Solid-phase radioimmunoassay of serum immunoglobulin A antibodies to respiratory syncytial virus and adenovirus

Application of ELISA for IgM, IgA and antigen detection for rapid diagnosis of respiratory syncytial virus infections: a comparative study

BACKGROUND

Infection with Respiratory Syncytial Virus (RSV) can be rapidly diagnosed by detection of viral antigen in nasopharyngeal secretions (NPS) or serologically by detecting IgM and IgA antibodies.

OBJECTIVES

To evaluate the above methods for reliability and rapidity, and compare them with the complement fixation (CF) test and virus isolation.

STUDY DESIGN

Viral antigen was tested in 145 NPS samples by ELISA in parallel with tissue culture isolation. The geometric mean titer (GMT) of complement fixing antibodies in various age groups was determined from 92 individual serum samples by CF test. The diagnostic methods, CF test, ELISA-IgM and ELISA-IgA, were evaluated using 21 pairs of acute and convalescent sera. Appearance of IgM and IgA in serum samples with low or negative CF titers was studied in two age groups: 0-10 months (n = 82), and 11 months-9 years (n = 47).

RESULTS

From the 145 NPS samples, 20 samples were positive by both ELISA and virus isolation, 9 were positive only by ELISA and 5 were positive only by virus isolation. The GMT by age group for 92 sera evaluated by CF test were 40 (0-10 months), 195 (11-24 months), 269 (2-4 years), 173 (5-12 years) and 132 (adults). Among the 21 paired sera examined, CF test detected 13 RSV infections by antibody rise or seroconversion while the ELISA-IgM/IgA tests identified all 21 infections, 7 of them in the first sample. The presence of IgM alone or IgM and IgA antibodies was demonstrated in both age groups examined; however, IgA alone was found only in the age group 11 months and older.

CONCLUSIONS

ELISA for antigen detection is better than virus isolation because it is faster (6-20 h vs. 3-20 days, respectively) and more sensitive (29/34 vs. 25/34 positives, respectively). ELISA-IgM and ELISA-IgA was more sensitive and reliable than the CF test, particularly for the 0-10 month age group. Thus, when necessary, serological diagnosis of RSV infection can be based on the presence of IgM and/or IgA antibodies in serum samples obtained early after onset of symptoms.

Detection of enterovirus-specific total and polymeric IgA antibodies in serum using a synthetic peptide or heated virion antigen in ELISA

The presence of enterovirus-specific total and polymeric IgA antibodies was assessed in serum from different groups of patients and healthy controls by indirect ELISA using heated virions and synthetic peptide, both enteroviral broad reactive antigens. Total IgA antibody response against a synthetic peptide, representing an enterovirus group-common epitope, was detected in 52% of the patients with an acute enterovirus infection and in 12% of the patients with other infections (P = 0.02). We also found a significant difference (P = 0.005) in the prevalence of peptide IgA antibodies between serum samples collected from blood donors during summer (20%), the prevalent season of enterovirus infections, and winter (6%). A polymeric IgA activity against the peptide was detected in only three patients with an enterovirus infection. In contrast, when a heated coxsackie B5 (coxB5) virus antigen was used, the prevalence of total serum IgA antibodies was not significantly different between patients with an acute enterovirus infection and patients with other infections (71% vs. 53% respectively; P = 0.3). Also no difference was found between the two groups of blood donors (47% in summer vs. 51% in winter; P = 0.7). However, the prevalence of serum polymeric IgA antibodies against coxsackie B5 antigen was significantly greater (P = 0.02) in patients with an acute enterovirus infection (57%) than in patients with other infections (18%). These findings suggest that the presence (18%). These findings suggest that the presence of total peptide-IgA or of polymeric coxsackie B5-IgA in serum is a specific marker of acute enterovirus infection. Finally, we show that the total peptide-IgA- and polymeric coxsackie B5-ELISAs may have a diagnostic value for the serodiagnosis of enterovirus infections when they are used in combination with enteroviral IgG-ELISA.

