Mumps infection and insulin-dependent diabetes mellitus (IDDM)

In order to select a population at risk for the development of diabetes for a prospective study of the relationship of islet cell antibodies (ICA), islet cell surface antibodies ( ICSA ), and glucose tolerance after mumps infection, we carried out a screening program for diabetes. A diabetic survey was conducted among 1581 children (less than 16 yr of age) with mumps infection 14 mo before the survey, using a brief questionnaire combined with urinary glucose analysis. Responses to the screening program were obtained from 68.4% (N = 1080) of the children. Out of a total of 1080 subjects, 1069 (99%) had no diabetes mellitus, diabetic symptoms, or glucosuria. A "positive urine glucose screen" was obtained in 11 subjects (1%) of the study group. These individuals all had a normal oral glucose tolerance test according to the new WHO definition. A group of 86 children was randomly selected from the total group of 1080 children for follow-up glucose tolerance, ICA, and ICSA . Irrespective of the negative urine glucose screen impaired glucose tolerance was diagnosed in 3.5% (N = 3) of the 86 children. The prevalence of ICA and ICSA was 78% and 36%, respectively. The simultaneous prevalence of ICA and ICSA was 33%. The pathogenetic role of mumps infection and ICA/ ICSA and their possible relationship to slow progressive beta cell destruction remain to be elucidated.

Antibody responses to mumps virus proteins in natural mumps infection and after vaccination with live and inactivated mumps virus vaccines

Paired sera from 20 patients with acute mumps infection, 16 from persons vaccinated with live attenuated mumps virus vaccine, and 12 from persons vaccinated with formalin-inactivated virus vaccine were studied for mumps antibodies by single radial hemolysis (SRH), hemagglutination inhibition (HI), and by enzyme immunoassays (EIA) specific for whole virus, envelope glycoprotein, and nucleocapsid antibodies. Mumps patients had diagnostic rises in serum mumps antibodies in 90-100% of the cases depending on the method of assay. Vaccination resulted in seroconversion in 75-88% (live vaccine) and in 92% (inactivated vaccine) of the cases as detected by SRH or EIAs, whereas HI detected seroconversion only in 38% and 58% of the cases, respectively. Immunoprecipitation analyses revealed that all sera from mumps patients and nearly all postvaccination sera had antibodies against the main structural proteins of mumps virus. By immunoblotting, antibodies against denatured hemagglutinin-neuraminidase (HN) and fusion protein (F) were detected in 15-25% of mumps patients and persons vaccinated with live vaccine, whereas most postvaccination sera from those vaccinated with inactivated vaccine had HN (92%) and F (83%) protein antibodies, suggesting that antibodies against the denatured form of proteins are formed.

Serological diagnosis of parainfluenza virus infections by enzyme immunoassay with special emphasis on purity of viral antigens

Enzyme immunoassay (EIA) for parainfluenza virus type 1, 2, and 3 antibodies was compared with the complement fixation test (CF) as a diagnostic method in 180 patients with respiratory symptoms. The CF test detected rises in parainfluenza virus antibodies in 30 cases, whereas EIA detected 47 rises. Patients with antibody rises in parainfluenza or mumps virus antibodies were studied for cross-reactions by CF, hemagglutination inhibition (HAI), and EIA using purified viral envelope glycoprotein and nucleocapsid preparations. All methods showed marked cross-reactivity between parainfluenza virus type 1 and 3 antibodies. Mumps virus infection often raised heterologous antibodies even against purified viral antigens. Rabbit antisera produced against viral envelope glycoproteins showed heterologous antibody responses between parainfluenza 1 and 3 antibodies and between parainfluenza 1 and mumps antibodies by HAI, EIA, and immunoprecipitation. The cross-reactive antibodies were usually directed against both of the envelope glycoproteins, HN and F proteins, of the viruses.

[Vaccination against epidemic parotitis]

Parotitis is usually a mild illness infrequently associated with severe complications, such as encephalitis, deafness or orchitis. The early studies of mumps vaccine (1940-1950) led to the development of killed virus preparations, which offered quite weakly protective immunity. Subsequently, attenuated live virus vaccines became available. These vaccines are more immunogenic and can be used mixed with measles and rubella vaccines. The widespread use of mumps vaccine in the United States has caused a dramatic reduction of the disease, with concomitant decrease of its complications. Although this may be explained by the vaccine-induced seroconversion (in over 95% of cases), the duration of protection is still unclear, since it is theoretically possible that after mumps immunization the infection could occur in older age-groups.

