A simplified method for the detection of rubella-specific IgM employing sucrose density fractionation and 2-mercaptoethanol

Prevalence of serum antibodies to Toxoplasma gondii in the small Indian mongoose (Herpestes auropunctatus) on Amami-Oshima Island, Japan

Prevalence of antibodies to Toxoplasm gondii was studied using the latex agglutination (LA) method, followed by sucrose density gradient centrifugation (SDGC) method on the small Indian mongoose (Herpestes auropunctatus), which inhabits Amami-Oshima Island. Of the 362 samples, 38 (10.5%) revealed positive. Single or double peaks in the 7–8 and/or 12–14 fraction to LA titer by SDGC indicated the early stage of T. gondii infection. It is suggested that domestic/feral cats play an important role for spreading this zoonotic pathogen to the mongoose as well as other species that are endemic to this island. Future studies are warranted to prevent the transmission of T. gondii among cats and wild animals in order to maintain the ecosystem health.

Evaluation of RepliVAX WN, a single-cycle flavivirus vaccine, in a non-human primate model of West Nile virus infection

West Nile virus (WNV) causes serious neurologic disease, but no licensed vaccines are available to prevent this disease in humans. We have developed RepliVAX WN, a single-cycle flavivirus with an expected safety profile superior to other types of live-attenuated viral vaccines. In this report we describe studies examining RepliVAX WN safety, potency, and efficacy in a non-human primate model of WNV infection. A single immunization of four rhesus macaques with RepliVAX WN was safe and elicited detectable neutralizing antibody titers and IgM and IgG responses, and IgG titers were increased in two animals that received a second immunization. After challenge with WNV, three of four immunized animals were completely protected from viremia, and the remaining animal showed minimal viremia on one day. In contrast, the unvaccinated animal developed viremia that lasted six days. These results demonstrate the efficacy and safety of RepliVAX WN in this primate model of WNV infection.

The prevalence of Toxoplasma gondii antibodies in wild and captive cetaceans from Japan

The seroprevalence of Toxoplasma gondii was investigated in wild and captive cetaceans from Japan. Antibodies against T. gondii were examined by both latex agglutination test (LAT) and indirect hemagglutination test (IHAT) for 77 serum or plasma samples obtained from 59 individuals of 6 species, including 2 hybrids. Antibody titers greater than 1:64 in LAT and greater than 1:640 in IHAT, indicative of the presence of T. gondii, were found in 11.9% of 59 individuals. In 7 samples that showed a positive reaction by IHAT, T. gondii titers were examined for each immunoglobulin (Ig) fraction separated by sucrose gradient centrifugation. The antibody peaks in each fraction were divided into 3 types, thought to be a reaction of IgM (type 1), IgG (type 2), and IgM with IgG (type 3). Type 1 was found in serum from a bottle-nosed dolphin (Tursiops truncatus) and a killer whale (Orcinus orca) sampled soon after capture off the Japanese coast in 1988; it was concluded that infection in the wild had occurred less than 15 yr before the study was performed. The prevalence of putative IgM and IgG antibodies from a captive-bred T. truncatus suggested that T. gondii infection also occurred in the aquarium.

Australian encephalitis in Western Australia, 1978-1991

OBJECTIVE

To review the various clinical manifestations of Murray Valley encephalitis (MVE) or Kunjin virus encephalitis in patients in Western Australia.

DESIGN

Review of clinical records, 1978 to 1991.

PATIENTS

Of 26 reported cases of Australian encephalitis, four were excluded from study because the patient's symptoms were not definitely associated with MVE virus or Kunjin virus infection. Two further cases of MVE were not reviewed as case records were not available. Of the remaining 20 patients, 18 had MVE and two had Kunjin virus encephalitis.

RESULTS

Sixteen cases were in the Kimberley, a tropical region where the viruses are endemic. Four were in the subtropical Pilbara and Gascoyne regions. Thirteen of the 20 cases were in Aborigines, of whom 11 were children. The seven non-Aboriginal patients were adults. Seventeen of 20 cases were in males. The range of neurological disease and outcome was similar to that in previously reported cases, with convulsions, brainstem disease or respiratory failure in severe and fatal cases, and involvement of the spinal cord, cranial nerve or cerebellum in the moderate cases. One mild cases without neurological involvement was caused by Kunjin virus.

