Schick Test Research Articles

Chronic mucocutaneous candidiasis: T cell deficiency associated with B cell dysfunction in man

Routine immunologic screening of four patients with chronic mucocutaneous candidiasis (CMC) revealed that they manifested positive Schick tests in vivo despite adequate diphtheria toxoid immunization and the presence of circulating hemagglutinating antibody to diphtheria. Plasma from these individuals was found to neutralize Schick toxin in rabbits. Unlike normal individuals who preferentially make IgG neutralizing antibody to diphtheria toxin when immunized, these patients with CMC have neutralizing activity in plasma fractions containing IgM. IgM is predominantly an intravascular protein which would account for the failure of our patients to neutralize Schick toxin in vivo. These findings suggest that T cell deficiency as it occurs in CMC may lead to B cell dysfunction in man.

Micro cell culture method for determination of diphtheria toxin and antitoxin titres using VERO cells: II. Comparison with the rabbit skin method and practical application for sero-epidemiological studies

The antitoxin titres obtained by the micro cell culture colour change method was compared with those determined by the rabbit skin test. The results confirmed a high correlation between the two techniques. The cell culture method was successfully applied to determine the relative potency of diphtheria toxoid preparations. Sero-epidemiological patterns of the age distribution of diphtheria antitoxin which were explored by this method on 243 sera from healthy Japanese agreed with that obtained by the Schick test. It is concluded that the micro cell culture colour change method using VERO cells is a highly recommended procedure for diphtheria toxin and antitoxin determinations because of its sensitivity, reproducibility and economy of time, labour and materials.

Combined immune deficiency, autoantibody formation, and mucocutaneous candidiasis

A 6-year-old girl with chronic mucocutaneous candidiasis (MCC) and an immunologic deficiency syndrome was studied in detail over a period of 2 years. The patient had a severe defect in cell-mediated immunity characterized by failure to mount a 48-hr delayed response to a battery of intradermal skin tests, persistent lymphopenia, and failure to be sensitized with 1-chloro, 2,4-dinitro-benzene (DNCB). Her lymphocytes neither produced migratory inhibitory factor nor consistently responded with an increased 3H-thymidine uptake when placed in tissue culture medium with Candida antigen. There was no evidence of a circulating factor in the patient's plasma capable of inhibiting the incorporation of 3H-thymidine by homologous lymphocytes cultured in the presence of Candida albicans and other antigens. The patient had defective antibody production to some but not all antigens. She failed to produce protective tetanus toxoid antibody titers and remained Schick test positive despite repeated diphtheria, pertussis, and tetanus (DPT) injections. She also had defective antibody responses to repeated paratyphoid-typhoid injections and was found to have a low serum IgA level. This patient possessed autoantibodies against smooth muscle and parietal cells and an inconstant positive antilymphocytotoxic assay. Immunologically unrelated precipitin antibody systems against human and calf thymus were also demonstrated in the patient's serum. Eradication of the Candida infection with intravenous amphotericin B, although resulting in marked clinical improvement, did not alter the immunologic abnormalities.

Sisters with low birth weight, dwarfism, congenital anomalies, and dysgammaglobulinemia.

Two sisters had low birth weight dwarfism, psychomotor retardation, and congenital anomalies including hyperextensible joints, brachydactyly, clinodactyly, low total ridge counts, bilateral simian creases, and calcaneovalgus foot deformities. In addition, both girls had repeated bacterial infections and elevated serum IgA levels. The older sister had no immune response to intradermal antigens and did not develop a protective level of diphtheria antitoxin following two series of diphtheria and tetanus toxoids and pertussis vaccine injections and three Schick tests. These sisters represent a newly described genetic syndrome, most probably an autosomal recessive trait.

United States Standard Diphtheria Toxin for the Schick Test and the Erythema Potency Assay for the Schick Test Dose

United States Standard Diphtheria Toxin for the Schick Test and the Erythema Potency Assay for the Schick Test Dose

United States standard diphtheria toxin for the Schick text and the erythema potency assay for the Schick text dose.