Antibodies against varicella-zoster virus and herpes simplex virus deoxythymidine kinase in heterologous infections

Antibody responses to varicella-zoster virus (VZV) deoxythymidine kinase (dTK) and herpes simplex virus (HSV) dTK in homologous and heterologous infections were studied. Antibodies blocking the enzymatic activity of VZV-dTK appeared late after varicella and decreased more or less in parallel with the decreasing complement fixing [CF] titre. In herpes zoster, on the other hand, antibodies to VZV-dTK appeared soon after infection. Antibodies against HSV dTKs appeared long after primary infection, but they were subsequently present in all other HSV-CF positive sera. In recurrent HSV, all acute sera were already HSV-dTK antibody positive, and three of nine persons showed an increase in titer between their acute and convalescent sera. Blocking antibodies to VZV-dTK appeared rapidly in specimens from three of 18 individuals positive by an immunofluorescence VZV-immunity test during HSV infection, whereas all other specimens remained devoid of blocking antibodies against VZV-dTK. A rise in antibody titre against HSV-dTK during VZV infections was observed in serum specimens from three of 13 HSV-CF positive patients, whereas an antibody response against HSV-dTK was not found in HSV-CF negative individuals in connection with VZV infections. The relevance of the sporadic increase in the titres of antibodies against heterologous viral dTKs is discussed.

Specific serum IgA, IgG and IgM antibody determination by a modified indirect ELISA-technique in primary and recurrent herpes simplex virus infection

Twenty-three patients with a herpetic infection as diagnosed by a positive culture of herpes simplex virus (HSV) were studied with respect to serological responses of IgA, IgG and IgM antibodies in paired serum samples by an indirect (sandwich) enzyme linked immunosorbent assay (ELISA). Eight of the patients had a primary infection and 15 a recurrent one. In the ELISA test a detergent treated cell lysate of HSV type 1 was used as antigen. In the IgM assay all sera were pretreated with antihuman IgG with the purpose to precipitate IgG of the samples. The conjugate was a F(ab)2-fragment of antihuman-IgM. In primary infections all patients had significant titre rises of IgG and presence of high IgM titres in the convalescent serum. IgA antibodies were found in all of them, while titre rises were detected in 5/8. In recurrent infections titre rises of IgG and IgA antibodies were found in 4 and 5, respectively. Six had detectable IgM in one or both of the paired samples. The IgG titres were higher in recurrent infections than in primary, in contrast to IgM of which much higher titres were found in primary infections. It is concluded that in primary infections a conclusive serological diagnosis was established in all patients, whereas in recurrent infections this was achieved in two of three patients. The indirect ELISA method used for IgM detection was sensitive, reliable and convenient. Interfering rheumatoid factor was effectively eliminated by treatment with antihuman IgG.

Rapid etiological diagnosis of pneumonia in young men

The major findings and conclusions of the present study are: 1. Evidence of the etiology of the pneumonia was established in 86% of 106 young men with pneumonia. Pneumococcus was the most common etiologic agent; it was detected definitely in 30% of the pneumonia patients, and possibly in another 20%, by blood culture, sputum culture, antigen detection, and serological methods. 2. Pneumococcal antigen detection from purulent pretreatment sputum samples was the best rapid diagnostic method for pneumococcus; it was capable of identifying 90% of the pneumococcal pneumonias definite by our criteria, whereas sputum Gram stain was positive in 65% of these. 3. Detection of adenoviral antigens from nasopharyngeal specimens (NPS) by EIA or IF method or adenovirus DNA by HYB method showed good specificity but a somewhat lower sensitivity than did adenovirus isolation from NPS. 4. Adenovirus antigens and DNA can be demonstrated also from sputum specimens. 5. EIA is slightly superior to the CF method in detecting antibody responses to adenovirus, but the detection of different antibody classes offers no additional diagnostic possibilities. 6. Isolation of Mycoplasma pneumoniae from bronchoalveolar fluid in pneumonia patients is a specific and sensitive method in the diagnosis of mycoplasmal pneumonia. 7. It seems possible to differentiate by clinical signs and symptoms and by high CRP (over 85mg/1) and WBC (over 10 x 10(9)/1) values pneumococcal pneumonias from viral, mycoplasmal and mixed pneumonias and from upper respiratory infections. Moderately elevated CRP values were observed in adenoviral (Mean 50 mg/1) and in mycoplasma (mean 59 mg/l) pneumonias, as well as in MRI (mean 44 mg/l).