CONCLUSIONS

The poor outcome in young Aboriginal children indicated that disease resulting from exposure early in life was more likely to be severe. The disease in adults, irrespective of facial background, was similar to that in cases reported previously from south-eastern Australia, but generally milder.

Detection of rubella virus immunoglobulin G (IgG) and IgM antibodies in whole blood on Whatman paper: comparison with detection in sera

We compared detection of rubella virus hemagglutination inhibition (HI) antibody and rubella virus-specific immunoglobulin M (IgM) in dried whole blood spotted onto Whatman filter paper and serum samples, both of which were obtained from the same subject by venipuncture. Of 1,000 paired serum samples obtained to study HI antibodies, 807 dried blood samples had HI titers identical to those of the corresponding serum samples, and 193 dried blood samples showed 1 dilution difference. Storage of dried blood at room temperature for 28 days did not affect the HI antibodies. In a study of specific IgM by a solid-phase immunosorbent HI test done with blood from healthy subjects and patients with rubella, the result of the presence, positive or negative, of specific IgM from both blood sample sources corresponded when the dried blood samples were stored at room temperature from 5 h to 38 days. This study demonstrated that the use of Whatman filter paper as a transport medium for blood samples for the determination of rubella virus immunity and the diagnosis of rubella virus infection is possible.

IgM antibody to hepatitis C virus in acute and chronic hepatitis C

To assess possible role of testing for IgM-specific antibody in the diagnosis and monitoring of patients with hepatitis C, we tested sera from 14 patients with acute and 97 patients with chronic non-A, non-B hepatitis for IgG and IgM antibody to hepatitis C virus. IgG antibody to hepatitis C virus was detected in 93% of acute cases and 91% of chronic cases. Of the 101 patients with IgG antibody to hepatitis C virus, 57% had IgM antibody to hepatitis C virus. None of the 20 healthy subjects or 40 patients with acute or chronic hepatitis A or hepatitis B had IgM antibody to hepatitis C virus. At the onset of clinical symptoms in acute hepatitis C, IgG antibody to hepatitis C virus was detected in 8 (57%) and IgM antibody to hepatitis C virus in 9 of 14 patients (64%). Eventually, both IgG and IgM antibody to hepatitis C virus became detectable in 13 of 14 patients with acute hepatitis C. Seven patients with antibody to hepatitis C virus resolved the acute infection within 6 mo and all seven cleared IgM antibody to hepatitis C virus, whereas two cleared IgG antibody to hepatitis C virus. Six patients had a chronic outcome of the acute infection and IgM antibody to hepatitis C virus persisted in detectable amounts for more than 6 mo in all (mean = 15.5 mo). Among 88 patients with chronic non-A, non-B hepatitis with IgG antibody to hepatitis C virus, IgM antibody to hepatitis C virus was detected in 45 (51%).(ABSTRACT TRUNCATED AT 250 WORDS)

Naturally occurring immunoglobulin M antibodies to Toxoplasma gondii in Japanese populations

Varying degrees of naturally occurring immunoglobulin (Ig) M antibodies to Toxoplasma gondii were observed in almost all of adult Japanese populations negative for IgG antibodies as determined by an enzyme-linked immunosorbent assay (ELISA). The antibody activity was reduced by absorption of sera with Toxoplasma soluble antigen or by 2-mercaptoethanol treatment of the IgM fraction after sucrose density gradient centrifugation. Umbilical cord sera had almost no detectable IgM antibodies, and the ELISA value in infants increased with age until 1 year. Most paired sera collected from adults at a 1-year interval showed constant IgM antibody levels, suggesting retention of natural IgM antibodies throughout their lives without changing ELISA values of greater than or equal to 0.1/year. Polar staining was observed in immunofluorescent studies for 14 serum samples with natural IgM antibody levels of greater than or equal to 0.5, while samples obtained from a pregnant woman with natural IgM antibody levels of greater than or equal to 0.9 reacted to the whole organism as was observed in positive sera of acute patients. Western blotting analysis revealed that natural IgM antibodies were directed to multiple antigen molecules. The band pattern differed slightly from one serum to another, but almost consistent patterns were observed in sera sequentially obtained from an adult over 4 years.