A diphtheria toxin shown to have high toxicity and avidity and to combine with antitoxin in multiple proportions was selected for the U.S. standard diphtheria toxin for the Schick test and freeze-dried. Assayed values per vial were 1.09 L(f), 1.09 L(r), 1,090 Schick test doses (STD), 33 LD(80), 38 LD(50), and 43,000 minimum skin reactive doses. One STD (L(r)/1000) is slightly more toxic than one unit of the international standard (L(f)/1,000). Experiments showed that the potency assay of Schick test toxin by guinea pig erythema toxicity, determined relative to the toxicity of the standard, was highly reproducible and significantly more reproducible than the lethal (minimum lethal dose) test and that the STD, defined as one L(r)/1000, was equivalent to approximately 1/50 minimum lethal dose. The erythema potency assay was prescribed in the U.S. standards for Schick test toxin effective in 1969.

Diphtheria in a welfare home.

This paper reports the steps taken on receipt of notification of a case of diphtheria in a welfare home, and discusses the use of the Schick test when the immunity status of the inmates of the home is unknown.

Anti-LW antibody production in a child with combined immune deficiency disease (thymic alymphoplasia).

IN 1967 a six-month-old boy was evaluated for severe moniliasis and persistent pneumonia. A diagnosis of thymic alymphoplasia was established by the following data: low gamma-globulin levels, absence of isohemagglutinins and positive Schick test after DPT immunization; absence of delayed hypersensitivity skin responses to eight antigens and 2,4-dinitrofluorobenzene sensitization; failure of in vitro proliferative response of lymphocytes to phytohemagglutinin and DPT stimulation; lymphopenia; and lymphoid tissue morphology typical of thymic alymphoplasia, the sex-linked form of lymphopenic agammaglobulinemia, according to the criteria of Hoyer et al.1 There was no family history of similar cases. Serum immune globulin analysis done by the . . .

Adult hypogammaglobulinemia with malabsorption and iron deficiency anemia

This thirty year old woman, who had had recurrent respiratory tract infections from age two, was found to have a severe deficiency of serum immunoglobulins IgG, IgA and IgM. She also had scant peripheral lymphoid tissue with only rare plasma cells. Functionally, she rejected a homograft in normal time. Delayed hypersensitivity was present only to mumps antigen. She failed to respond to typhoid vaccine with specific antibody, but a reaction to the Schick test was negative. Injected virus particles were cleared normally from the circulation despite very low specific antibody production. Jejunal villous atrophy, histologically similar to celiac sprue, was associated with impaired absorption of orally administered iron. No response to a gluten-free diet occurred histologically. One son lacked detectable serum IgA and the serum IgA of the other son was low. The maternal grandfather had a high serum IgA perhaps age-related. In all other family members immunoglobulin levels were normal. The association of immunoglobulin deficiency and malabsorption remains unexplained.

IMUNIDADE À DIFTERIA FRENTE À PROVA DE SCHICK E À DOSAGEM DE ANTITOXINA DIFTÉRICA CIRCULANTE

Of the 95 second year medicai students of the F.C.M.S.C., 56 were suhmitted to the Schick test, which was performed on two occasions with 28 days interval hetween each one. Blood was drawn from the subjects on three occasions: before the first Schick test and seven and twenty-eight days after the said test. Diphtheria antitoxin was titrated in hlood by the passive hemagglutination test.In Schicknegative suhjects. hoth tests agreed in 94.1$, 97.1%, and 97% on first, serond and third titrations respectively. In Schkk-positive suhjects agreement was ohserved in 59,1%, 54,5% and 72%; for same titrations. Alterations of antitoxin leveis due to performance of the Schick test itself are discussed. Diphtheria antitoxin titration is recommended in adults and adolescenb which show susceptibility to the Schick test.

