloidiasis patients there was reactivity to each of the proteins by IgG1 and IgG4, but reactivity by IgG2 or IgG3 was detectable only in a minority. A rabbit antiserum raised to a 41-kDa size fraction of S. stercoralis larvae reacted against a doublet of 41-kDa which was distinct from the immunodiagnostic 41-kDa protein.(AU)

Prospective evaluation of enzyme-linked immunosorbent assay and immunoblot methods for the diagnosis of endemic Strongyloides stercoralis infection.

Recently described enzyme-linked immunosorbent assay (ELISA) and immunoblot methods for the detection of serum IgG against Strongyloides stercoralis larval antigens were prospectively evaluated for the diagnosis of endemic strongyloidiasis. A modification of the ELISA involved preincubation of sera with Onchocerca gutturosa phosphate-buffered saline-soluble extract to remove cross-reactivity with other helminths. The sensitivity of the ELISA increased from 80% to 85% following preincubation. Similarly, there was an increase in specificity from 94% to 97%. The IgG recognition of 41-, 31-, and 28-kD filariform larval components showed sensitivities of 100%, 85%, and 65%, respectively. Both the ELISA following incubation of sera with O. gutturosa extract and serum IgG reactivity to a 41-kD larval component using immunoblotting are sensitive and specific techniques for diagnosing endemic strongyloidiasis.

Prospective evaluation of enzyme-linked immunosorbent assay and immunoblot methods for the diagnosis of endemic Strongyloides stercoralis infection

Recently described enzyme-linked immunosorbent assay (ELISA) and immunoblot methods for the detection of serum IgG against Strongyloides stercoralis larval antigens were prospectively evaluated for the diagnosis of endemic strongyloidiasis. A modification of the ELISA involved preincubation of sera with Onchocerca gutturosa phosphate-buffered saline-soluble extract to remove cross-reactivity with other helminths. The sensitivity of the ELISA increased from 80 percent and 85 percent following preincubation. Similarly, there was an increase in specifity from 94 percent to 97 percent. The IgG recognition of 41-, 31-, and 28-kD filariform larval components showed sensitivities of 100 percent, 85 percent and 65 percent, respectively. Both the ELISA following incubation of sera with O. gutturosa extract and serum IgG reactivity to a 41-kD larval component using immunoblotting are sensitive and specific techniques for diagnosing endemic strongyloidiasis.(AU)

Guatemalan human onchocerciasis. II. Evidence for IgG3 involvement in acquired immunity to Onchocerca volvulus and identification of possible immune-associated antigens.

Ag-specific isotypic differences in immune response to Onchocerca volvulus Ag were assessed for 778 long term residents of endemic Guatemalan areas by quantitative ELISA with 5-min incubation steps and immunoblot. The study population was separated into five groups based on clinical status: N+F+, N+F-, N-F+, N-F-H+, and N-F-H-, where N = O. volvulus adults (nodule), F = microfiladermia, and H = history of O. volvulus infection. A subset of 44 individuals with high exposure to onchocerciasis from the N-F-H- group were critically evaluated and designated as "putatively immune." IgG1 reactivity to O. volvulus Ag was elevated in the majority of infected persons, but not in putatively immune individuals. Specific IgG3 levels, however, were equally elevated in all groups. The majority of N+F- persons also had elevated IgG1 levels, but they were lower than those found in F+ persons. IgG3 reactivities to a group of antigens at 20 kDa (GP20) were seen in many uninfected persons and some N+F- persons. In contrast, most F+ persons, react to this Ag with IgG1 and not IgG3. A mangabey inoculated with the infectious larval stage of O. volvulus (L3), but showed no signs of infection, began to recognize GP20 at 2 wk postinoculation. Early recognition of GP20 was possibly elicited by the larval stage. Purified nodule Ag from N+F+ individuals contained GP20, however, identical nodule Ag prepared from N+F- individuals did not. These data suggest that GP20 Ag may be common to both uterine microfilaria and the infectious larval stages. The fact that GP20 is predominantly recognized by IgG3 in putatively immune persons and some N+F- persons suggests that this increased IgG3 activity may be important in acquired immunity to onchocerciasis.

Antigen detection in onchocerciasis: correlation with worm burden.

