Immunoglobulin E antibodies against Staphylococcus aureus cell walls in the sera of patients with hyperimmunoglobulinemia E and recurrent staphylococcal infection

The immunopathogenesis of staphylococcal skin infections - A review

Staphylococcus aureus and S. pseudintermedius are the major causes of bacterial skin disease in humans and dogs. These organisms can exist as commensals on the skin, but they can also cause severe or even devastating infections. The immune system has evolved mechanisms to deal with pathogenic microorganisms and has strategies to combat bacteria of this type. What emerges is a delicate "peace" between the opposing sides, but this balance can be disrupted leading to a full blown "war". In the ferocious battle that ensues, both sides attempt to get the upper hand, using strategies that are comparable to those used by modern day armies. In this review article, the complex interactions between the immune system and the organisms are described using such military analogies. The process is described in a sequential manner, starting with the invasion itself, and progressing to the eventual battlezone in which there are heavy casualties on both sides. By the end, the appearance of a simple pustule on the skin surface will take on a whole new meaning.

Nematode infections are risk factors for staphylococcal infection in children

Nematode infection may be a risk factor for pyogenic liver abscess in children and we hypothesized that the immunomodulation induced by those parasites would be a risk factor for any staphylococcal infection in children. The present study was designed to compare, within the same hospital, the frequency of intestinal nematodes and Toxocara infection in children with and without staphylococcal infections. From October 1997 to February 1998, 80 children with staphylococcal infection and 110 children with other diseases were submitted to fecal examination, serology for Toxocara sp., evaluation of plasma immunoglobulin levels, and eosinophil counts. Mean age, gender distribution, birthplace, and socioeconomic conditions did not differ significantly between the two groups. Frequency of intestinal nematodes and positive serology for Toxocara, were remarkably higher in children with staphylococcal infections than in the non-staphylococcal group. There was a significant correlation between intestinal nematodes or Toxocara infection and staphylococcal infection in children, reinforced by higher eosinophil counts and higher IgE levels in these children than in the control group. One possible explanation for this association would be the enhancement of bacterial infection by the immunomodulation induced by helminth infections, due to strong activation of the Th2 subset of lymphocytes by antigens from larvae and adult worms.

Pathology of pyogenic liver abscess in children

Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children.

A syndrome characterized by nodular eosinophilic infiltration of the skin and immunoglobulin isotype imbalance

A 9-year-old boy had recurrent acute, plaquelike, nodular infiltrations with overlying vesicles and bullae of the face and right hand. Histologically, the lesions consisted of a perivascular and periadnexal lymphohistiocytic infiltrate with many eosinophils. The lesions responded to dapsone therapy. Laboratory studies revealed blood eosinophilia, hyperimmunoglobulinemias E and G4, and hypoimmunoglobulinemias M and G1-3, which normalized after treatment. The patient's immune deviation is consistent with a transient imbalance of lymphokine production in helper T cells.

Strategies for management of recurrent pyoderma in dogs

Staphylococcal skin infection (pyoderma) is a common clinical problem in dogs. The infection can be either superficial or deep. Most cases of staphylococcal pyoderma occur secondary to a definable underlying cause. Treatment consists of finding the underlying cause and correcting it, if possible, and treating the pyoderma with antibiotics. Antibacterial shampoos may be used as adjunct treatment, but corticosteroid drugs should not be used. When canine pyoderma recurs in the absence of an identifiable underlying cause, several treatment strategies can be effective in eliminating recurrence or limiting its severity. Frequent antibacterial shampoos are an easy and sometimes effective method. Immunomodulatory drugs are variably effective. Some commercially available bacterins are clearly helpful in treating recurrent pyoderma. As a last resort, the clinician may opt to keep the patient on long-term antibiotic therapy. Such therapy may promote development and dissemination of resistant strains of Staphylococcus and should be used only if absolutely necessary.