[Chromosome changes in the blood lymphocytes compared to the strength of the immunity in parotitis virus infection and vaccination]

Alterations of chromosomes in T-lymphocytes of peripheral blood reflected their participation in immune reactions. The associative index of acrocentric chromosomes in T-lymphocytes depended on their proliferative and migratory activity in the organism. The degree of cytogenetic and serological alterations in patients with parotitis was higher than in those having a contact and vaccinated children.

Local T cell subsets in mumps meningitis

In the acute phase of mumps meningitis, more than 85% of the cells in cerebrospinal fluid (CSF) were OKT 3 positive, while 76% of the peripheral mononuclear cells (PMN) were OKT 3 positive. The ratio of OKT 4:8 positive cells in CSF was significantly lower than that in PMN, showing that suppressor/cytotoxic T cells had selectively accumulated in CSF. In addition, 58% of CSF cells were immune associated (Ia) positive, probably activated T cells.

Antibody response following measles-mumps-rubella vaccine under conditions of customary use

A study of 301 children who had been immunized two to 19 months previously with measles, mumps, and rubella (MMR) vaccine at 36 different sites in San Antonio, Tex, including physicians' offices and clinics, revealed that 99.7% had antibody against rubella and 98.3% had antibody against measles and mumps. None of the 49 infants who were tested prior to receipt of MMR vaccine had antibody against any of these viruses, indicating that the antibody found after immunization was unlikely to be due to false-positive results. The lack of antibody in these infants confirmed that there had not been a significant number of cases of these diseases that could contribute to the high frequency of antibody found after immunization. A single dose of MMR vaccine administered under customary conditions appears to be an effective method of conferring immunity against these diseases.

Delayed cutaneous hypersensitivity response in patients receiving nutritional support

The sensitivity and specificity of skin-test antigens were assessed, and the prevalence of anergy was determined in a group of hospitalized patients receiving aggressive nutritional therapy. All patients referred to a nutritional support service during a nine-month period were assessed for intact cellular immunity using Candida albicans, mumps, streptokinase/streptodornase, and tetanus toxoid skin tests for delayed cutaneous hypersensitivity. Some patients were retested at two-week intervals while they were receiving nutritional support. A total of 195 patients (97 men) ranging from 15 to 92 years old were tested; 68 patients received repeat skin tests. Of the 195 patients, 181 (92.8%) reacted positively to one or more antigens when tested initially; all patients (including anergic ones) who were retested reacted positively. Candida and mumps tests produced the highest percentages of positive responses (80 and 75%, respectively); the use of these two antigens concurrently produced a 92.3% response rate. Nonresponding patients to a nonresponding antigen converted to responders to that antigen upon second testing more frequently than responders converted to nonresponders. Candida and mumps skin tests detected anergy and demonstrated that immune responses were maintained and often restored by aggressive nutritional support.

Immune-specific production of gamma interferon in human lymphocyte cultures in response to mumps virus

The production of interferon (IFN) was investigated in human peripheral lymphocyte cultures stimulated by mumps virus. IFN-alpha and IFN-gamma were produced in lymphocyte cultures from immune donors. However, no IFN-gamma was produced in lymphocyte cultures from nonimmune donors. IFN-alpha was produced by B lymphocytes, and IFN-gamma was produced by T lymphocytes. An increase in the production of IFN-gamma resulted from the mixture of autologous macrophages in T-lymphocyte cultures. The production of IFN-gamma by T lymphocytes was found to depend on prior, possibly cellular, immunity.

Clonal analysis of HLA-restricted virus-specific cytotoxic T lymphocytes from cerebrospinal fluid in mumps meningitis

T lymphocytes were cloned directly from the cerebrospinal fluid of a patient with mumps meningitis by limiting dilution in the presence of irradiated feeder cells and T cell growth factor. Of 84 colonies analyzed, 41 were cytotoxic, as shown by their ability to exert phytohemagglutinin-dependent killing. Of these, 39 showed specificity for the autologous mumps-virus infected target cells. The cytotoxic T cell colonies showed the same pattern of HLA restriction as bulk cultures of CSF lymphocytes. This study shows that it is possible to perform functional assays on inflammatory exudate cells at the clonal level. The data also suggest that recruitment of effector cells from the peripheral compartment into the meningeal spaces in mumps meningitis is highly antigen-specific.

