Due à un flavivirus transmis par morsure de tiques, la méningo-encéphalite saisonnière menace les personnes qui fréquentent les zones forestières. Sa progression se déroule d'Est en Ouest sur le ...continent européen depuis des années, marquée par des épidémies saisonnières liées à l'activité des tiques. Après une incubation silencieuse, la virémie est marquée par un syndrome pseudo-grippal et 1/3 des patients, après une phase asymptomatique de 2 à 3 semaines, présentent une méningite voire une méningo-encéphalite, pouvant être à l'origine de décès (1 à 2 %) ou de paralysies séquellaires (10 à 20 %). La recherche d'anticorps spécifiques dans le sang ou le LCR permet d'établir le diagnostic. Les tentatives d'éradication des tiques s'étant révélées inefficaces, l'information des populations exposées sur les dangers des morsures par tiques est la première démarche à entreprendre. La vaccination est vivement recommandée aux personnes à risques dans les zones d'endémie (vaccin FSME-Immun®, Immuno) assurant une protection dans 97 % des cas. En son absence, l'utilisation de gammaglobulines spécifiques (FSME-Bulin®, Immuno), permet d'assurer rapidement une immunothérapie passive à condition de ne pas l'employer plus de 4 jours après la morsure de la tique. En Autriche, l'un des foyers de l'épidémie, cette politique de prévention, menée depuis plus de 10 ans, a démontré toute son efficacité.
Caused by a flavivirus transmitted to man by tick bites the Tick-Borne Encephalitis (TBE) threaten persons in forest countries. Progressing for years on the european continent form East to West the TBE prevalence presents seasonal outbreaks due to tick activity. TBE has a diphasic course. After a silencious incubation period viremia is marked by a pseudo-grippal syndrom and a third of patients after an asymptomatic period of 2 to 3 weeks develop a meningitis or a meningo-encephalitis which may provoke death (1 to 2 %) or residual paresis (10 to 20 %). The detection of specific antibodies in blood or CSF makes TBE to be safely diagnosed. Because past effort to eradicate ticks were inefficient, alert the exposed populations to the risk of tick bites is the first measure to take. Vaccination is highly recommanded to exposed individuals living in endemic areas (FSME-Immu® vaccin, Immuno) assuring a protection rate in 97 %. In absence of vaccination passive immunization with specific immunoglobulins (FSME-Bulin®, Immuno) procures a good and rapid protection before exposure or up to 4 days after the tick bite. In Austria, an epidemic area, this preventive policy conducted for 10 years, was very effective.
Specific IgG antibodies against bee venom and bee venom components were studied in the serum of 40 bee-sting patients, 60 bee keepers, and 31 control subjects. The highest titres were observed in ...successfully hypothesized patients and in bee keepers. Subclass-typing in bee-sting allergic patients showed the highest antibody levels in subclass IgG2, followed by IgG3, IgG 4 and IgG1. During hyposensitization, a rise in specific IgG antibodies in all subclasses and against bee venom and all its components was found. The allergic reaction to bee stings disappeared with the rise of specific IgG antibodies, as demonstrated by a bee-sting challenge. After 6 months of hyposensitization therapy, the specific IgG antibodies remained above, and the specific IgE antibodies fell below, the pretreatment levels.
Specific IgE and IgG antibodies and basophil response to Candida albicans were examined in 115 patients with bronchial asthma and compared to responses to house dust antigen. 1. The incidence of ...patients with specific IgE antibodies to Candida albicans was highest in cases aged between 41 and 50 years, and high in cases aged between 31 and 40 years and between 51 and 60 years. The incidence was also high in cases with the age at onset of the disease between 21 and 30 years and between 41 and 50 years, and in cases with serum IgE levels between 101 and 200IU/ml and more than 1001IU/ml. On the other hand, specific IgE antibodies to house dust were more frequently observed with younger patient age and age at onset of the disease, and higher serum IgE levels. 2. The concentrations of specific IgG antibodies to Candida albicans increased as patient age was higher. 3. A ratio of histamine release induced by Candida against anti-IgE-induced release was lower in cases aged between 0 and 40 years, and higher in cases aged between 41 and 50 years, while the ratio of housedust-induced release against the release by anti-IgE was lower as patient age became greater.
To evaluate the performance of Aspergillus-specific IgG antibodies for diagnosing chronic pulmonary aspergillosis (CPA) by using a cohort of patients with histologically proven CPA as a reference ...standard.
We collected Aspergillus-specific IgG antibody titres from patients with histologically proven CPA in collaboration with CPAnet study sites in Denmark, Germany, Belgium, India, Moldova, and Pakistan (N = 47). Additionally, sera from diseased and healthy controls were prospectively collected at the Medical Clinic of the Research Center, Borstel, Germany (n = 303). Aspergillus-specific IgG antibody titres were measured by the ImmunoCAP® assay (Phadia 100, Thermo Fisher Scientific, Uppsala, Sweden). An Aspergillus-specific IgG antibody titre ≥50 mgA/L was considered positive.