Immunoblotting of a Staphylococcus aureus DNA library as a tool for isolating potential antigenic proteins

A Staphylococcus aureus DNA library was created in the lambda vector EMBL4 and expressed in Escherichia coli strain Y1090. Plaques were screened using serum from a S. aureus-infected patient. A number of positive clones that expressed proteins recognised by serum antibodies were further analysed using Western blots of total lysates from cultures infected with the lambda clones. Differences were found between patient and control sera in both the specificity and titre of anti-S. aureus antibodies. Expressed staphylococcal proteins appeared to be stable and were easily distinguishable from E. coli proteins in the Western blot. This method may have applications in specifically selecting clones encoding antigens associated with infection and may be of potential use clinically.

Increased in vitro cell-mediated immune response to staphylococcal antigens in atopic dermatitis

Atopic dermatitis patients have both a chronic colonization of their skin with Staphylococcus aureus and a delayed cutaneous hyporesponsiveness to intradermally injected staphylococcal antigens. It has not been established whether the cutaneous anergy merely reflects a specific lymphocyte hyporesponsiveness to staphylococcal antigens. Therefore the lymphocyte proliferative response to staphylococci was assessed in twelve patients with slight to severe atopic dermatitis and in eleven healthy subjects. Compared to the normal subjects, the patients showed significantly higher stimulation indices with S. aureus Wood 46 (p less than 0.05) and purified S. aureus cell walls (p less than 0.05). There was no significant correlation between the lymphocyte stimulation and the clinical severity of the disease. Therefore, chronic colonization of the skin of atopic dermatitis patients by S. aureus does not correlate with a defect in the cellular immune response to the bacteria but may rather stimulate such a response.

Abnormal humoral immune response to Staphylococcus aureus in patients with Staphylococcus aureus hyper IgE syndrome

Patients with the S. aureus hyper IgE syndrome (SAHIGES) have an abnormal IgE response to cell wall and surface antigens of S. aureus. In this paper we describe the detection of IgE antibodies to soluble antigens of staphylococci (S. aureus and S. epidermidis) and qualitative abnormalities of the IgG response to soluble S. aureus antigens in patients with SAHIGES. These findings may be of pathogenetic importance and help to delineate SAHIGES from other diseases.

Nasal carriage of Staphylococcus aureus and antistaphylococcal immunoglobulin E antibodies in atopic dermatitis

Twelve atopic dermatitis patients were studied to investigate the relationship between levels of antistaphylococcal immunoglobulin E antibodies in serum and quantitative cultures of Staphylococcus aureus strains from the anterior nares and chronic lesions. A positive correlation was found between logarithmic counts of S. aureus strains from the anterior nares and levels of antistaphylococcal immunoglobulin E in serum. The observation is important for understanding the pathophysiology of atopic dermatitis.

Plasma separation in patients with bronchial asthma, atopic dermatitis and hyperimmunoglobulinaemia E

The effect of intensive plasma separation performed eight times within 5 weeks in four patients with atopic dermatitis, bronchial asthma and hyperimmunoglobulinaemia E was followed as regards clinical symptoms and changes in the concentrations of serum (S) IgE, S IgG, S IgA, S IgM, plasma complement C3 split products, S transferrin, blood eosinophils, chemotaxis of neutrophil cells and histamine metabolites in urine in samples obtained consecutively during the period of observation. The occurrence of circulating immune complexes (IC) was analysed by a polyclonal rheumatoid factor (pRF) agglutination inhibition assay and an IgE IC specific technique. IgE IC were demonstrated in three of the patients prior to plasma separation, complexed IgE was 2-3% of the total concentration of S IgE. In one patient complexes were detected by the pRF agglutination inhibition assay, also. In the three patients with IgE IC, the complexes disappeared during treatment, but recurred in two of the patients shortly after the last plasma separation. Shortly after eight separations the S IgE was reduced in all patients to a mean level of 46% of the pre-exchange concentrations. During the following 3 weeks the relative increase of S IgE in three of the patients was similar to the values obtained for S IgG. Serum IgG was subnormal in all patients during the period of treatment. Increasing numbers of eosinophils were observed in three of the patients after the fifth separation procedure. The histamine metabolite 1,4-methylimidazoleacetic (1,4- MIAA ) in urine was increased in all patients, but no significant changes were observed during the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous and pokeweed mitogen-induced in vitro IgG production specific for S. aureus cell wall determinants in man