Development and evaluation of an IgM capture enzyme immunoassay for diagnosis of recent Norwalk virus infection

A capture enzyme immunoassay specific for Norwalk IgM class antibody was developed. The assay was moderately sensitive, identifying 33/53 (62%) of patients with naturally acquired Norwalk virus infection and 17/18 (94%) of experimentally infected volunteers. The assay was also specific for IgM class antibody and acute Norwalk virus infection and results were generally reproducible. A specific IgM response correlated with seroconversion by total antibody blocking assay and occurred independently of clinical symptoms. Among 81 symptomatic cases composing seven Norwalk outbreaks, specific IgM was absent from acute phase sera collected less than or equal to three days post onset, and was uncommon in sera collected within one week and after five weeks, with an optimal collection time at about two to three weeks. The Norwalk IgM capture immunoassay may be used to augment paired sera assays in the identification of Norwalk-associated outbreaks of acute gastroenteritis.

Quantitation of antibodies to Toxoplasma gondii in swine sera by enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay (ELISA) was developed for quantitation of antibodies to Toxoplasma gondii in swine sera. Because a commercial anti-swine IgG conjugate was directed also against swine IgM, the conjugate was absorbed with the IgM fraction to eliminate the interference of naturally occurring IgM antibodies that appeared consistently in sera collected from slaughtered pigs at an abattoir. The ELISA values of 0.2 or more observed in most of the sera successfully decreased to less than 0.2 by the use of absorbed conjugate. An attempt to use a protein A conjugate has failed. Evaluation of this system by comparing it with the latex agglutination test provided a high significant correlation, indicating its usefulness for serodiagnosis of swine toxoplasmosis.

The development of an M antibody capture ELISA for rubella IgM

An M antibody capture enzyme-linked immunosorbent assay for rubella IgM was developed. The enzyme label was prepared from a monoclonal antibody raised against rubella haemagglutinin (Tedder et al., 1982). Paired sera from acute rubella infections and vaccines as well as sera from blood donors, antenatal patients and patients whose sera contained rheumatoid factor and patients with acute non-rubella infections were tested by this method.

Rapid separation of IgM from whole serum using spun column chromatography

Spun columns were used to separate IgM from serum samples by exploiting molecular weight and size difference between IgM and other serum antibodies. Miniature gel chromatography columns were prepared in 3 ml syringe barrels. A polyacrylamide liquid chromatography gel, Bio-Gel P-200, was chosen to exclude proteins with molecular weights greater than 200,000. IgM, 900,000 MW, was excluded while IgG, 150,000 MW, was retained in the gel column. Centrifugation of the serum-loaded columns in test tubes accomplished the separation in one step by eluting a void volume equal to the sample volume from each column into a holding tube. IgM recovery in the eluent exceeded 96% of the total serum IgM in the pre-column sample. No IgG was detected in the eluent. IgM separated from La Crosse encephalitis immune human serum retained immunological activity in a viral neutralization test. Spun column chromatography is eminently suitable for diagnostic laboratories as more than 100 sera may be fractionated in one day using inexpensive materials and a low-speed centrifuge equipped with a swinging-bucket rotor.