Using patients with histologically proven CPA as the reference standard, the ImmunoCAP® Aspergillus-specific IgG antibody test had a sensitivity and specificity of 85.1% (95% CI: 71.7–93.8%) and 83.6% (95% CI: 78.0–88.3%), respectively. Patients with histologically proven CPA had significantly higher Aspergillus-specific IgG antibody titre with a median of 83.45 mgA/L (interquartile range 38.9–115.5) than all other cohorts (p < 0.001). False-positive test results occurred in one-third of 79 healthy controls.
Our study results confirm a high sensitivity of the Aspergillus-specific IgG antibody test for the diagnosis of CPA when using patients with histologically proven CPA as a reference standard. However, positive test results should always match radiological findings as false-positive test results limit the interpretation of the test.
Aspergillus-specific IgG antibody (Asp IgG) has been successfully applied in the diagnosis of chronic pulmonary aspergillosis. We explored its value in nonneutropenic invasive pulmonary aspergillosis ...(IPA) by a multicenter, prospective, and controlled study.
We enrolled 372 clinically suspected nonneutropenic patients with IPA from February 2015 to August 2022. After excluding 4 cases with Aspergillus colonization, the remaining 368 cases were finally confirmed as patients with IPA (n = 99), or non-IPA patients (n = 269) consisting of community-acquired pneumonia (n = 206), tuberculosis (n = 22), nontuberculous mycobacteria (n = 5), lung abscess (n = 6), or noninfectious diseases (n = 30). Asp IgG in plasma samples was tested by enzyme-linked immunosorbent assay.
At cut-off value of ≥80 AU/mL, Asp IgG had much higher sensitivity (59.6% vs. 19.2%, p < 0.0001), but lower specificity (77.0% vs. 96.3%, p < 0.0001) than serum galactomannan (GM) (cut-off value of ≥1.0), and similar sensitivity (59.6% vs. 55.6%, p = 0.611) but lower specificity (77.0% vs. 91.2%, p = 0.001) than bronchoalveolar lavage fluid (BALF) GM (cut-off value of ≥1.0), respectively. Combination diagnosis of either positive for Asp IgG or BALF GM had higher sensitivity (81.0% vs. 55.6%, p = 0.002), but lower specificity (75.2% vs. 91.2%, p = 0.001) than BALF GM alone. The receiver operating characteristic curve showed that Asp IgG had an optimal diagnostic value when the cut-off value was 56.6 AU/ml, and the sensitivity and specificity were 77.8% and 63.9%, respectively.
The diagnostic value of Asp IgG for IPA is superior to serum GM, and a little inferior to BALF GM in nonneutropenic patients with IPA. Considering the convenience of taking blood samples, it is a good screening and diagnostic method for nonneutropenic patients with IPA, especially for those who cannot bear invasive procedures.
Background
Toxoplasmosis is a rare but life‐threatening infection occurring in immunocompromised hosts, including allogeneic hematopoietic stem cell transplantation (allo‐HSCT) recipients. However, ...thus far, the clinical features and incidence of toxoplasmosis in autologous HSCT (auto‐HSCT) recipients remain unknown. This retrospective survey aimed to analyze 152 patients who received auto‐HSCT between 1998 and 2017.
Methods
Serological tests for Toxoplasma gondii‐specific IgG were performed on 109 (71.7%) recipients, and 12 pre‐HSCT recipients (11%) were Toxoplasma seropositive. Among the 12 recipients, three who did not receive trimethoprim‐sulfamethoxazole (TMP/SMX) prophylaxis developed cerebral, pulmonary or disseminated toxoplasmosis due to reactivation after auto‐HSCT and died despite treatment.
Results
The incidences of toxoplasmosis were 2% and 25% among 152 auto‐HSCT recipients (five recipients received auto‐HSCT two times) and 12 pre‐HSCT Toxoplasma seropositive recipients, respectively. Further, we conducted a literature review and identified 21 cases of toxoplasmosis following auto‐HSCT. In these previous cases, the mortality rate was high, especially for pulmonary and disseminated toxoplasmosis. Our findings suggest that, similar to toxoplasmosis after allo‐HSCT, toxoplasmosis after auto‐HSCT is a fatal complication.
Conclusions
Serial screening of T. gondii‐specific IgG before HSCT could contribute to the detection of Toxoplasma reactivation and allow for prompt diagnosis and treatment. The present study is the first to reveal the incidence of toxoplasmosis after auto‐HSCT among seropositive patients in Japan.