[Pathologico-anatomic findings in sudden, unexpected death in children and adults with influenza A infection]

Thé following observations resulted from studies on forensic autopsy cases: In 76% of the adults and 55% of the infants the cases of unexpected sudden death without morphologically verifiable causes of death showed virologic evidence of recent influenza-A (H3N2)-infection. The pathologic findings corresponded with the findings in lethal infections with influenza-A viruses. Investigation of cases of sudden and unexpected death should always include virologic serum tests. The demonstration of IgM antibodies against influenza-A virus confirms that there was a recent infection. Death from influenza-A infections occurs also in the interepidemic periods.

Immunoglobulin class-specific serological responses to adenovirus in respiratory infections of young adult men

Complement fixation and enzyme immunoassay (EIA) were used for measuring viral antibodies in 103 military conscripts with pneumonia and 98 conscripts with other respiratory infections. Diagnostic rises in antibody to adenovirus were found in 23 (22%) patients with pneumonia and in 42 (43%) patients with other respiratory infections. EIA detected more diagnostic rises than did complement fixation (22 versus 17 for pneumonia and 42 versus 40 in other infections). Adenovirus antibodies were analyzed for different immunoglobulin classes by EIA. Diagnostic rises in immunoglobulin G (IgG) and IgA isotypes were observed in 89 and 77% of the cases, respectively. IgM antibodies were positive in 39% of the cases. In five cases (8%), the demonstration of adenovirus antibodies of the IgM class was the only serological evidence for adenovirus infection. The present study demonstrates that the immunoglobulin class-specific EIA is a sensitive method for the diagnosis of respiratory adenovirus infections.

Proportions of Ig classes and subclasses in rubella antibodies

The proportions of six immunoglobulin isotypes (IgA, IgM, IgG1, IgG2, IgG3, and IgG4) in rubella antibody responses were quantified in 40 serum samples (20 patients). The first sample from each patient was taken during the first days of the illness, and the second sample 10 +/- 1 days later. A tenfold average increase in antibody concentration was observed between the first and the second sample. IgM was the predominant isotype in the first sample (average, 73% of all antibodies), followed by IgG1 (19%). IgA and IgG3 antibodies were detected in only a few of the first samples, and IgG2 or IgG4 in none. In the second samples IgG1 was the predominant antibody isotype (average, 59%). Next came IgM (23%), followed by IgA (8%) and IgG3 (3%). No IgG2 or IgG4 antibodies were detected. Although the proportion of IgM antibodies was lower in the second than in the first samples, their concentration increased in all patients (the average factor was 7). The kinetics of the IgA response was irregular. In some patients there was a strong (up to 90-fold) increase in IgA antibodies, but in two patients a small drop was detected. The kappa- to lambda-chain ratio of rubella antibodies appears to be close to the expected 2:1. It decreased in some patients during the 10 days and increased in others.

Serological diagnosis of influenza A and B infections by enzyme immunoassay. Comparison with the complement fixation test

Paired sera from 784 patients with symptoms of acute respiratory disease were examined for antibodies against influenza A, B and parainfluenza (1 and 3) viruses by complement fixation (CF) and enzyme immunoassay (EIA). The internal variation of the EIA test results was low and an increase of 0.250 in absorbance values which corresponded to a two-fold increase in end-point titres was considered a diagnostic antibody rise. EIA detected significantly more diagnostic rises than the CF test in the case of influenza A (222 vs. 162, P less than 0.001) and parainfluenza virus antibodies (29 vs. 16, P less than 0.01). More diagnostic rises in influenza B antibodies were also observed by EIA compared to the CF test (104 vs. 99, not significant). There were only two patients who showed a diagnostic rise in CF antibodies (both influenza B) but not in EIA. Most often patients with a diagnostic antibody rise only by the EIA method had a two-fold rise in the respective CF antibodies (68% of cases). EIA was found to be a sensitive and reliable method for the serological diagnosis of influenza A, B and parainfluenza infections.

