Assay of teichoic acid antibodies and antistaphylolysin in the diagnosis of Staphylococcal osteomyelitis

Serological evidence for the role of bacterial infections in the pathogenesis of thyroid diseases

Subacute thyroiditis is generally believed to be of viral origin, and infection is also suspected of playing a role as a triggering factor in the pathogenesis of autoimmune thyroid diseases. We have measured a broad spectrum of bacterial and viral antibodies in paired sera of 32 patients with thyroid disease of recent onset. The data indicate a preceding infection in 14 (44%) of the patients, enterobacterial in 5, streptococcal in 4 and staphylococcal in 2. A viral infection was suggested in 6 patients, in each case caused by different agents; 3 of them also showed evidence of a bacterial infection. Patients with positive microbial serology were found in all diagnostic groups, including subacute thyroiditis, Graves' disease and Hashimoto's disease. These results suggest an association between a preceding bacterial infection and the development of thyroid disease in some patients.

Rapid serodiagnosis of Staphylococcus aureus surgical site infection following median sternotomy

OBJECTIVES

To determine the sensitivity and specificity of a novel ELISA for the serodiagnosis of surgical site infection (SSI) due to staphylococci following median sternotomy.

METHODS

Twelve patients with a superficial sternal SSI and 19 with a deep sternal SSI due to Staphylococcus aureus were compared with 37 control patients who also underwent median sternotomy for cardiac surgery but exhibited no microbiological or clinical symptoms of infection. A further five patients with sternal SSI due to coagulase-negative (CoNS) staphylococci were studied. An ELISA incorporating a recently recognised exocellular short chain form of lipoteichoic acid (lipid S) recovered from CoNS, was used to determine serum levels of anti-lipid S IgG in all patient groups.

RESULTS

Serum anti-lipid S IgG titres of patients with sternal SSI due to S. aureus were significantly higher than the control patients (P<0.0001). In addition, patients with deep sternal SSI had significantly higher serum anti-lipid S IgG titres than patients with superficial sternal SSI (P = 0.03). Serum anti-lipid S IgG titres of patients with sternal SSI due to CoNS were significantly higher than the control patients (P = 0.001).

CONCLUSION

The lipid S ELISA may facilitate the diagnosis of sternal SSI due to S. aureus and could also be of value with infection due to CoNS.

Association between high antistaphylolysin and teichoic acid antibody titres with rheumatic syndromes

To analyse which rheumatic syndromes are associated with serological evidence of recent Staphylococcus aureus infection, we studied retrospectively 44 adult patients, gathered between 1979-1990, having an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high antistaphylolysin (ASTA > 4,0) and/or high teichoic acid antibody titre (TAA > 8). Patients with septic arthritis or endoprosthetic infections were not included. 25 patients had arthritis/arthralgia associated with a known rheumatic disease, 9 patients had reactive arthritis and 8 patients had arthralgia. The frequency of HLA-B27 in tested patients was significantly higher in the whole patient group than in the healthy Finnish population (43% v 14%, p < 0.001). It is concluded that high ASTA and/or TAA titres are associated with various acute rheumatic syndromes including reactive arthritis.

Antibodies against some bacterial antigens in children

The prevalence of bacterial antibodies was determined in 173 children aged 0-15 years. The prevalence of IgG Borrelia burgdorferi antibodies in titres > 500 in children less than 8 years of age was 6% while none of the older children had these antibodies in titres > 400. IgG Helicobacter pylori antibodies were detected only in children older than 6 years of age, with a prevalence of 6.5%, as were IgA H. pylori antibodies, with a prevalence of 3.7%. The prevalence of high-titre IgG Campylobacter jejuni antibodies was 1.2%, that of IgA 1.8% and IgM 1.2%. The prevalence of high-titre (> 500 IU/ml) antistreptolysin O was 3%, that of antistaphylolysin-alpha (> or = 4 IU/ml) 2% and that of anti-teichoic acid antibodies (titre 2) 2%. Low-titre Yersinia antibodies were detected in 2%. High-titre Bordetella pertussis antibodies were detected in 6% of recently vaccinated children and in 8% of children in their first years of school. In the latter, high-titre antibodies were mainly of the IgM and IgA classes. Altogether 35 children tested positive for bacterial antibodies other than Bordetella pertussis antibodies. Clinical evaluation revealed a possible infection, suggested by the antibody, in 5 (3%) of the children. Two (vaccinated) children had evidence of whooping cough. Eight of the 35 children with high-titre bacterial antibodies (23%) also had elevated levels of autoantibodies (but not autoimmune diseases).