Prediction of sepsis in the multitraumatic patient by assays of lymphocyte responsiveness

In vitro lymphocyte response to antigens, mitogens and in mixed lymphocyte culture were studied at intervals after injury in 31 patients with extensive trauma. Mean responses were significantly depressed up to 15 to 20 days. Responses were lower and the duration of suppression longer in those patients who become infected, and the suppression of response preceded the onset of infection. Extremely low responses were found in three patients who later died. This in vitro system is suitable for the serial monitoring of patients, as it reflects the extent of injury, infectious sequelae and prognosis. Its results are quantifiable and avoid the problems associated with repeated skin testing.

Characterization of classes of intrathecally synthesized antibodies by imprint immunofixation of electrophoretically separated sera and cerebrospinal fluids

The use of imprint immunofixation (IIF) method to identify IgG, IgA and IgM classes of microbial antibodies in electrophoretically separated sera and cerebrospinal fluids (CSF) is described. The method was applied to the analysis of intrathecal antibody responses in mumps meningitis, subacute sclerosing panencephalitis (SSPE), neurosyphilis and multiple sclerosis (MS). Intrathecally synthesized mumps virus-specific IgG, IgA and IgM antibodies were demonstrated in the CSF of patients with mumps meningitis. The intrathecally synthesized IgG and IgM antibodies displayed oligoclonal characteristics, while the IgA antibodies appeared to be mainly polyclonal. The intrathecal measles antibody responses in SSPE appeared to be confined to IgG antibodies. In neurosyphilis, the intrathecal treponemal antibody response was predominantly of the IgG class, but IgA antibodies were demonstrated in two of nine patients. Intrathecally synthesized IgG antibodies to measles and/or varicella-zoster viruses were demonstrated in 17 of 18 patients with MS; IgA or IgM antibodies to these viruses were not detected.

Mitogen and antigen stimulation of multiple sclerosis cerebrospinal fluid lymphocytes in vitro

Responses of cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocytes from 20 MS patients to phytohemagglutinin (PHA), measles, rubella, mumps and herpes simplex virus antigens were followed during periods of from 6 to 13 months. Up to 6 examinations, each with 1-5 stimulants, were performed with a lymphocyte blast transformation test. Most of the patients responded with their CSF cells to PHA (14/19) and at least to some of the viral antigens tested (15/20) during the follow-up. Although the maximal responses of CSF and PB cells to PHA and measles virus antigen were of the same magnitude, non-reactive or weakly responding lymphocytes were more common in CSF than in PB. In 7 of 15 patients having viral antigen responsive CSF cells simultaneous reactivity to several antigens could be shown. The stimulation results of CSF lymphocytes did not correlate with the numbers of CSF leukocytes or the intrathecal IgG synthesis. A negative correlation was observed between the strength of the CSF cellular response to PHA or measles virus antigen and the rate of intrathecal antibody synthesis to measles virus antigen, suggesting that the stimulated cells may at least partially represent suppressor cells.

[Cellular and humoral immunity indices in chickenpox, rubella, measles and epidemic parotitis in adults]

Immunity characteristics at the height of the infectious process and at the period of convalescence were studied in 170 adult patients, aged 18-45 years, with chickenpox, rubella measles and epidemic parotitis. In chickenpox, rubella and measles a significant decrease, more pronounced in a severe course of the disease, in the number of T- and B-lymphocytes was observed, the immunosuppressive effect being more pronounced in measles. During convalescence the number of T- and B-lymphocytes in patients with the above-mentioned diseases approached the normal level with the exception of measles patients; in these patients the number of T-lymphocytes remained significantly below the normal level, while the content of IgG was increased. In the isolated form of epidemic parotitis no essential changes in immunity characteristics were detected, while in the disseminated forms, especially in those cases when the disease took a severe course, the tendency towards a decrease in the number of T-cells and a significant decrease in the levels of B-lymphocytes and IgG were observed. Prednisolone therapy used in such cases, though giving a good anti-inflammatory effect in parotitic orchitis, produced no immunosuppressive effect.

A solid-phase reverse immunosorbent test (SPRIST) for the demonstration of specific-mumps virus IgM-class antibody

A solid-phase reverse ImmunoSorbent Test (SPRIST) was developed for the detection of mumps-specific IgM in serum samples. This technique involves antibody attachment to a solid-phase using anti-human IgM followed by the addition of hemagglutinin and erythrocytes. In a retrospective study on 40 sera, total agreement was obtained between SPRIST and hemagglutination-inhibition after density gradient centrifugation of sera. Neither rheumatoid factor nor heterophil antibody seemed to affect the reaction. This preliminary study was fully confirmed when 2438 sera were prospectively examined; 84 sera yielding positive results originated from patients with clinical symptoms of mumps. SPRIST might offer an interesting alternative to routine detection of recent mumps infections.

