Elena Noris-García

IgG1,IgG2 and IgE intrathecal synthesis in Angiostrongylus cantonensis meningoencephalitis

INTRODUCTION Angiostrongylus cantonensis meningoencephalitis is an emergent zoonotic disease in the Caribbean basin, characterized by the presence of eosinophils and third stage larva of the helmint. OBJECTIVE To analyze the IgG subclasses and IgE intrathecal synthesis patterns obtained by reibergrams in pediatric patients suffering from eosinophilic meningoencephalitis due to A. cantonensis. PATIENTS AND METHODS 20 pediatric patients with the disease were studied. During the first diagnostic lumbar puncture an eosinophilic pleocytosis was found. Simultaneously a serum sample was taken. Eight days later, a second lumbar and venous puncture was performed. IgA, IgM, IgG, albumin in serum and cerebrospinal fluid samples were quantified by immunodiffusion in addition to a differential cell count in cerebrospinal fluid. IgG subclasses were quantified in 10 patients by immunodiffusion and IgE in four patients by nephelometry. RESULTS During the first diagnostic lumbar puncture, all the cases had a blood-cerebrospinal fluid barrier dysfunction with absence of immunoglobulins intrathecal synthesis, a mean of 450 cells/mul and an average of 48% of eosinophils. In the second lumbar puncture 40% of the patients had a dysfunction of the blood-cerebrospinal fluid barrier and an intrathecal synthesis pattern of IgA+IgM+IgG in 50% of the patients. Eight patients had an intrathecal IgA+IgG class response. The synthesis pattern of IgG subclasses was IgG1+IgG2 in six patients, IgG1+IgG2+IgG3 in one patient, IgG1+IgG2+IgG4 in one more patient. Two patients from the second lumbar puncture remained without intrathecal synthesis. IgE intrathecal synthesis was observed in the four analyzed patients in the first diagnostic lumbar puncture. CONCLUSIONS The IgG1+IgG2 and IgE intrathecal synthesis pattern demonstrated the complexity of the antigenic mosaic of the helmint and it can contribute to diagnosis of eosinophilic meningoencephalitis due to A. cantonensis.

C3c intrathecal synthesis evaluation in patients with multiple sclerosis

INTRODUCTION Multiple sclerosis (MS) is a chronic, inflammatory and progressive disease of the central nervous system in which local inflammatory injuries of the brain white matter appears, being the most outstanding feature the myeline loss (demyelination). OBJECTIVE To determine if the complement system might be involved in the MS immunopathogeny favouring the mechanism intervening in the myelin destruction. METHOD Samples of sera and CSF from twelve patients with a diagnosis of MS obtained at the moment of the admission to the hospital at the beginning of the break out, were collected. Levels of C3c and albumin in sera and in CSF were quantified using radial immunodiffusion plates. RESULTS High values over 80% of intrathecal synthesis were obtained except in one of the patients. CONCLUSION Intrathecal synthesis of C3c and its liberation to the CSF means that the activation of the complement system in any of the two ways has taken place, and that once performed its biological functions, has suffered a degradation process.

Reibergrama para la evaluación de la síntesis intratecal de C3c

RESUMEN - I n t roduccion: El diagrama de las razones de Reiber o re i b e rgrama cobra cada dia mayores usospara la caracterizacion de la sintesis intratecal de proteinas. El re i b e rgrama fue definido para las clasesm a y o res de inmunoglobulinas pero luego ha sido utilizado para evaluar otras proteinas basado en la teoriade la difusion molecular/velocidad de flujo del liquido cefalorraquideo (LCR). Metodo: El C3c, productode la degradacion del factor del complemento C3 y con una masa molecular de 145 KDa, se acerca a lascaracteristicas moleculares de la IgG para las leyes de la difusion de Fick. Se asume las constantes de la IgGen la formula de Reiber para evaluar la sintesis intratecal de C3c asi como su correspondiente re i b e rg r a m a .Se estudiaron 27 pacientes y 27 controles a los que se les dosifico albumina y C3c en suero y LCR porinmunodifusion radial. Resultados: Con el re i b e rgrama propuesto para el C3c se evaluaron estos pacientes.Se comprueba la validez de este re i b e rgrama para distintas condiciones de barrera con o sin sintesis intratecalde C3c.

IgG2 immunodeficiency: association to pediatric patients with bacterial meningoencephalitis.