A system has been established to produce in vitro IgG specific for cell wall determinants of S. aureus by human peripheral blood mononuclear cells (PBMC). PBMC of healthy individuals, of patients with S. aureus infections and of patients with other bacterial infections were cultured for 12 days. In the culture supernatants (SN) total IgG was determined by a competitive RIA, and IgG to purified cell walls (PCW) of S. aureus strain H by a two step ELISA. PBMC of 11 healthy persons produced anti-PCW IgG upon stimulation by pokeweed mitogen (PWM). This indicates the presence in some healthy persons of circulating B cells which can be induced in vitro to synthesize PCW specific IgG. PBMC of S. aureus infected patients, however, synthesized anti-PCW IgG in culture medium alone. This is the first description of spontaneous in vitro production of specific IgG during a bacterial infection and may be analogous to short phases of spontaneous specific IgG production described after immunizations and viral infections. Finally, compared to healthy individuals, an increased total IgG synthesis in vitro by PBMC obtained from patients with S. aureus and from patients with other severe bacterial infections was found. It is concluded that this polyclonal B cell activation has been initiated in vivo. Its biological significance is unknown.

Specific immunoglobulin A antibodies to a peptide subunit sequence of bacterial cell wall peptidoglycan

Immunoglobulin A (IgA) antibodies in human sera with binding specificity for the C-terminal R-D-Ala-D-Ala sequence of the precursor peptide from bacterial cell wall peptidoglycan were detected by an enzyme-linked immunosorbent assay (ELISA). Specificity of the test system was proved by comparing the high binding of specific IgA to albumin-(D-Ala3) as an antigen with the failure to bind to albumin-(L-Ala3), by binding inhibition studies with L-Ala3, D-Ala3, or peptides with structural analogy to peptidoglycan peptide subunit peptides as inhibitors, and by excluding binding of peroxidase-labeled anti-human IgA to immunoglobulin classes others than IgA. Interference of rheumatoid factors of IgA class was excluded by an ELISA for assaying IgA-rheumatoid factor and by the fact that an IgA fraction essentially free of IgG and IgM was isolated from a serum reacting strongly positive in the ELISA for measuring specific IgA to the peptide subunit of peptidoglycan. This isolated IgA again exhibited binding specificity in the ELISA, thus corroborating the existence of specific IgA in human serum to the C-terminal R-D-Ala-D-Ala sequence of peptidoglycan precursor peptide. The existence of IgA antibodies with specificity for bacterial peptidoglycan was further proved by preadsorption of serum to peptidoglycans and subsequent measurement of specific IgA in the ELISA. Screening of human sera for IgA antibodies with specificity for R-D-Ala-D-Ala peptides revealed that specific antibodies directed against this sequence of bacterial cell wall peptidoglycan may be detected in several human sera.

Whole organisms and purified cell walls compared as immunosorbents for the detection of IgE antibodies to Staphylococcus aureus

We have developed an immunoradiometric assay for IgE antibodies to Staphylococcus aureus (Staph IgE-Ab) which uses purified cell walls (PCW) from the Wood 46 strain of S. aureus as an immunosorbent. We compared Wood 46 PCW and whole organisms (WO) as immunosorbents for Staph IgE-Ab by performing tests on sera from patients with atopic dermatitis (AD) or the hyperimmunoglobulin E syndrome (hyper IgE syndrome). Sera with Staph IgE-Ab demonstrated dose-dependent binding to PCW and WO, but the ratio of specific to non-specific binding was much greater with PCW. Mean non-specific binding to WO was greater than to PCW, 5% versus 2%; and non-specific binding to WO varied directly with the serum concentration of IgE. Results of tests on patients' sera indicated that PCW are required in screening assays for Staph IgE-Ab to avoid false positive results caused by high levels of non-specific binding to WO.