Antibody class capture assay (ACCA) for rubella-specific IgM antibody

Enzyme-linked immunosorbent assays for IgM antirubella were carried out on 1,546 sera, using an IgM capture method with a F (ab')2 conjugate (ACCA). Under the conditions described, sera containing IgM antirubella bound up to 15 times as much enzyme activity as negative specimens. Paired serum specimens from 27 patients, serial serum specimens from 6 patients, and single serum specimens from 15 patients who had had recent rubella were examined by the haemagglutination inhibition test (HAI) in the presence and absence of 2-mercaptoethanol following sucrose density gradient centrifugation (SDGC). ACCA confirmed all the results found with HAI following SDGC. Specimens were examined from ten patients with congenital rubella; ACCA confirmed the results found with both immunofluorescence following SDGC and radioimmunoassay. Pre- and post-vaccination specimens from 123 patients who had been vaccinated against rubella were examined. An IgM response could only be demonstrated in the 57 cases when IgG was absent in the first specimen. The specificity of the assay was confirmed by testing 31 serum specimens from rubella immune patients that also contained rheumatoid factor, 163 serum specimens from patients with acute infections other than rubella, and 12 serum specimens from infants with miscellaneous neonatal abnormalities other than congenital rubella. The ACCA proved a simple, sensitive, and specific test for IgM antirubella and the results compared favourably with those obtained by the SDGC technique.

Low molecular weight IgM in cytomegalovirus infections and cardiac patients

When 71 ischaemic heart disease and cardiomyopathy patients' sera were examined by the IFA (indirect fluorescent antibody) test, 18 of the 49 (36%) with CMV (cytomegalovirus) CF antibody appeared to contain a specific LMW (7S approx) IGM. This IgM was unrelated to the presence of RF (rheumatoid factor) demonstrable by agglutination of IgG-coated latex and by an immunofluorescence test, was not absorbed by heat-aggregated IgG and latex, nor did its demonstration appear to be complement dependent. It was demonstrable in acute CMV infection and in some cardiac patients, binds to HSV (herpes simplex virus) and CMV-infected cells.

Dissociation of hepatitis A virus antigen-anti-HAV antibody complexes by 2-mercaptoethanol and dithiothreitol

Intravenous inoculation of two marmosets and one chimpanzee with hepatitis A virus (HAV) resulted in the replication of virus in liver, excretion of HAV particles in stool, and the appearance of circulating antibodies specific for hepatitis A. The development of an early antibody response in the chimpanzee and in one of the two infected marmosets was shown to interfere with the serologic detection of HAV antigen (HAV Ag) in homogenates of acute phase liver tissue obtained from these animals. Treatment of HAV Ag-positive and IgM anti-HAV-positive liver homogenates with thiol reducing compounds was shown to release HAV Ag from in vitro formed immune complexes. The increased RIA response for HAV Ag in homogenates treated with 2-mercaptoethanol (2-ME) or dithiothreitol (DTT) was further shown not to be due to activation of HAV Ag itself or to a nonspecific effect on the RIA coating antibody, radiolabeled probe, or homogenized liver tissue. IgG and IgM double-antibody sandwich RIAs for HAV Ag were also compared for their ability to detect HAV Ag under reducing and nonreducing conditions. Application of the 2-ME or DTT treatment procedure to the serologic detection of other viral antigens or viruses whose presence in blood, stool, tissue macerate, or other milieu may be masked by specific antibody appears to be feasible.

Comparison of radioimmunoassay and the gel filtration technique for routine diagnosis of rubella during pregnancy

Radioimmunoassay (RIA) for rubella-specific IgM antibodies was compared with haemagglutination-inhibition (HI) in conjunction with gel filtration for the diagnosis of rubella infection in pregnant women during a 1-year period. In total 476 women were investigated of whom 221 were tested for rubella IgM. Both techniques gave positive results with 64 sera, and RIA alone with one additional serum. Difficulties associated with the removal of non-specific HI activity were encountered with four sera all of which were negative by RIA. RIA was found to have practical advantages over the gel filtration method but is at present technically more difficult to perform.

Trypsinised human O erythrocytes in the detection of rubella-specific IgM by sera fractionation on sucrose density gradient and absorption with staphylococcal protein A

Detection of rubella virus-specific IgM employing trypsin-treated human group O erythrocytes was evaluated using the method of sera fractionation on sucrose density gradients (SDG) and that of sera absorption with staphylococcal protein A. The former method proved to be highly specific and sensitive in confirming or excluding rubella by demonstration of specific IgM. In contrast, the latter method provided comparable results in only 71.43% of specimens tested by both methods while false-positive or -negative IgM results were obtained in the remaining 28.57% of specimens. In view of these results, therefore, it is recommended that all those specimens found positive for specific IgM by the protein A method must be confirmed by another procedure, possibly that of specific IgM reduction with 2-mercaptoethanol.