Chronic pulmonary disease and immunologic deficiency

A female patient who was referred for evaluation of cardiorespiratory insufficiency was found to have hypogammaglobulinemia. Subsequent studies showed that she was deficient in all four types of antibody globulins, had no demonstrable immediate cutaneous hypersensitivity reactions, and gave a positive Schick test. The half-life of mismatched erythrocytes in her circulation was prolonged to 15.2 hours. Gross evidence of rejection of an allogeneic skin graft was not apparent until the forty-fifth day after the transplant. In contrast, delayed cutaneous reactions to several antigens were found and the subject was able to respond to immunization with typhoid vaccine.Survey of the patient's family revealed that three close relatives were deficient in IgA and several other family members had abnormal concentrations of serum immunoglobulins.The morphology of the patient's peripheral blood lymphocytes was studied after exposure to cellular extracts from the skin donor. An increase in the number of large “blast-like” cells was observed during the period after the graft, suggesting that this technic may be of value in detecting incipient graft rejection.The current concepts of the molecular mechanisms of antibody deficiency syndromes are reviewed and a hypothesis for the defect in sex-linked hypogammaglobulinemia is offered.

Results of Dick and Schick tests in Liberian children

Results of Dick and Schick tests in Liberian children

Results of Dick and Schick tests in Liberian children

1. 1) A series of 488 infants and children of pre-school age and 917 school children between the ages of 6 and 16 years on two rubber plantations in Liberia were tested for susceptibility to diphtheria and scarlet fever, using Dick and Schick tests. 2. 2) The results of the Dick test show a very low percentage of the Liberian children studied in the first 3 months of life to be susceptible to scarlet fever. The percentage of susceptibles was highest in the children who were in the second 6 months of life. However, the percentage of susceptibles was progressively lower in successive age-groups until it was less than 10 per cent. in the school age-groups. 3. 3) The results of the Schick test show a low percentage of the Liberian children in the first 3 months of life studied, to be susceptible to diphtheria. The percentage of susceptibles was highest in the 6–11 months age-group, inclusive, and then progressively decreased. School age-groups had still fewer susceptibles and, between the ages of 10 and 15 years, inclusive, less than 10 per cent. of the children were found susceptible to the disease.

Antibody Response to Booster Dose of Diphtheria and Tetanus Toxoids and Pertussis Vaccine: Thirteen Years after Inoculation of Institutionalized Subjects

IN 1943 several groups of mentally ill adult patients in the Pontiac State Hospital, Pontiac, Mich., were inoculated with different combina,tions of diphtheria and t,etanus toxoids, pertussis and typhoid vaccines, and scarlet fever toxin, according to defined dosage schedules. The subjects' reactions were studied, and their specific immune responses were measured in terms of circulating antibodies. The results forme,d the basis for a series of reports, which demonstrated that responses to each antigen were excellent in all combinations studied (14). In 1956 many of the subjects from this investigation were still in residence at the hospital and available for a study of their responses to a booster dose oif antigen. These institutionalized subjects represented a different population from the noninstitutionalized subjects reported earlier (5). Not only did they differ with respect to their age ancd environment, but owing to an institutional policy, they had received subsequent boosters of diphtheria and tetanus toxoids. Even before we gave them tlhe injections in 1943, the institutionalized subjects had received numerous Schick tests and booster injections of diphtheria toxoid at intervals throughout their hospitalization, exteniding back as far as 1932. The study reported here was designed primarily to measure the responses of 290 institutionalized subjects to a small dose of diphtheria and tetanus toxoids to determine whether their responses differed from those of the noninstitutionalized subjects, reportecl previously, who had not been given intervening booster injections (5). Secondarily, the investigation was concerned with the effect of a small dose of pertussis vaccine on production of agglutinins. Because pertussis may occur in older children and adults, even t,hough injected with pertiissis vacc.ine in infancy (personal communication fromI Dr. Harold J. Lambert, July 1963), thlere is a growing interest in the extension of pertussis boosters beyond preschool age. It seemed Dr. Volk is commissioner, Saginaw County Health Department, Saginaw, Mich. Dr. Gottshall is chief, antigens and antisera unit, biologic products section, and Dr. Anderson is chief, biologic products section, division of laboratories, Michigan Department of Health, Lansing. Dr. Top is head, department of hygiene and preventive medicine, State University of Iowa, Iowa City. Dr. Bunney is vice president and director of manufacturing operations, E. R. Squibb & Sons, New York City. Dr. Serfling is chief, Statistics Section, Epidemiological Branch, Communicable Disease Center, Public Health Service, Atlanta, Ga. Maud G. Gilbert, Saginaw County Health Department, and Frances Angela, Michigan Department of Health laboratories, gave technical assistance in this study. This study was made in cooperation with the technical committee on immunization, epidemiology section, American Public Health Association, and was supported in part by research grant E-1115 from the National Institute of Allergy and Infectious Diseases, Public Health Service.

