Serological Follow-up Of Patients Research Articles

Long-term serological follow-up after primary Coxiella burnetii infection in patients with vascular risk factors for chronic Q fever

We evaluated the long-term serological follow-up of patients with vascular risk factors for chronic Q fever that were previously Coxiellaburnetii seropositive. C. burnetii phase I IgG titers were reevaluated in patients that gave informed consent or retrospectively collected in patients already deceased or lost to follow-up. Of 107 patients, 25 (23.4%) became seronegative, 77 (72.0%) retained a profile of past resolved Q fever infection, and five (4.7%) developed chronic Q fever. We urge clinicians to stay vigilant for chronic Q fever beyond two years after primary infection and perform serological testing based on clinical presentation.

TULAREMIA IN SOUTH-EASTERN SERBIA IN TWELVE-YEAR FOLLOW-UP

Tularemia is a serious bacterial zoonosis caused by the highly infectious agent Francisella tularensis. Microbiological diagnosis of tularemia mainly relies on serology. The occurrence of a tularemia epidemic in the Southeast of Serbia in 1998/999 initiated an epidemiological as well as a clinical and microbiological research in this area. Objective was establishing the correlation between the clinical-epidemiological and serological diagnosis of tularemia as well as the clinical and serological follow-up of patients in the period from 1 to 12 years since the disease onset. From the beginning of 1999 until the end of 2011, 113 patients diagnosed with tularemia were examined. The control group was formed of 111 patients with lymphadenopathy of different origins. The following serological methods were used: microagglutination test (MAT), immunoensyme assays: ELISA (VMA, Belgrade), Serion ELISA IgG i IgM, Serazym ELISA and ELISA in house and immunochromatographic test (ICT). Clinical-epidemiological diagnosis of tularemia was confirmed serologically in all 113 patients. The high sensitivity and specifity were found for all the examined tests. IgG Virion ELISA demonstrated the highest sensitivity (97.4%) and specificity (93.1%). IgG and IgM class of antibodies remained positive in the serum in a high percentage, even as long as 12 years from the infection. Oropharyngeal form (93.8%), with predominant unilateral cervical lymphadenopathy (91.5%), was the most common clinical form. Complications, such as suppurative lymphadenitis and recurrent lymphadenitis, were seen in 41.6% of patients. A positive correlation between clinical-epidemiological and serological diagnosis of tularemia has been established. Serological findings must be interpreted only within the clinical picture of tularemia. A finding of IgM and IgG class antibodies or total antibodies of F. tularensis in the sera of patients without clinical disease manifestations, from one to 12 years from the disease onset, does not indicate an acute but a past infection.

Serological Follow-up of Patients with Erythema Migrans: Persistence of Antibody Response to Borrelia Burgdorferi in Lyme Disease Patients

The rate of seroconversion before treatment and antibody kinetics after treatment were analyzed and possible interpretations of serologic findings was proposed. Serum samples from 219 patients with Erythema migrans were tested by ELISA for antibodies against B. burgdorferi. Twenty-eight (28 %) to 55 % of the patients showed isolated IgM antibody response, 3–5 % showed isolated IgG response, 6–16 % showed concomitant IgM and IgG responses, and 24–63 % tested seronegative depending on number of days passed after the onset of Lyme borreliosis. One year after treatment, 38 % of the patients still had IgG response and 10% had IgM antibodies against B. burgdorferi. Furthermore, 4 of 106 seronegative patients revealed IgM response three months after treatment despite lack of signs or symptoms of active Lyme borreliosis. We concluded that persistence of antibody response is not indicative of treatment failure, although regular clinical and laboratory examinations, including PCR, should follow successful treatment.

Clinical and serological follow-up of patients with human granulocytic ehrlichiosis in Slovenia.