Specific IgG and IgA antibodies to herpes simplex virus (HSV)-induced surface antigen in patients with HSV infections and in healthy adults

Herpes simplex virus (HSV)-specific IgG and IgA antibody response in patients with HSV infection and in healthy adults was studied by the immunoperoxidase antibody-membrane antigen (IPAMA) technique. In all HSV infections in which specific IgM antibodies were detected by enzyme-linked immunosorbent assay (ELISA), a significant rise in the titer of HSV IgG and IgA antibodies was found. In contrast, in patients with recurrent herpes labialis in which no specific HSV IgM antibodies were detected by ELISA, HSV IgG and IgA antibodies were not found to fluctuate significantly during the course of infection. A higher geometric mean titer (GMT) for HSV IgG and for IgA antibodies was found in seropositive individuals with a previous history of recurrent HSV than in seropositive individuals without a previous history of recurrent HSV infection. Nineteen of 26 HSV IgG seropositive healthy medical students without a previous history of recurrent HSV infection had HSV IgA antibodies to membrane antigen. The significance of this finding in understanding the mechanism of latency in healthy seropositive individuals without previous history of HSV recurrent infections is discussed.

Indirect and reverse radioimmunoassays and their apparent specificities in the detection of antibodies to enteroviruses in human sera

Indirect radioimmunoassays (RIAs) of IgM and IgG antibodies to enteroviruses have been developed, using coxsackieviruses B1 and B3, and echoviruses 11 and 30. The titres of IgM and IgG were assayed in paired sera from patients infected with one of these viruses or coxsackieviruses A7, A9, A16, B2, B4, B5 or echoviruses 4, 17, or 25. Both IgM and IgG were found in almost all serum pairs with each of the four viruses used as an antigen, and there were no certain differences between titres obtained with homologous and heterologous antigens. The convalescent phase specimens contained significantly higher titres compared with the acute phase specimens, the difference being most pronounced for IgG. Of the specimens from patients with nonenterovirus infections, a relatively high percentage contained IgM and IgG against enterovirus antigen. However, no increases in titres were seen between acute and convalescent specimens. When specimens from younger patients, aged 2 days to 22 months, without evidence of enterovirus infections, were assayed with enterovirus antigen, the frequency of IgM titres was seen to increase with age. Almost all specimens from newborns were negative, whereas the specimens from 12- to 22-month-old children showed a high frequency of IgM titres. In specimens from patients aged 2 days to 8 months, the ratio between IgM and IgG titres increased with age, probably due to a loss of maternal IgG. The IgG titres in specimens from 8.5- to 22-month-old children were similar to the titres of specimens from the patients with nonenterovirus infections. A reverse IgM assay was also developed, using the same viruses and serum specimens as for the indirect assays. In contrast to the indirect IgM assay, the reverse IgM assay was apparently type specific, provided that the amount of labeled virus was carefully standardized. The reverse IgM RIA detected and identified antibody responses better than the neutralization test. Attempts to develop a reverse IgG assay were promising concerning the specificity, but the sensitivity was low.

Detection by ELISA of IgA and IgM antibodies in secretion and IgM antibodies in serum in primary lower respiratory syncytial virus infection

Twenty-six infants and children with primary lower RS virus infection, diagnosed by the detection of RS virus in nasopharyngeal secretion (NPS) by use of immunofluorescent antibody (FA) technique, were studied with respect to the presence of IgA and IgM antibodies. Samples of NPS and serum obtained during the first 3-4 months following the beginning of illness, were investigated. Employing a reverse ELISA technique, we found IgM antibodies in the acute, but not during the convalescent, phase of illness in NPS from 20 of the patients and in serum from 21 of the patients. The majority of the IgM antibody conversions observed occurred in NPS as well as in serum on days 5-8 following the illness. RS virus IgA antibodies, also detected by a reverse ELISA technique, were demonstrated in NPS in 22 of the patients, with antibody conversions being found in 19 of the patients on days 5-8 following the beginning of the illness. Two patients still had IgA antibodies in NPS approximately 3 months FSOI. By comparison, RS virus was detected in acute-phase NPS by double-antibody sandwich ELISA in 25 of the 26 patients investigated.