Virus antibodies in the cerebrospinal fluid of multiple sclerosis patients detected with ELISA tests

The enzyme-linked immunosorbent assay (ELISA) was used to determine levels of specific IgG antibodies against measles, rubella, vaccinia, corona (OC43) and mumps viruses in cerebrospinal fluid (CSF) and serum of 18 patients with clinically definite multiple sclerosis (MS), 8 patients with optic neuritis (ON), 27 patients with other neurological disease (OND), and 88 control subjects without central nervous system disease. Serum antibody levels were not significantly different between the four groups. Differences in the frequency and levels of CSF antibodies between the four groups were observed. Control patients had serum/CSF antibody ratios from 2.0 to 3.0 (log) with an average of 2.5 corresponding to a 320-fold difference between serum and CSF antibody levels. MS patients had ratios from 1.1 to 2.1 with an average of 1.6. The average was 2.0 for the ON patients. The average for the OND patients was similar to the controls. The altered serum/CSF ratios for several viruses within an individual patient was similar. These results suggest that nonspecific immunostimulation is responsible for the increased levels of CSF virus antibodies.

Radioimmunoassay for the detection of virus-specific IgA antibodies in saliva

The use of a sensitive and versatile radioimmunoassay (RIA) for detection of mumps-specific IgA and measles-specific IgA in unconcentrated saliva samples is described. The samples were obtained either by expectoration or by swabbing of the oral cavity, with or without stimulation of secretion, and were inactivated and clarified before testing. Mumps-specific IgA antibodies were detected as early as one day after onset of illness and peaked at 1-2 weeks after onset. Measles-specific salivary IgA antibodies were detected in 15-month old children 2-3 weeks after immunization. These results suggest that the RIA technique may be useful for early diagnosis of viral infections and for confirmation of response to immunization without the need for a blood sample, as well as for the study of the secretory immune response in very young and older subjects.

A study of measles virus and canine distemper virus antibodies, and of childhood infections in multiple sclerosis patients and controls

We investigated the levels of neutralizing antibodies to measles virus and canine distemper virus (CDV) in 72 multiple sclerosis patients (MS) and matched controls and also examined the frequency and age of onset of a number of childhood illnesses, including measles. The frequency of each childhood illness was not significantly different between cases and controls, but cases did report a later age at measles infection. Our data suggest that the risk of MS is increased by a factor of 1.9 if measles infection occurs between 5 and 9 years of age. A validity survey, based on a questionnaire to general practitioners, suggested substantial inaccuracy in the patients' reports of when they had measles, but the direction and degree of inaccuracy did not appear to be different between cases and controls. We also found higher titres of neutralizing antibodies in cases than controls to both measles virus and CDV, although the CDV difference was not statistically significant. In the light of a significant correlation between measles and CDV titres in both cases and controls, we used paired logistic regression to determine if the case-control difference in titres for each virus could be explained by a confounding effect on one by the other. The numbers were too small, however, to enable us to separate out any independent association of either virus with MS.

Enzyme-linked immunosorbent assay (ELISA) for detection of specific IgA antibodies to mumps virus

A sensitive enzyme-linked immunosorbent assay (ELISA) is described for detection of IgA antibodies to mumps virus. Specific mumps IgA antibodies could be demonstrated in 10 patients with mumps virus infections. No specific mumps IgA antibodies (titres <1/40) were detected by ELISA in 46 control sera (healthy adults; hospitalised patients with various other diseases). The potential application of the ELISA mumps IgA technique in serodiagnosis of mumps infections is discussed.

HLA restriction of secondary mumps-specific cytotoxic T lymphocytes

Mumps virus-specific cytotoxic T lymphocytes (CTL) were induced by incubating peripheral lymphocytes from healthy blood donors with autologous mumps virus-infected stimulator cells. Maximum cytotoxicity was generated after 5 to 7 days in culture. No cytotoxic activity was induced in the absence of viral antigens. The cytotoxicity induced in vitro was a secondary immune response, because no specific lytic activity could be generated in lymphocyte cultures from mumps seronegative donors. The effector cells were restricted by the HLA complex in a "hierarchical" pattern. The major restriction antigens for secondary CTL were certain HLA B determinants such as B18, B27, Bw25, Bw62, and Bw63. Mumps responses in spite of high [3H]-thymidine uptake in sensitized cultures. The present data suggest that mumps virus-specific CTL may be directly regulated by certain genes of the HLA B locus.