An evaluation of the clinical outcome and the duration of the antibody response of patients with human granulocytic ehrlichiosis (HGE) was undertaken in Slovenia. Adult patients with a febrile illness occurring within 6 weeks of a tick bite were classified as having probable or confirmed HGE based on the outcome of serological or PCR testing. Thirty patients (median age, 44 years) were enrolled, and clinical evaluations and serum collection were undertaken at initial presentation and at 14 days, 6 to 8 weeks, and 3 to 4, 6, 12, 18, and 24 months. An indirect immunofluorescence assay (IFA) was performed, and reciprocal titers of > or =128 were interpreted as positive. Patients presented a median of 4 days after the onset of fever and were febrile for a median of 7.5 days; four (13.3%) received doxycycline. Seroconversion was observed in 3 of 30 (10.0%) patients, and 25 (83.3%) showed >4-fold change in antibody titer. PCR results were positive in 2 of 3 (66.7%) seronegative patients but in none of 27 seropositive patients at the first presentation. IFA antibody titers of > or =128 were found in 14 of 29 (48.3%), 17 of 30 (56.7%), 13 of 30 (43.4%), and 12 of 30 (40.0%) patients 6, 12, 18, and 24 months after presentation, respectively. Patients reporting additional tick bites during the study had significantly higher antibody titers at most time points during follow-up. No long-term clinical consequences were found during follow-up.

Serological follow-up of patients with paracoccidioidomycosis treated with itraconazole using Dot-blot, ELISA and western-blot.

Twenty-seven mycologically proven cases of paracoccidioidomycosis (PCM) were treated with itraconazole (100-200 mg/day in month 1 and 100 mg/day until month 6-8) and evaluated clinically and serologically, up to 3.5 years post-therapy, using Dot-blot and ELISA for measuring the titers of IgG, IgA and IgM anti-P.brasiliensis antibodies and Western-blot for determining IgG, IgA and IgM antibodies against the antigen components of the fungus. Before treatment, 81.5% (Dot-blot) and 84% (ELISA) of the patients presented elevated IgG anti-P.brasiliensis antibody titers which dropped slightly with treatment. On the other hand, the percentages of pre-treatment high-titered sera for IgA and IgM anti-P.brasiliensis were lower (51.9% and 51.8%: Dot-blot; 16.5 and 36%: ELISA, respectively) but the titers tended to become negative more frequently with treatment. Prior to treatment, the percentages of positivity for IgG, IgA and IgM anti-P.brasiliensis antibodies in Western-blot were 96%, 20.8% and 41.6%, respectively. Antigens with molecular weights varying from 16-78 kDa, from 21-76 kDa and from 27-78 kDa were reactive for IgG, IgA and IgM antibodies, respectively. The most frequently reactive antigenic components had molecular weights of 27, 33 and 43 kDa for IgG, and 70 for IgA and IgM antibodies. During the period of study, the patients responded well to treatment. The present data confirm the diversity and complexity of the humoral response in PCM, and the importance of utilizing different serological tests to detect IgG, IgA and IgM anti-P. brasiliensis antibodies.

Clinical and Serological Follow-up of Patients with Polyarthritis, Raynaud's Phenomenon, and Circulating RNP Antibodies

Fourteen patients with polyarthritis, Raynaud's phenomenon/sclerodactyly, and circulating (U1)RNP antibodies were followed up for 10 years. All patients could be classified as having the mixed connective tissue disease at the end of the follow-up. The immunoblotting analysis revealed marked heterogeneity in the ribonucleoprotein antibody profiles. The antibodies were mainly of the IgG isotype but in four sera only IgA and/or IgM type antibodies were demonstrated. Three patients who were found to have anti-RNP by the immunodiffusion assay proved negative for anti-U-RNP antibodies by immunoblotting. Patients with antibodies against the BB' polypeptides of U-RNP particles had a disease characterized by non-erosive arthritis, sclerodactyly and cutaneous manifestations. Patients who had antibodies against the 70 kD polypeptide of U1-RNP particles only had an erosive polyarthritis. However, these patients did not tolerate treatment with either gold salts or with D-penicillamine. Thus, the classification of the RNP antibodies by immunoblotting technique seemed to define patient groups whose disease took differing courses.