Intrathecal antibody synthesis to virus antigens in multiple sclerosis

Intrathecal antibody synthesis against 17 common viruses and Mycoplasma pneumoniae lipid antigen was measured in 30 multiple sclerosis patients and 30 patients with other neurological diseases. Antibody synthesis was found against all of the antigens in at least a few of the MS patients. The highest number of patients had intrathecal synthesis of antibodies to measles, rubella and paramyxo type viruses and the lowest frequency was against M. pneumoniae, herpes simplex virus, adenovirus and cytomegalovirus antigens. Simultaneous antibody synthesis occurred against 1-11 different antigens in these patients. When the summation of different antibody specificities synthesized intrathecally was compared to the CSF-IgG Index, which measures the intrathecal immunoglobulin G synthesis, a fairly close correlation was found. The control patients had occasional antibody synthesis but generally only against one single virus antigen. The intrathecal antibody synthesis against viruses did not correlate to the disability of the MS patients. The intrathecal antibody synthesis was not different in younger and older patients or patients with shorter or longer disease duration, suggesting that events leading to intrathecal antibody synthesis may occur relatively early in life in these patients. When presence of Dw2 antigen was compared to different specificities of intrathecally synthesized immunoglobulins, only measles virus antibody synthesis showed correlation.

Human cytomegalovirus specific IgA antibodies detected by immunoperoxidase assay in serum of patients with cytomegalovirus infections

Cytomegalovirus (CMV)-specific IgA antibodies were determined by an immunoperoxidase assay in sequential serum samples of 10 patients with CMV infection in order to evaluate the feasibility of the use of this technique for diagnosis. In parallel, IgM and IgG antibodies to CMV were studied by enzyme-linked immunosorbent assay (ELISA) and by the immunoperoxidase assay, respectively. CMV IgA antibodies were detected in all 10 CMV patients studied. Specific IgM was detected earlier than IgA in only one of these ten patients. No CMV-specific IgA antibodies (titer less than 2) were detected in 45 medical students. Neither were they found in paired sera of 5 patients with herpes simplex infection, 5 patients with varicella, 6 patients with zoster and 2 patients with Epstein-Barr virus infection. The potential application of the indirect immunoperoxidase IgA assay for serodiagnosis of CMV infections is discussed.

Respiratory syncytial virus infection in young hospitalized children. Identification of risk patients and prevention of nosocomial spread by rapid diagnosis

Detection of RSV by immunofluorescence was used for rapid confirmation of the diagnosis in 89 infants during an epidemic. This made it possible to plan the care of the patients and use the personnel in an optimal way in order to maintain nosocomial infection at a low level. Somatic and environmental risk factors connected with serious disease were also identified. The course of the disease was more severe in children with chronic illnesses or those who had had perinatal complications. Allergy was more frequently reported by these families. Breast feeding for at least two months was practised in most families.

Detection and persistence of specific IgA antibodies in serum of patients with hepatitis A by capture radioimmunoassay

The serum immunoglobulin A (IgA) response to hepatitis A virus (HAV) was investigated with a sensitive capture radioimmunoassay. In serial serum samples drawn from 15 patients with viral hepatitis A, IgA anti-HAV antibodies reached their highest titer between 1-2 weeks after onset and peak titers ranged from 10,000-20,000. Serum samples were available from six patients 30-32 months after onset of illness. These samples were all positive for IgA anti-HAV and some had titers similar to peak titers during illness. However, the height of the titration curves, expressed as the binding ratio (BR) at a dilution of 1/1000, was in all cases significantly lower at 30-32 months than during acute illness and early convalescence. The significance of the persistence of the IgA anti-HAV and possible reasons for the change in the BR are discussed.

An indirect haemadsorption procedure (MRSPAH) for detecting antibodies to respiratory syncytial virus

A simple haemadsorption procedure for the detection of isotype specific antibodies to R.S. virus has been developed. Correlation between detection of R.S. virus IgG antibodies by mixed reverse (solid phase) passive antiglobulin haemadsorption (MRSPAH) and other serological procedures has been obtained. IgA antibody was detected in 62% of milk samples studied. The method is rapid, simple and uses commonly available serological reagents.

Intrathecal synthesis of virus antibodies in multiple sclerosis patients

A follow-up study on the intrathecal synthesis of viral antibodies in multiple sclerosis patients was made on 28 patients over a period of about 2 years. Serial serum and cerebrospinal fluid specimens were assayed for antibodies against measles, rubella, parainfluenza type 2, respiratory syncytial, mumps, influenza A, influenza B, adeno, and herpes simplex viruses by employing a solid-phase enzyme immunoassay technique. All patients had local antibody synthesis against one or more of the antigens studied. Rubella and measles virus antibodies were found with the highest frequency and were synthesized at the highest rate. Simultaneous intrathecal antibody synthesis against the greater number of the viruses studied was associated with higher local immunoglobulin G synthesis. A good overall correspondence in the fluctuations of the different viral antibodies synthesized intrathecally was usually found. Sometimes the changes in intrathecal antibody levels correlated well with the changes in immunoglobulin G index and sometimes not. These fluctuations could not be correlated with the clinical course of the disease. The results of this study suggest that the viral antibodies studied are not relevant to the etiology or the pathogenesis of multiple sclerosis.