Prospective study on humoral immune response induced by fungal infection in patients with hematologic malignancies

To evaluate the immune response in an immunosuppressed population, antibodies against commercially available Candida albicans antigens were prospectively studied during 37 episodes of acute stomatitis caused by C. albicans and 36 episodes complicated by deep-seated mycoses in 62 adult patients with hematologic malignancies. During uncomplicated stomatitis in patients with acute leukemia, the mean peak IgM, IgG and IgA class enzyme-linked immunosorbent assay (ELISA) units differed significantly from the basic level preceding fungal infection. Mean time until peak values was 2.7-3.8 weeks after diagnosis of stomatitis. During systemic mycoses the antibody response was similar. Among patients with other hematologic malignancies, predominantly lymphomas, several were terminally ill and responded infrequently by antibody production. Similar results were given by Ouchterlony immunodiffusion and counterimmunoelectrophoresis. Thus, patients with acute leukemia showed an antibody response to fungal infection; the peak values, however, were somewhat delayed.

Experimental mandibular Staphylococcus aureus osteomyelitis; antibody response and treatment with dicloxacillin

Staphylococcus aureus mandibular osteomyelitis was produced in 20 rabbits by injection of a sclerosing agent and 1 X 10(9) colony-forming units of Staphylococcus aureus V8 into the medullary cavity of the mandible. After 2 weeks all rabbits developed infections. 10 of the rabbits were then treated with dicloxacillin (22.5 mg/kg body weight) every 12 h for 7 days and 10 were left untreated. The animals were sacrificed after 8 weeks and histopathological examination was performed. An enzyme-linked immunosorbent assay (ELISA) was used to measure IgG response against staphylococcal teichoic acid and alpha-toxin during the observation period. In the treated group, there was a decrease in clinical symptoms after the treatment period, while in the untreated group, progression of the infection was a common finding. At the end of the treatment period, Staphylococcus aureus V8 could not be recovered from aspirates obtained from animals in the treatment group, while in the non-treatment group, Staphylococcus aureus V8 could be recovered from abscesses in 6 rabbits. Both in the treated group and in the untreated group, the rabbits showed increasing IgG titers against teichoic acid and alpha-toxin during the first 2-3 weeks. No significant differences in antibody response patterns were noted between the treated and untreated groups and no clear correlation between the immunological response and the severity of the disease was observed.

Antibody determinations by counterimmunoelectrophoresis in the diagnosis and management of Pseudomonas aeruginosa bone and joint infections

Antibody titers were measured by counterimmunoelectrophoresis in eight patients with Pseudomonas aeruginosa and in eight patients with Staphylococcus aureus bone and joint infections. Titers were obtained at the beginning of therapy in all patients with pseudomonas infections and at various intervals during and after completion of therapy in seven patients. These patients were followed clinically, with 99mTc-MDP bone and 67Ga scans, and with serial erythrocyte sedimentation rates. Six of eight of these patients had detectable pseudomonas antibodies. A fall in antibody titer occurred in all six successfully treated antibody-positive patients. By contrast, none of the control patients with staphylococcal infections had antibodies to pseudomonas heptavalent antigen. The predictive value of a positive test was 100% and of a negative test, 80%. Counterimmunoelectrophoresis is a helpful adjunctive test in supporting the diagnosis and documenting a successful treatment of chronic pseudomonas bone or joint infections.

Association between cerebral infarction and increased serum bacterial antibody levels in young adults

Increased antibody levels against several bacteria were found in 15 of the 34 stroke patients (44%) under the age of 45 years, but in only six of the 68 controls (9%) (p less than 0.001). Based on the serologic data, the most common preceding infections were streptococcal, staphylococcal, and enterobacterial. There was no relationship between viral antibodies and cerebral infarction. When the clinical history of the patients was also taken into consideration, stroke was found to be associated with a recent infection in 68% of the patients, as compared with 26% for the second most common risk factor, ethanol intoxication. The results suggest an association between cerebral infarction and bacterial infections in young adults.