IgM responses to hepatitis-A virus and hepatitis-B core antigen in acute and chronic liver disease in Malawi; possible role of non-A, non-B, hepatitis

Of 33 patients with acute hepatitis in Malawi, 21 had infection by hepatitis-B virus (HBV), five by hepatitis-A virus (HAV) and seven, who had no markers of current HBV or HAV infections, were probably infected by the agent(s) of non-A, non-B, hepatitis. 87 of 88 sera from persons without liver disease contained antibody to HAV and 49 antibody to hepatitis-B surface antigen (anti-HBs) (six were positive for hepatitis-B surface antigen). The diagnosis of recent infection by HAV was made by detecting HAV-specific IGM in single serum samples and, although such tests showed that HAV caused acute hepatitis, its absence in patients with chronic liver disease suggests that, unlike HBV, infection by HAV does not play a role in chronic liver disease in Malawi. Anti-hepatis-B core antigen (anti-HBc)-specific IgM was detected in 19 of 21 patients with acute HBV infection, in three of five HbsAg-positive patients with cirrhosis, but in none of five HbsAg-positive patients with hepatoma.

Seroepidemiology of rubella infection in Chinese and Caucasians in Hong Kong

The seroepidemiology of rubella infection in Hong Kong Chinese was examined by haemagglutination inhibition of normal sera and a comparison made where feasible with Caucasians living in Hong Kong. Taking reciprocal titre of 20 as a baseline, the incidence of maternally acquired antibody was 84% for Chinese and 90% for Caucasians. In babies up to 2 months this incidence was maintained in Caucasians but declined to 54% in Chinese. High titre antibody was more frequently detected in Caucasians generally, including women of child-bearing age. The detection of rubella-specific IgM in the Caucasian babies was suggestive of recent maternal infection. However, fewer Caucasian (20%) than Chinese (36%) women of child-bearing age (15-40 years) appeared unprotected against rubella. When all age groups were considered, 88% of Caucasians and 53% of Chinese were seropositive. The occurrence of a rubella outbreak during the study did not give rise to a significant increase in the incidence of seropositivity in Chinese 19-25 years, the only age group able to be evaluated in this manner. The ethnic differences in seroepidemiology are considered in the light of known HLA-1 and HLA-8 antigen distributions in Caucasian and Mongoloid people and the apparently low incidence of congenitally acquired rubella in Chinese.

Use of the ultracentrifuge vertical rotor in the detection of rubella-specific IgM on a sucrose density gradient

A comparison was made of the performance of swing-out and vertical ultracentrifuge rotors in the detection of rubella-specific IgM on a sucrose density gradient. Tests were performed on 30 sera, of which 11 were found to contain rubella-specific IgM by both methods. The centrifugation time for the swing-out rotor was 16 hours at 35,000 rpm. This was reduced to 2 hours using the vertical rotor at 50,000 rpm. Routine use of the vertical rotor would allow a reduction in the time taken to perform the test, increase the number of sera tested each time, and reduce wear on the ultracentrifuge.

Diagnosis of postnatal rubella by the enzyme-linked immunosorbent assay for rubella IgM and IgG antibodies

A semi-automated enzyme-linked immunosorbent assay (ELISA) was established for the detection of rubella IgM antibodies in non-fractionated sera. A cut-off level between rubella IgM positive and negative sera was determined by a study of sera without rheumatoid factor from 200 blood donors. Testing of 12 donor sera containing rheumatoid factor showed that 5 sera gave a positive result in the rubella IgM assay. Rubella IgM antibodies were quantified by ELISA in a study of 214 serial serum specimens drawn from 16 patients with rubella during a period of up to 10 years after the infection. Peak values of the IgM antibodies were reached approximately 8 days after onset of the rash, and the persistence of the IgM antibodies ranged from 17-90 days, with the exception of one patient with a prolonged IgM response. The rubella IgG antibodies increased slowly after the rash and reached maximum levels about 50-120 days, after which a monor decrease was observed. The results of the present study indicate that ELISA is suitable as a routine procedure for the serodiagnosis of recent rubella.