Detection of O. volvulus antigen by indirect ELISA test in the serum and the urine of 169 individuals with residence in the southeast onchocerciasis endemic focus in Chiapas, Mexico was performed. Every individual under study was physically examined for signs of onchocerciasis in particular for subcutaneous nodules, dermic lesions, ocular damage and history of Mazzotti reaction. Of the total cases, 91.7% were positive for skin microfilariae. Only 32.2% of the microfilariae positive cases carried at least one palpable nodule. The sensitivity of the ELISA test was 92.3% for serum and 85.9% for urine. A good correlation between the transformed numbers of skin microfilariae (square root of x + 1) and the positivity of the ELISA test for serum and for urine was found. It was also observed that the ELISA test values for the sera and for the urine showed a good correlation with r = 0.76 and Z0.95 less than 0.005. This serological test can be used for seroepidemiological surveys and for orientating the activity of massive onchocerciasis treatment campaigns.

Identification of an antigen of Onchocerca volvulus of possible diagnostic use.

Adult Onchocerca volvulus worms obtained by enzyme digestion from nodules of infected Mexicans were radio-isotope labelled by the chloramine-T or Bolton-Hunter methods. No antigenic determinants were detected in extracts of worms labelled by the chloramine-T method but 3 antigens were detected in extracts of the Bolton-Hunter labelled worms. Two were present in such small amounts that it was impractical to investigate them further, but a major component of mol. wt 20 kDa was purified by gel filtration and used in a serological survey of inhabitants of villages in Southern Mexico. Using the 20 kDa antigen, which is superficially located on both sexes of O. volvulus, sera from both non-endemic and endemic regions were analysed by radio-immunoprecipitation of this antigen. In Southern Mexico, the average sensitivity of the test was 92%, and the specificity 98%. Whilst the 20 kDa antigen did not detect antibodies in the sera of Trinidadians infected with Wuncheria bancrofti or Mansonella ozzardi, this antigen detected high levels of antibodies in Indians exposed to W. bancrofti.

Comparison of heterologous adult Brugia malayi and homologous Onchocerca volvulus antigen in the enzyme-linked immunosorbent assay (ELISA) for Guatemalan onchocerciasis.

To determine the susceptibility of a heterologous filarial antigen for measuring Onchocerca volvulus antibodies, worms were compared using an enzyme-linked immunosorbent assay (ELISA) test. Control serum samples from helminth-free U.S. residents and from helminth-infected but filariae-free Salvadoran residents were tested and compared with serum obtained from microfilariae-positive and -negative Guatemalan residents living in an area of endemic onchocerciasis. The results showed that none of the sera from U.S. residents had positive O. volvulus ELISA titers (greater than or equal to 1:160); however, 8.51% (4/47) had positive B. malayi ELISA titers (greater than or equal to 1:640). The geometric mean titers with the B. malayi ELISA test were higher than with the O. volvulus ELISA test--in sera from 47 U.S. residents (1:219 vs. 1:49), from 108 Salvadoran residents (1:92 vs. 1:71), and from 145 microfilariae-negative (1:539 vs. 1:167) and 303 microfilariae-positive (1:1,270 vs. 1:561) Guatemalan residents. The B. malayi ELISA test exhibited slightly less sensitivity than the homologous O. volvulus ELISA test; nevertheless, a good correlation (r = 0.74) was found between the 2 test antigens, indicating that the B. malayi antigen could be used to measure O. volvulus antibodies.

Serologic studies on onchocerciasis in Guatemala using fixed-tissue sections of adult Onchocerca volvulus.

Sera from 458 residents of a coffee plantation in an area of Guatemala endemic for onchocerciasis were examined for the presence of antibodies to Onchocerca volvulus using a fluorescent antibody (IFA) test with sections of adult worms as the antigen. Antibody response increased with age of the residents and microfilarial density. A total of 70.0% of the residents were serologically positive and 65.1% were positive for microfilariae. Males had higher microfilarial densities and higher IFA responses. Sixty-three individuals were positive for microfilariae and IFA-negative indicating a lack of sensitivity on the part of the test antigen. Seventy-four individuals were negative for microfilariae and IFA-positive, suggesting the possible usefulness of the test in the determination of present or past infection in the absence of microfilariae.

The use of an Onchocerca volvulus microfilarial antigen skin test in an epidemiological survey of onchocerciasis in Guatemala.

Onchocerca volvulus microfilariae obtained from onchocercal nodules were used as antigenic material for a skin test. This antigen is as specific as those previously employed in skin tests, detecting 85.2% of the persons with positive diagnostic signs of onchocerciasis in endemic areas. A low rate of false positives was found in the control group in nonendemic areas. The positive rate of reactions in the persons without positive signs in the endemic areas might be due to the presences of cases not detected as a result of palpation for nodules and two skin biopsies. In the examination of the residents of several populations, a close correlation was found between the positive rates of skin tests and the presence of infection. From these findings, we conclude that the skin test using the microfilarial antigen is a suitable procedure for the diagnosis of onchocerciasis. The skin test could also be useful as an epidemiological tool in assessing the effectiveness of control programmes.