Intra-blood-brain barrier IgG synthesis in cerebral cysticercosis.

Patients with central nervous system cysticercosis show elevated binding of cerebrospinal fluid (CSF) IgG to homogenized cysticercus. To determine whether any of the CSF IgG was the result of de novo intra-blood-brain barrier (BBB) synthesis, CSF and serum samples from six patients were examined for elevated rate of synthesis and oligoclonal bands. Five of the six patients had increased intra-BBB IgG synthesis rate and four of these patients also had oligoclonal IgG bands present in the CSF that were absent in the serum. These results demonstrate intra-BBB IgG synthesis similar to that observed in other infectious and inflammatory diseases of the central nervous system.

A new immunologic test for CNS cysticercosis.

A new radioimmunoassay for cerebral cysticercosis was studied in 70 patients. The assay showed nearly 100% sensitivity for ventricular cysts or meningitis, 86% sensitivity for multiple parenchymal cysts, and a false-positive rate of 7%. Both serum and CSF antibody levels were useful diagnostically, and the contribution of both improved accuracy. In some patients, there was endogenous CNS production of IgG against the cysticercus antigen, which leads to elevated CSF levels and normal serum levels. Patients with high CSF total IgG levels may show false-positive CSF antibody elevation with normal serum levels.

Spontaneous radiographic disappearance of cerebral cysticercosis: three cases.

We demonstrate spontaneous resolution of cysticercosis cysts in CTs of three patients. This benign course has not been emphasized previously and should be considered prior to surgical intervention or institution of other treatments.

Significance of immunoglobulin G subclasses.

IgG subclasses differ from one another both immunochemically and functionally. An isolated absence of a certain specific subclass may or may not be associated with disease. However, an absence of serum IgG4 as measured by a sensitive radioimmunoassay is usually, if not always, associated with severe recurrent pyogenic infections, usually of the respiratory tract. IgG2 and IgG4 deficiencies tends to occur together, often in association with deficiencies of immunoglobulin A (IgA) and/or immunoglobulin E (IgE). The properties of IgG1 are similar to those of IgG3 and those of IgG2 appear to resemble those of IgG4 in certain respects. Specific combined deficiencies tend to be associated with certain diseases. Some patients with deficiency of an immunoglobulin G (IgG) subclass appear able to compensate and to avoid clinical disease whereas others are not. Overlap zones exist in the lower ranges of serum concentrations in which both healthy and immunoincompetent subjects are found. It is important to consider the concentration of each IgG subclass present in a gamma globulin preparation or in plasma used for replacement therapy. If specific antibody deficiencies exist, it may be critical that the preparation used for replacement contains goodly amounts of the missing antibodies.

Abnormal maxillary sinus radiographs in children: do they represent bacterial infection?

Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 10(4) colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.

Familial IgE deficiency associated with sinopulmonary disease.

Three generations of relatives of 58-year-old nonidentical twins with chronic bronchitis and fibrotic lung disease were evaluated. Sera of 23 family members, 14 with a history of excessive sinopulmonary infections, were examined for deficiencies of immunoglobulin classes, IgG subclasses, and specific antibody to tetanus toxoid and Hemophilus influenzae type b. Of 14 symptomatic family members, 12 had serum IgE concentrations less than 5 IU/ml. Four had values less than 1 IU/ml. Serum IgE was greater than 10 IU/ml in all nine asymptomatic individuals. Inheritance of low IgE appeared to be autosomal dominant, with variable penetrance. IgA was low normal (70-90 mg/dl) in three individuals. Two of these were IgE deficient. One symptomatic child had unmeasurable IgG2 (less than 10 mg/dl) and IgE (less than 0.5 IU/ml). This kindred demonstrates that IgE deficiency can be familial, and associated with sinopulmonary disease.

IgG subclass deficiency associated with corticosteroids in obstructive lung disease.

IgG subclass levels were measured in three groups of adult patients with obstructive airways disease to discern the relationships among depressed IgG subclass levels, chronic corticosteroid use, and recurrent sinopulmonary infections. Group 1 consisted of patients with corticosteroid-dependent bronchial asthma, group 2 patients had corticosteroid-dependent chronic bronchitis/emphysema, and group 3 was comprised of asthma patients not requiring oral corticosteroids but associated with recurrent sinopulmonary infections. One or more IgG subclass deficiencies were noted in 66.7 percent of group 1, 46.7 percent of group 2, and 6.7 percent of group 3. Significant differences were noted between groups 1 and 3 (p = .0008) and between groups 2 and 3 (p = .018), but not between groups 1 and 2 (p = .5). IgG1 deficiency was the most common subclass deficiency found; 14 (77.8 percent) of 18 patients with detectable subclass deficiency demonstrated IgG1 deficiency. In this study population, IgG subclass level deficiencies appeared to be secondary to long-term low-dose corticosteroid therapy.

Immunoglobulin E in Nigerian onchocerciasis.

Total serum IgE was measured by radioimmunoassay in 58 adult Nigerian patients with untreated onchocerciasis. Levels in excess of 244.9 IU/ml, the mean level of the healthy Nigerian control subjects tested, were found in 86% of the patients. The levels were comparable to IgE levels found in 15 atopic Nigerian patients from the same residential area (mean = 1,028.7 IU/ml). The findings suggest that onchocerciasis, like allergy, is one of the causes of elevated total serum IgE, though normal levels may occur in this disease.

Cytomegalovirus retinitis secondary to chronic viremia in phagocytic leukocytes.

We studied the relationship between the duration and intensity of cytomegalovirus viremia, cytomegalovirus complement fixing antibody, and cytomegalovirus retinitis in 61 renal transplant recipients. Five (8%) patients had chronic viremia which lasted more than six months. Two of the five developed typical cytomegalovirus retinitis and a severe fungal infection after intensive viremia of more than 11 months' duration. Retinitis did not develop in 22 patients with short-term viremia. Infectious cytomegalovirus was largely associated with polymorphonuclear leukocytes, but the virus was associated with monocytes during the immature granulocytic response accompanying one patient's terminal illness.

A common pathway for chemical-induced tissue injury and immune responses leading to hypersensitivity and/or carcinogenesis.

A common requirement for chemical-induced allergy, carcinogenesis and certain forms of liver injury appears to be the ability of the chemical to react with protein and/or nucleic acid to form covalent conjugates. Tests to detect immune responses to such conjugates can provide useful information concerning the propensity of an individual to convert normally innocuous chemicals to immuno-reactive forms under physiological conditions and may provide an indicator of the risk for developing one of the above disorders. They will enable offending substances and their active metabolites to be identified, the status of diseases which they induce determined, and the degree to which exposure has been avoided monitored. Very few studies have been published relating to this important problem. Implications of this approach are discussed.