An IgG subclass deficiency is often associated with bacterial infections. We studied four pediatric patients suffering from meningoencephalitis, two of them due to Streptococcus pneumoniae and two due to Haemophilus influenzae type b. Simultaneous diagnostic serum and cerebrospinal fluid samples were taken during income. The four subclasses of IgG and albumin were quantified in both biologic fluids by radial immunodiffusion. Very low levels of seric IgG2 with non detectable cerebrospinal fluid IgG2 were found in the patients. No intrathecal IgG subclass synthesis was found in two patients. One patient with S. pneumoniae had IgG3 intrathecal synthesis. Intrathecal IgG1, IgG3 and IgG4 synthesis was found in one patient suffering from H. influenzae according with reibergrams. Substitutive therapy with intravenous gammaglobulin was given to the patients as part of the treatment.

sICAM-1 in meningoencephalitis due to Angiostrongylus cantonensis

INTRODUCTION Angiostrongylus cantonensis meningoencephalitis is an emergent disease in the Americas. METHOD Twelve children suffering from eosinophilic meningoencephalitis due to this parasite aged between 6-10 years were studied. Cerebrospinal fluid (CSF) and serum samples were taken simultaneously in the first diagnostic puncture at admission. RESULTS All cases showed typical findings on the routine CSF and serum analysis: increased CSF total protein, increased Q (CSF/serum) albumin accompanied by eosinophilia in CSF. No intrathecal synthesis of immunoglobulins was found. Mean serum and CSF sICAM-1 values were 337.4 and 3.97 ng/mL. Qalbumin and QsICAM-1 mean values were 4.1 and 6.2 respectively. In 50% of the patients an increased brain-derived fraction of sICAM-1 was found. CONCLUSION It may be suggested that a dynamic of the sICAM-1 brain derived fraction is perhaps associated to the immune response in the evolution of the disease.sICAM-1 may be an agent in negative feedback for eosinophils passage through the blood-CSF barrier into the inflammatory brain response.

SEASONAL DISTRIBUTION AND EVOLVING FORMS OF MULTIPLE SCLEROSIS PATIENTS DIAGNOSED FROM APRIL 2004 TO NOVEMBER 2007

BACKGROUND Multiple sclerosis (MS) was first reported in Cuba in 1965. The most frequent appearance is observed in the first six months of the year. OBJECTIVE To determine the seasonal distribution and evolving forms of MS patients diagnosed with the disease between April 2004 and November 2007. METHOD Twenty-one patients with suspected MS and 42 outbreaks were studied. Patients were classified according to Lublin and Revingolds criteria for clinical forms and according to McDonald. RESULTS Most patients were classified in outbreak and remission and only two patients classified as primary-progressive multiple sclerosis. The higher number of outbreaks occurred in the first two quarters of the year. CONCLUSION It is recommended to study further weather variables that may be related to the emergence of these outbreaks in our environment.

sICAM-1 intrathecal synthesis and release during the acute phase in children suffering from Coxsackie A9 and S. pneumoniae meningoencephalitis

The intercellular adhesion molecule is a transmembrane glycoprotein belonging to the immunoglobulin superfamily. Serum and cerebrospinal fluid (CSF) soluble intercellular adhesion molecule 1 (sICAM-1) from normal control children as well as from children with Guillain-Barré syndrome (GBS), with Coxsackie A9 virus meningoencephalitis and with Streptococcus pneumoniae meningoencephalitis were studied. sICAM-1 was quantified using an immunoenzimatic assay and albumin using the immunodiffusion technique in both biological fluids. Increased sICAM-1 values in CSF in patients with GBS correspond to an increase of the albumin CSF/serum quotient. In contrast, in inflammatory diseases like S. pneumoniae and Coxsackie A9 virus meningoencephalitis an increased brain-derived fraction was observed. In particular cases these values are 60-65% and 70-75% respectively. The results indicate an additional synthesis of sICAM-1 in subarachnoidal space during central nervous system (CNS) inflammatory process. An important role of sICAM-1 in the transmigration of different cell types into CSF during CNS inflammation in children with S. pneumoniae and Coxsackie A9 meningoencephalitis may be suggested.

Detection of intrathecal IgM, IgG and IgA in a Cuban West Nile virus confirmed case

Laboratorio Central de Liquido Cefalorraquideo (LABCEL).Facultad de Ciencias Medicas “Dr. Miguel Enriquez” Habana, Cuba.Received 18 September 2007, received in final form 6 June 2008. Accepted 11 June 2008.Dra. Maritza Pupo-Antunez – Novia del Mediodia Km 6 ½ - La Lisa, Habana, Cuba. E-mail: mpupo@ipk.sld.cu