Astrovirus-associated gastroenteritis in children

In a small astrovirus-associated outbreak of gastroenteritis in a ward of a local children's hospital two out of five children with symptoms excreted astrovirus particles. No astrovirus particles were found in faeces from the remaining asymptomatic child, and no other viral or bacterial pathogens were found in any of the children. Virus excretion persisted for only a few days. Rising antibody titres to the astrovirus particles were demonstrated in one child, and IgM was also demonstrated in this patient's serum.

Immunological response to infection with human reovirus-like agent: measurement of anti-human reovirus-like agent immunoglobulin G and M levels by the method of enzyme-linked immunosorbent assay

The report describes the development of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against the human reovirus-like agent of infantile gastroenteritis (HRVLA). This ELISA system proved to be four times as sensitive as the standard anti-HRVLA fluorescent-antibody assay and ten times as sensitive as the standard anti-HRVLA complement fixation assay. In addition, the ELISA was capable of determining immunoglobulin G (IgG) and IgM subclasses of anti-HRVLA antibody using a single dilution os serum. With this assay, it was discovered that 11 of 21 infected children had anti-HRVLA IgM in their acute sera before the appearance of anti-HRVLA IgG. ELISA is a useful tool in the evaluation of immunological response to HRVLA infection.

Evaluation of a simplified sucrose gradient method for the detection of rubella-specific IgM in routine diagnostic practice

Rubella-specific IgM was measured in a single fraction of serum from a sucrose density gradient. Haemagglutination inhibition (HAI) tests were performed on paired aliquots of the fraction untreated and after treatment with 2- mercaptoethanol, dilutions of the aliquots being incubated over night with rubella antigen before the addition of red cells. Of 822 sera tested, specific IgM was found in 249, but not in 492. When first tested, the remaining 81 sera gave unsatisfactory results because of contamination of the IgM fraction with IgG (6.0%), probable aggregation of IgG (3.5%), or the persistence of chick red cell agglutinins (0.4%). Tests were performed on 134 patients with rubella confirmed by a rise of HAI antibodies. Rubella-specific IgM was found at a titre of more than eight in the sera taken from 62 of 64 patients between 10 and 29 days after the onset of the rash but in only one of the sera taken between 80 and 119 days, and in none taken later. However, specific IgM was still to be found at lower titre in the sera of 13 patients collected between 80 and 162 days after the onset of the illness. In routine diagnostic tests over three years on the serum from 479 patients with suspected acquired rubella, specific IgM was found at a titre of more than eight in 51 patients and in only 10 instances (2.1%) did a lower level pose a problem in interpretation.

The IgM antibody responses to the core antigen of hepatitis B virus

Little is known about the immunoglobulin class of antibodies to HBcAg. In the present study sera containing anti-HBc were fractionated by surcose density-gradient centrifugation, and all serum fractions were tested against HBcAg by immunoelectro-osmophoresis. In addition selected fractions were examined by complement fixation test, immune adherence hemagglutination and immune electron microscopy. Anti-HBc activity in IgG serum fractions was demonstrated by all four techniques used, but HBcAg-specific IgM was detected only by immunoelectro-osmophoresis and by immune electron microscopy. In acute hepatitis B, HBcAg-specific IgM was detected for up to eight weeks after the onset of jaundice. It was also found transiently in two patients who developed chronic hepatitis B without an icteric episode and in one out of thirteen patients with HBsAg-positive chronic liver disease, but in none of eight healthy HBsAg carriers. The results suggested that HBcAg-specific IgM is formed transiently in response to primary HBV infection but is generally undetectable in established HBsAg carriers.