Background
Information on tick‐borne encephalitis (TBE) in patients already vaccinated against the disease is limited.
Objectives
To compare the course and outcome in patients with vaccination ...breakthrough TBE with findings in patients who developed TBE without previous vaccination.
Methods
All adult patients diagnosed with TBE at a single medical centre during a 16‐year period and who had received at least two doses of TBE vaccine before the onset of illness qualified for the study. For each patient with breakthrough TBE, two unvaccinated sex‐ and age‐matched patients, diagnosed with TBE in the same year, were included for comparison.
Results
Amongst 2332 patients diagnosed with TBE in the period 2000–2015, 39 (1.7%) had been vaccinated against the disease. Their median age was 59 (20–83) years; 22 of 39 (56.4%) were male. In comparison with unvaccinated patients with TBE, those with breakthrough disease more often experienced a monophasic course of illness (P = 0.006), had a higher CSF leucocyte count (P = 0.005), more often had urine retention (P = 0.012), more often needed ICU treatment (P = 0.009), were hospitalized for longer (P = 0.002) and had more severe acute illness (P = 0.004 for simple clinical assessment, P = 0.001 for severity score).
Conclusion
In addition to several findings corroborating previous results in patients with vaccination breakthrough TBE, such as older age and the presence of a particular specific serum antibody pattern indicating anamnestic response, findings in this study indicate that the acute illness in patients with breakthrough TBE is more severe than in unvaccinated sex‐ and age‐matched patients who develop the disease.
Bird-related hypersensitivity pneumonitis (BRHP) is an extrinsic allergic alveolitis caused by inhalation of bird antigens. Although the measurement of serum-specific IgG antibodies against ...budgerigar, pigeon, and parrot with ImmunoCAP® is available in Japan, the utility of the test for patients with causes by bird breeding other than these three species, including contact with wild birds/poultry/bird manure, and use of a duvet is unknown.
Of the 75 BRHP patients who participated in our previous study, 30 were included. Six cases were caused by bird breeding of species other than pigeon, budgerigar, and parrot, seven were in contact with wild birds/poultry/bird manure, and 17 were using a duvet. Bird-specific IgG antibodies were compared among the patients, 64 controls, and 147 healthy participants.
In patients with BRHP caused by bird breeding, budgerigar and parrot-specific IgG levels were significantly higher than in disease controls. Only parrot-specific IgG was significantly higher than in disease controls in patients caused by duvet use. However, among patients with acute episodes (acute and recurrent type of chronic BRHP), IgG antibodies against all three species were significantly higher than those of disease controls caused by bird breeding and the use of a duvet.
Bird-specific IgG antibody with ImmunoCAP® was useful for screening and diagnosing BRHP caused by other bird species and duvets.
Chronic pulmonary aspergillosis (CPA) is an underdiagnosed and misdiagnosed disease and now increasingly recognised. However, the diagnosis of CPA remains challenging. In this study, we aimed to ...investigate the diagnostic values of serum Aspergillus-specific IgG, IgA and IgM antibodies in patients with CPA.
The prospective study was performed at Chinese People's Liberation Army General Hospital in Beijing, from January 2017 to December 2017. Adult patients with lung lesions presented as cavity, nodule, mass, bronchiectasis or severe fibrotic destruction with at least two lobes in CT imaging were enrolled. One hundred healthy persons were also enrolled as additional controls. The serum levels of Aspergillus-specific IgG, IgA and IgM antibodies and galactomannan (GM) levels were measured simultaneously by plate ELISA kit.
A total of 202 patients were enrolled in this study, including 42 CPA patients, 60 non-CPA patients and 100 healthy persons. The most common underlying lung diseases in CPA patients were bronchiectasis (28.6%) and COPD (19.0%). The most common symptoms in the CPA patients were cough (76.2%), sputum (71.4%), and fever (45.2%); chest pain (4.8%) was infrequent. Receiver operating characteristic (ROC) curve analysis revealed that the optimal CPA diagnostic cut-off of Aspergillus-specific IgG, IgA and IgM assays and GM test were 89.3 AU/mL, 8.2 U/mL, 73.3 AU/mL and 0.5μg/L, respectively. The serum levels of Aspergillus-specific IgG and IgA in CPA patients were higher than these in non-CPA patients or healthy persons. The sensitivities and specificities of Aspergillus-specific IgG, IgA, IgM tests and GM test were 78.6 and 94.4%, 64.3 and 89.4%, 50.0 and 53.7% and 71.4 and 58.1%, respectively.
The sensitivity and specificity of serum Aspergillus-specific IgG assay are satisfactory for diagnosing CPA, while the performance of Aspergillus-specific IgA assay is moderate. Aspergillus-specific IgM assay and serum GM test have limited value for CPA diagnosis.
NCT03027089 . Registered 20 January 2017.
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