Herpes simplex virus-specific serum immunoglobulin a: detection in patients with primary or recurrent herpes infections and in healthy adults

A sensitive radioimmunoassay was used to determine levels of herpes simplex virus (HSV)-specific immunoglobulin A (IgA) in serial serum samples drawn from patients with primary HSV infections and from persons with recurrent HSV infections, and in single samples from 90 healthy adults. Significantly rising HSV IgA titers were detected in patients with primary infections, whereas those with recurrent infections had nonfluctuating titers. Sera of IgG-seropositive healthy adults were all positive for HSV-specific IgA without special pretreatment.

Determination of specific IGA antibodies to varicella zoster virus by immunoperoxidase assay

An indirect peroxidase technique was developed for determination of IgA antibodies to varicella zoster virus (VZV). The antigen consisted of acetone-fixed trypsinised VZV-infected cells. Rabbit antihuman IgA peroxidase conjugate was used to detect human IgA antibodies bound to viral antigen. In parallel IgG antibodies to VZV were determined by an immunoperoxidase antibody to membrane antigen (IPAMA) technique. Varicella zoster virus IgA antibodies were detected in all five varicella and seven zoster patients. No VZV IgA antibodies (less than 2) were detected in 45 healthy control sera. Neither were they found in paired sera of five patients with herpes simplex infection, five patients with human cytomegalovirus infection and two patients with Epstein-Barr virus infection. Application of immunoperoxidase IgA technique in serodiagnosis of primary and reactivated VZV infections is discussed.

Enzyme-linked immunosorbent assay for acute adenovirus infection

An enzyme-linked immunosorbent assay (ELISA) is described for demonstrating antibodies to the hexone antigen of adenoviruses. The antigen-coated, flat-bottomed microtiter plates are incubated sequentially with dilutions of patients' sera (2 h at 37 degrees C) and peroxidase-coupled anti-human IgG (2 h at 37 degrees C). After a final washing, orthophenylenediamine is added to the plates, and the absorbance (A) measured 30 min later. The ELISA was found to be a hundred-fold more sensitive than complement fixation. An evaluation methods for determining antibody concentration is described which correlates the absorbance of sera diluted 10(-3) to the absorbance of a reference serum containing an arbitrary value (100) of antibody. This methods avoids titration of sera and day-to-day assay variations by different background reactions. A significant increase in antibody concentration of acute-phase serum over that of convalescent phase serum is observed. The ability to test sera in a single dilution and the automatic reading of results and their evaluation by computer make this assay suitable for diagnostic laboratories.

False RIA IgM titres to herpes simplex virus and cytomegalovirus: factors causing them, and their absorption by protein A-Sepharose/IgG-protein A-Sepharose

A method for the absorption of false radioimmunoassay (RIA) IgM titres against herpes simplex virus (HSV) and cytomegalovirus (CMV) is presented. The serum specimens were absorbed by a mixture of protein A-Sepharose and protein A-Sepharose saturated with normal human gamma globulin (PAS/IgG). The detection of rheumatoid factor of IgM class (IgM-RF) as well as antinuclear antibodies (ANA) of both IgM and IgG class by solid-phase RIA is also described, and their role in the false IgM results was studied. It was found that the PAS/IgG absorption removed 50-90% of both IgM-RF and total IgG. The reduction of IgM-ANA clustered at 50-90% or nothing, whereas the reduction of IgG-ANA was approximately 50%. The studies with HSV and CMV antigens indicated that the removal of false IgM titres was more effective than the removal of each of these four factors. It was concluded that the IgM-RF titres alone were not sufficiently high to explain the false IgM results, but the ANA activity probably contributed.