Persistence of immunoglobulin G and immunoglobulin M antibodies after postnatal rubella infection determined by solid-phase radioimmunoassay

The appearance and persistence of immunoglobulin M (IgM) and IgG antibodies in postnatal rubella infections were studied by employing a solid-phase radioimmunoassay test. Altogether, 222 serial serum specimens from 51 patients with acute rubella infection were tested. Both IgG and IgM antibodies developed rapidly and appeared in all patients within 4 days after the onset of rash. In some patients, the IgM antibodies clearly preceded the IgG antibodies; however, the reverse situation was also noticed in a few cases. The IgG antibodies showed only minor changes after 8 to 10 days from the onset of rash. The IgM titers also reached a maximum level at approximately 8 to 10 days after the onset of rash, after which time a rapid decrease was normally seen. The mean half-life of IgM antibodies after 15 days from the onset of rash was 4.5 days, giving for IgM antibodies persistence times from 43 to approximately 80 days. Two patients with a prolonged IgM antibody response were detected. One of these patients had bilateral arthritis of the knee as a complication, whereas in the other patient no complication caused by rubella virus was detected. The IgM antibody response and its value in diagnosis are discussed.

Evaluation of a new test system for rubella haemagglutination inhibiting antibodies

A recently available kit for the determination of rubella haemagglutination inhibiting antibodies (Rubindex, Ortho diagnostics) was was compared with the method used routinely in this laboratory. Rubindex compared favourably in that no significant difference in titre was found in 95.1% of 287 sera tested. Difficulty occurred with some sera from cases of Mycoplasma pneumoniae infection, rheumatoid arthritis, and a small number of normal sera containing human "O" cell agglutinins. This was overcome by treatment of the sera with 2-mercaptoethanol. Rubindex had the advantage that all reagents were provided in kit form and the trypsinised human "O" cells provided had a longer shelf life than chick erythrocytes.

BK antibody and virus-specific IgM responses in renal transplant recipients, patients with malignant disease, and healthy people

Haemagglutination-inhibition (HAI) antibodies to BK virus, including BK-virus-specific IgM, were determined before and after renal transplantation in 20 patients, in 57 patients with malignant disease, and in 66 healthy controls, Before transplantation 11 of the renal transplant recipients were seronegative, but eight later serocconverted, two before and six after transplantation. Twenty of the patients with malignant disease and 22 controls were also seronegative. The geometric mean titre of BK HAI antibodies was significantly higher among transplanted patients (1/180) than among controls (1/90). BK-virus-specific IgM antibody was detected in seven renal transplant recipients, six patients with malignant disease, and 13 healthy controls. In transplant recipients BK-virus-specific IgM antibody usually persisted throughout the duration of the study, and studies on controls from whom second serum samples were available suggested that they too had persistent BK-virus-specific IgM responses. The geometric mean titre of BK-virus-specific IgM HAI antibody was significantly greater in post-transplantation sera (1/223) than in control sera (1/28). The specificity of the detection of BK-virus-specific IgM HAI antibody was confirmed by direct visualisation of antibody by immune electron microscopy. The persistence of BK-virus-specific IgM suggested that BK virus continued to provide an antigenic stimulus. Nevertheless, there was no obvious association between the serological findings and any clinical features, and prospective studies will be needed to elucidate any such association.

Modified staphylococcal absorption method used for detecting rubella-specific immunoglobin M antibodies during a rubella epidemic

A recently described method for detecting rubella-specific immunoglobulin M (IgM) antibody based on absorption of IgG by Staphylococcus aureus strain Cowan I has been applied to 198 sera collected during a recent rubella epidemic in Israel. Modification of the original method introduced for the present study includes treatment with 2-mercaptoethanol of antibody remaining after absorption by staphylococci. This treatment confirms that the residual antibody is IgM (sensitive to 2-mercaptoethanol) rather than IgG (2-mercaptoethanol resistant). None of the 67 control patients (seropositive for rubella but without history of recent illness or contact) had specific IgM when tested by this method, though 15 showed some residual antibody after staphylococcal absorption. A total of 125 of 131 rubella convalescents (95%) were positive 4 to 49 days after onset of the clinical symptoms. Six patients had no IgM antibodies when tested by the method described, and all were convalescents tested late in relation to onset of clinical symptoms (beyond 3 weeks). When density gradient centrifugation was applied to clarify some results, 2 of 3 convalescents classified as IgM negative by the staphylococcal absorption method did in fact possess IgM antibody. None of 10 controls tested by density gradient centrifugation was IgM positive. This combination of staphylococcal absorption and 2-mercaptoethanol treatment is recommended as a screening test for selection of IgM positives, in addition to the use of a more sensitive method (such as density gradient centrifugation) on at least some samples classified as IgM negative.