Studies on bacterial hypersensitivity in man. Interrelationship between skin reactions to bacterial peptidoglycan and serum peptidoglycan antibody titers

The nature and extent of bacterially induced allergies are difficult to define. Since peptidoglycan, the main component of the cell wall of almost all bacteria, has been available in a highly purified, chemically and immunologically well-defined form, investigation of the allergological significance of this cell component is feasible. Intracutaneous tests were carried out on 181 test subjects with five different peptidoglycan (PG) preparations from Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus Pyogenes. The results of the investigation were compared with the result of determination of serum PG antibodies and serum IgE concentrations. It was shown that test subjects with dual and later reactions to three different staphylococcal PGs displayed significantly higher PG antibody titers than test subjects with negative reactions. Such a relationship could not be found with the cutaneous reactions to streptococcal PG. The total serum IgE values were very much higher in test subjects with immediate reactions to staphylococcal PG than in test subjects with a negative reaction. Typical Arthus reaction or late granulomatous reactions were not observed. Humoral antibodies are involved at least in part in the elicitation of dual and late reactions. Thus, there are interesting parallels to allergy to fungal spores and organic dusts.

Immunoglobulin E anti-Staphylococcus aureus antibodies in atopic patients

Sera from 56 patient and normal adults were examined to quantitate total immunoglobulin E (IgE) and IgE antibodies to Staphylococcus aureus and Staphylococcus epidermidis. Patients were divided into six groups based on clinical symptoms; a seventh group consisted of normal adults. Anti-S, aureus IgE binding was significantly higher in three groups of patients (those with eczema, those with or without series staphylococcal abscesses, and allergic patients with staphylococcal skin infections) than it was in the control group. Patients with high IgE due to allergies or parasitic infections without staphylococcal infections and patients with low or normal IgE and serious staphylococcal infection showed low levels of binding. The assay measured specific binding of IgE to bacterial antigens.

Factors affecting complement activation by Staphylococcus aureus cell walls, their components, and mutants altered in teichoic acid

In a previous study, Staphylococcus aureus purified cell walls (PCW), consisting of peptidoglycan (PG) plus covalently linked teichoic acid (TA), were found to be more active in complement consumption than isolated PG. Isolated TA has now been shown to be capable of activating complement. Mild sonication markedly increased the ability of PG to activate complement but had essentially no effect on the activities of PCW and TA. Optimal sonication of PG did not yield activities equal to those of PCW in dose-response and kinetic studies, which may imply that TA plays some role in complement consumption. Sonication did not lead to solubilization of PCW or PG but may have enhanced the activity of PG in complement consumption by better dispersing PG particles, thereby exposing more surface area. Lysostaphin solubilization of PCW and PG markedly decreased their activities in complement consumption. The PCW of an S. aureus TA-deficient mutant, which were mostly PG, caused similar amounts of complement consumption as the parent strain PCW. Of the treatments of PCW commonly used to isolate PG, formamide and periodate extractions in particular led to PG preparations with lower activities in complement consumption than the PCW from which they were prepared, although these activities were stimulated by sonication. When whole organisms were studied by using a TA-deficient mutant, a mutant with an additional cell surface polymer, and the TA-containing parent strains and complement consumption by these strains was compared, no difference was found in either the rate or the degree of complement activation. This led to experiments demonstrating that both material released extracellularly from staphylococci and the cytoplasmic fraction of S. aureus were active in complement consumption. The results of these experiments indicate that both physical and chemical factors must be considered in studies of complement activation by isolated bacterial cell wall components. Under certain conditions, staphylococcal TA may enhance complement activation, but studies with whole organisms clearly show that this cell wall constituent does not play an essential role in this process. In addition, studies of complement consumption with intact organisms have demonstrated that there may be contributions both from cell surface components and from material released by the cells.