Detection of respiratory syncytial, parainfluenza type 2, and adenovirus antigens by radioimmunoassay and enzyme immunoassay on nasopharyngeal specimens from children with acute respiratory disease

Four-layer antispecies radioimmunoassay (RIA) and enzyme immunoassay (EIA) procedures were developed for the detection of respiratory syncytial virus (RSV), parainfluenza type 2 virus, and adenovirus antigens in nasopharyngeal specimens from children hospitalized for acute respiratory disease. Polystyrene beads (RIA) or flat-bottomed polystyrene microtiter plates (EIA) were used as the solid phases, guinea pig anti-virus immunoglobulins were used as the captive antibodies, rabbit anti-virus immunoglobulins were used as the secondary antibodies, and 125I-labeled sheep anti-rabbit (RIA) or horseradish peroxidase-labeled swine anti-rabbit (EIA) immunoglobulins were used as the indicator antibodies. A comparison of the EIAs and RIAs with routinely used immunofluorescence (IF) techniques was made with 164 nasopharyngeal specimens collected from children with acute respiratory disease. Only 3 of 66 RSV IF-positive specimens were negative in RSV RIA, and of 83 RSV, parainfluenza type 2 virus, and adenovirus IF-negative specimens, 1 was positive in RSV RIA. Of 4 parainfluenza type 2 virus IF-positive and 11 adenovirus IF-positive specimens, each was positive in corresponding RIAs, and all 83 IF-negative specimens were negative in parainfluenza type 2 virus and adenovirus RIAs. The results of the RSV, parainfluenza type 2, and adenovirus EIAs confirmed the results of corresponding RIAs in each selected case tested. The RIAs and EIAs were found to be as specific and sensitive as IF techniques, and more practical in the rapid detection of respiratory viruses in nasopharyngeal secretions.

Solid-phase radioimmunoassay of serum IgG, IgM, and IgA antibodies to cytomegalovirus

A radioimmunoassay (RIA) using polystyrene beads as the solid phase for cytomegalovirus (CMV) antigen and iodinated immunosorbent purified anti-human IgG, IgM, and IgA as indicator antibodies was developed for the detection of immunoglobulin class-specific antibodies to CMV. An antigen prepared from extracellular virus was essential for reliable results, and a preparation ultracentrifuged and sonicated twice was better than a crude antigen. The optimal antigen gave low cpm values with a negative reference serum, resulting in cpm ratios of 10 or higher between early convalescent phase serum and negative reference serum. Of six patients with an increase in CMV CF titres, all six had an increase in RIA IgG titres, four had an increase in IgA titres, and all had IgM antibodies. The IgG titres were high, up to 1/64,000. In a group of 17 infants negative in CMV CF test, 14 had CMV IgG antibodies in RIA test, indicating mainly low levels of maternal antibodies. In six of seven patients with CMV isolations from urine specimens, an increase in IgG or IgA titres or the presence of IgM antibodies was found, and only one of these patients had an increase in CMV CF titre. The specificity of the developed CMV RIA test was further demonstrated by detecting no significant increase in RIA titres in serum specimens of patients with primary herpes simplex infection, chickenpox, herpes zoster, or infectious mononucleosis.

IgA antibody response in acute rubella determined by solid-phase radioimmunoassay

A solid-phase radioimmunoassay (RIA) for detecting rubella virus IgA serum antibodies was developed. Purified rubella virus grown in roller cultures of Vero cells was adsorbed onto polystyrene beads. The coated beads were then incubated with dilutions of serum, and rubella IgA antibodies which attached to the virus antigen on the solid-phase were subsequently detected with 125I-labelled anti-human-alpha antibodies. The specificity of the iodinated anti-human immunoglobulins was confirmed by RIA analysis of fractions obtained by chromatography of an early convalescent serum on an agarose column. A complete separation of IgM, IgA, and IgG was observed. A total of 144 serial serum specimens from 31 adult patients with an acute rubella infection were tested for rubella IgA antibodies, and the results were compared with the RIA IgG and IgM titres reported earlier from the same specimens. The RIA IgA response was detected in each of the 31 patients and the IgA antibodies appeared almost simultaneously with the IgG and IgM antibodies. The maximum titres, which were lower than the IgG and IgM titres, were reached in about 1 week after the onset of rash. In 6 patients out of 31 the IgA antibody response was transient and persisted approximately two months, while in the remaining 25 patients the IgA antibodies persisted throughout the study period of more than 5 months. The results obtained indicate that the presence of rubella IgA antibodies in serum is not an indication for a recent rubella infection.