Course of Immunity to Diphtheria Based on Study of Schick Test in 1,516 Vaccinated Children and Adolescents

Course of Immunity to Diphtheria Based on Study of Schick Test in 1,516 Vaccinated Children and Adolescents

In Reply: Positive Schick Test after Diphtheria Immunization, as Evidence of Hypogammaglobulinemia

Use of the Schick test in DPT immunized children to detect patients with hypogammaglobulinemia before smallpox vaccination may be a useful procedure, but more data would be needed to prove this. For instance, what percentage of children with a positive Schick test were hypogammaglobulinemic? Routine use of the Schick test to guide the immunization program is no longer justified if a regular schedule of injections and boosters is followed, and established proof of its efficacy would be required to revive it as a case-finding tool for hypogammaglobulinemia.

Positive Schick Test after Diphtheria Immunization, as Evidence of Hypogammaglobulinemia

The report of the Committee on the Control of Infectious Disease of the American Academy of Pediatrics in the 1961 edition states on the subject of Schick tests: "If immunization practices, including periodic recall injections, are carried out as outlined in this report, the routine use of the Schick test to determine individual susceptibility to diphtheria is unnecessary." I have been doing Shick test prior to vaccination for smallpox for several years as a means to determine the patient's gamma-globulin level by this indirect means.

Schick test in Ludhiana district.

Schick test in Ludhiana district.

Schick test resultsin R.A.F. boy entrants

Summary o 1. The Schick test results in 1,753 boys born in 1941 to 1943 and tested in 1957 to 1958 are reported. The susceptibility rate was found to be 31%. 2. The results were compared with those found, by the same methods, in recruits during 1956. Certain differences are discussed. 3. The results obtained by each of five inoculators were recorded and compared. It was concluded that in their hands the test was reliable. 4. It was concluded that the reading of test reactions and the assessment of the Schick status, as recommended by Barr et al. (1957), was well suited to station medical practice and that the immunisation of susceptible boys was worthwhile.

Immunization against tetanus and diphtheria with special combined toxoid.

Childhood immunization against diphtheria and tetanus has been established as a desirable and effective procedure. Ipsen 1 has recently clearly reemphasized the need for the continuance of this important immunization program into the older children and adult groups. Unfortunately, the frequency of severe local and systemic reactions to diphtheria toxoid injection in older children and adults has prevented widespread usage of this proved procedure. Many physicians have observed such reactions even after using the Schick test to determine the susceptibles in the group. Moreover, such screening procedures are inconvenient and cumbersome when one is dealing with large numbers of persons. Extensive studies by Edsall and his colleagues 2 have indicated that a satisfactory combined tetanus and diphtheria toxoid for adults could be produced and used, provided that the diphtheria toxoid was highly purified and used with an adjuvant. With such a toxoid a satisfactory primary immunization was obtained by giving