Triggering infections in reactive arthritis

Certain microbes like yersinia, salmonella, shigella, campylobacter, chlamydia, and possibly gonococcus can trigger reactive arthritis especially in patients of the HLA-B27 type. In the present study we have used serological and culture methods to identify the probable triggering infection in 50 consecutive HLA-B27 positive patients diagnosed as having reactive arthritis. The two most common triggering agents thus identified were Yersinia enterocolitica (12 patients) and Chlamydia trachomatis (11 patients). In addition six patients had high antistreptolysin O titres and two high teichoic acid antibody titres suggesting group A streptococci and Staphylococcus aureus as triggering agents. In 13 patients no preceding infection could be identified. The identity of the infective agent seems to have very little effect on the clinical picture of the reactive arthritis - the only difference between the various aetiological groups in the present material was absence of fever in the patients with a preceding C. trachomatis infection, of whom only one out of 11 had a temperature greater than or equal to 38 degrees C, whereas 13 of 16 patients with a preceding enterobacterial, and five of the eight patients with a streptococcal or staphylococcal infection had raised temperatures.

Comparison of anti-alpha-haemolysin and teichoic acid antibody tests in patients with Staphylococcus aureus endocarditis or bacteraemia

To assess the value of serological tests in differentiating endocarditis and complicated bacteraemia due to Staphylococcus aureus from uncomplicated S. aureus bacteraemia and from nonstaphylococcal endocarditis we measured teichoic acid antibodies (TAA) (by means of a gel diffusion method) and antibodies to alpha-haemolysin (ASta) in the serum of 22 patients with S. aureus endocarditis, 42 patients with complicated S. aureus bacteraemia, 21 patients with uncomplicated S. aureus bacteraemia, 27 patients with other than S. aureus endocarditis, 17 patients with culture-negative endocarditis and 337 non-infected control patients. TAA and ASta titres were found significantly more often in staphylococcal endocarditis than in non-staphylococcal endocarditis, 59 per cent versus 4 per cent for the TAA test and 32 per cent versus 0 per cent for the ASta assay. The combined use of the two tests proved best for differentiating the two groups of endocarditis from each other, 72 per cent versus 4 per cent respectively. In the culture-negative endocarditis group there were two serologically positive patients whose anti-staphylococcal antibiotic therapy based on the serological findings was successful, supporting the clinical usefulness of staphylococcal serological tests in endocarditis of unknown bacterial aetiology. The serological tests were not useful, however, in differentiating S. aureus endocarditis from complicated or uncomplicated bacteraemia due to S. aureus without endocarditis.

Detection of antibody to staphylococcal lipoteichoic acid with a microenzyme-linked immunosorbent assay

Sera from individuals with Staphylococcus aureus endocarditis and osteomyelitis and from some individuals with other forms of gram-positive endocarditis yielded higher readings in a microenzyme-linked immunosorbent assay against lipoteichoic acid from S. aureus than did sera from individuals with other types of serious staphylococcal infection or non-staphylococcal osteomyelitis, or from unselected inpatients.

An association between epileptic seizures and increased serum bacterial antibody levels

Increased serum levels of a variety of bacterial antibodies were more common in unselected patients with recent epileptic seizures than in healthy control subjects (17/29 versus 2/31; p less than 0.001). In most of these cases no infections were recognized clinically or bacteriologically. Although infections have been considered as one of the possible provocations for the manifestation of epileptic seizures, the demonstrated strong association may give a new approach to the pathogenetic mechanisms of epileptic seizures or may mean a nonspecific immune response. The explanation for the higher antibody titers in epileptic patients and their etiologic significance are uncertain, but these results also suggest that epileptic seizures may very often be triggered by bacterial infections even when no clinically apparent bacterial infection has been recognized.

Antibody response to alpha- and betahemolysin from Staphylococcus aureus in patients with staphylococcal infections and in normals

One hundred and nineteen patients with S. aureus infections and 22 patients with non-S. aureus septicemia were investigated for anti-alpha hemolysin antibodies using a radioimmunoassay (RIA). As compared to 16- healthy controls, patients with S. aureus endocarditis, septicemia, chronic osteomyelitis and recurrent furunculosis showed significantly higher antibody levels, while the non-S. aureus septicemia group showed normal levels. Corresponding results were obtained using the conventional anti-staphylolysin (ASTA) test. Only patients with recurrent furunculosis had significantly elevated anti-beta hemolysin antibody levels assessed by RIA, in comparison with healthy controls. The highest antibody levels were found in furunculosis patients infected with S. aureus strains which were high producers of beta hemolysin. The results indicate that furunculosis patients do not have a defective serological response against S. aureus beta hemolysin.