Comparison of human fecal and serum parvo-like viruses

Parvovirus-like particles found in the sera of two blood donors had the size and appearance on electron microscopy of a virus (B19) found in the serum of a blood donor by Cossart et al. (1975), and those of a virus found in the feces of a normal subject. Antibody to these viruses was detected by immune electron microscopy and immunoelectro-osmophoresis in the sera of 50 children aged 10 to 15 years. Of these, 36% had antibody to the fecal virus, 36% had antibody to B19, and 54% had antibody to the two other serum viruses. The results of these tests suggest that serologically the three serum viruses were similar to one another, but that the fecal virus was distinct. The two blood donors had nonspecific symptoms at the time of viremia. Both donors had developed immunoglobulin M antibody to the virus when tested 3.5 and 4.5 weeks later, but no viruses were detected in the feces or urine.

Specific immunoglobulins in infants with the congenital rubella syndrome

The indirect immunofluorescent technique has been used to detect and titrate the specific immunoglobulins in serum specimens from 154 infants with confirmed or suspected congenital rubella. IgM antibody was stained more efficiently in sucrose density gradient fractions than in whole serum and was detected in this way in 27 out of 40 patients with confirmed congenital rubella at ages ranging from birth to 2 years. It was present in 48 out of 50 serum specimens during the first 6 months of life and in 11 out of 38 specimens obtained at ages between 6 1/2 months and 2 years. IgM antibody was therefore estimated to persist for about 6 months in the majority of cases and up to 2 years in a few individuals. IgM antibody was also detected by this method in 11 out of 114 infants with suspected but unconfirmed congenital rubella at ages up to 5 months. The total concentrations of IgM were above the normal range in nearly all sera taken from confirmed cases during the first 3 months of life and in half the specimens obtained between the ages of 3 and 6 months. IgG antibody was detected by fluorescent staining of whole serum in all patients with congenital rubella. Geometric mean titres increased during the first 3 months of life and then declined slowly. IgA antibody was not detected, except in two patients in whom traces were present at the age of 6 months, and the total concentrations of IgA were usually within normal limits. Fluorescent staining of fractions showed that the sedimentation characteristics of rubella IgG and IgM antibodies were the same in infants as in adults. The peak IgM fractions never contained IgG antibody, and the presence of specific IgM in these fractions could usually have been safely inferred from their HAI titres. Fluorescent staining, however, was more sensitive and frequently detected IgM antibody in fractions which had no definite HAI activity. Fluorescent staining of whole serum for IgM antibody was less distinct, and often unsuccessful, even in specimens in which specific IgM was detected in the fractions. The addition of IgG- to IgM-containing fractions caused depression of IgM staining and suggested that failure to detect IgM antibody in whole serum was partly due to competitive inhibition by specific IgG.

Immunofluorescence test for IgM rubella antibodies in whole serum after absorption with anti-gammaFc

A technique for detecting IgM rubella antibodies by immunofluorescence was developed. Total serum IgG was removed by prior immunoabsorption with anti-gammaFc. This prevents interference by rheumatoid factors in the serum. The test appeared sensitive and specific in sera of rubella convalescents and infants with congenital rubella.

Elution patterns of rubella IgM, IgA, and IgG antibodies from a dextran and an agarose gel

The elution pattern of serum proteins and the distribution of rubella HAI activity in 95 sera from 65 cases were determined after gel filtration with (a) Sephadex G-200 and (b) Bio-Gel A-5M. Rubella HAI antibody in peak 1 after Sephadex G-200 fractionation of early convalescent sera consists of both IgM and high molecular weight IgA. However, these two classes of antibody can be distinguished by gel filtration with Bio-Gel A-5M. Bearing these differences in mind, the results of fractionation with the two gels correlate very well although the use of Bio-Gel A-5M gives a slightly less sensitive technique for the diagnosis of recent infection.