New horizons in surgical immunobiology. Host defence mechanisms in burns

Images

Comparison of a newly developed latex agglutination test and an immunodiffusion test in the diagnosis of systemic candidiasis

A newly developed latex agglutination (LA) test and a modified immunodiffusion (ID) test were evaluated. The antigen used was a homogenate of Candida albicans. A total of 167 antisera were employed in the evaluation. They included 36 sera from clinically well persons; 78 from patients with various clinical forms of candidiasis; 52 from patients with proven cases of aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, nocardiosis, paracoccidioidomycosis, sporotrichosis, and tuberculosis; and one serum from a patient with toruloposis. Use of the LA test in conjunction with the ID test permitted the detection of more than 90% of 43 proven candidiasis cases. Of all the heterologous cases and normal human sera tested, LA reactions were noted with 3 of 10 cryptococcosis case specimens, 1 of 9 tuberculosis case specimens, and with the torulopsemia case serum. In contrast, the only heterologous serum reactive in the ID test was that from the patient with torulopsemia. Torulopsis glabrata and C. albicans antisera gave identical reactions in LA and ID tests with T. glabrata or C. albicans antigens. ID tests with selected antigens, however, permitted differentiation of rabbit and human T. glabrata antibody from that of C. albicans antibody. Six different precipitins were recognized with the C. albicans antigens. The occurrence of multiple precipitin lines and high LA titers was suggestive of severe candidiasis. The LA test, in contrast to the ID test, appeared to have prognostic value. Together, the LA and ID tests provided a simple, rapid, and accurate means of detecting and monitoring infections by species of Candida.

EXTREME HYPERIMMUNOGLOBULINEMIA E AND UNDUE SUSCEPTIBILITY TO INFECTION

The clinical and immunologic features of two adolescent boys who had recurrent pyogenic infections are judged to constitute a new syndrome. Its characteristics include: recurrent cutaneous, pulmonary, and joint abscesses; growth retardation; coarse facies; chronic dermatitis; exquisite immediate hypersensitivity associated with exceptionally high serum concentrations of IgE and eosinophilia; and depressed in vivo cellular immunity and antibody formation. These patients lacked evidence of respiratory allergy or parasitism. Atopic dermatitis was not present in one boy and the physical characteristics of the other boy's dermatitis were not typical for that entity. Concentrations of immumnoglobulins G, A, M, D and the various IgG subtypes were normal, as were natural antibody titers to red cell antigens. Nevertheless, depressed anamnestic antibody responses were noted to diphtheria and tetanus antigens and neither patient demonstrated responses to primary immunization with KLH, typhoid, and DNCB antigens. Complement and polymorphonuclear functions were normal.

In vitro lymphocyte studies done demonstrated normal DNA synthesis in phytohemagglutinin and staphylococcal antigen-stimulated cultures and MIF production by some antigen-stimulated cultures from each. The explanation for the undue susceptibility to infection, increased IgE production, subnormal antibody formation, and impaired in vivo cell-mediated immunity in these patients remains conjectural.

Histochemical studies of tissue forms and of perifungal substance in subcutaneous phycomycosis

A histochemical study of phycomyces hyphae of a case of subcutaneous phycomycosis from India showed that the protoplast consists of PAS-positive polysaccharides and a small amount of RNA containing proteins. The cell wall is laminated and it is suggested that cellulose and hemicellulose compounds, as well as other polysaccharides but no proteins are present. Special attention was paid to the perihyphal substance. Adsorption of anti-human gamma globulin suggests the presence of host antibodies among the proteins present in precipitate. PAS-positive polysaccharides in this substance are probably products of the fungus. Thus, the perifungal substance of phycomyces may be considered as an immune precipitate, which is of a different nature to that of the capsular substance as produced by <i>Cryptococcus neoformans </i>and by spores of <i>Rhinosporidium seeberi.</i>