Detection of specific immunoglobulins (IgG, IgM, IgA, IgE) and total IgE levels in human trichinosis by means of the enzyme-linked immunosorbent assay (ELISA)

The enemy of my enemy is my friend: Immune-mediated facilitation contributes to fitness of co-infecting helminths

The conceptual understanding of immune-mediated interactions between parasites is rooted in the theory of community ecology. One of the limitations of this approach is that most of the theory and empirical evidence has focused on resource or immune-mediated competition between parasites and yet there is ample evidence of positive interactions that could be generated by immune-mediated facilitation. We developed an immuno-epidemiological model and applied it to long-term data of two gastrointestinal helminths in two rabbit populations to investigate, through model testing, how immune-mediated mechanisms of parasite regulation could explain the higher intensities of both helminths in rabbits with dual than single infections. The model framework was selected and calibrated on rabbit population A and then validated on the nearby rabbit population B to confirm the consistency of the findings and the generality of the mechanisms. Simulations suggested that the higher intensities in rabbits with dual infections could be explained by a weakened or low species-specific IgA response and an asymmetric IgA cross-reaction. Simulations also indicated that rabbits with dual infections shed more free-living stages that survived for longer in the environment, implying greater transmission than stages from hosts with single infections. Temperature and humidity selectively affected the free-living stages of the two helminths. These patterns were comparable in the two rabbit populations and support the hypothesis that immune-mediated facilitation can contribute to greater parasite fitness and local persistence.

Long lasting immunity in trichinellosis - insight from a small study group

Trichinellosis in humans is most often caused by the parasite Trichinella spiralis. The clinical course of the disease is diverse and the symptoms can vary from mild to severe. Symptoms usually disappear within a few months, but encysted larvae in the muscles can cause myalgia and weakness that last for years. However, the existence of chronic trichinellosis as a disease is still debatable. This study presents the results obtained at the National Reference Laboratory for Trichinellosis - INEP, Serbia. The study was conducted to assess the immunoserological, biochemical and symptomatic disease parameters of twelve patients who acquired trichinellosis 13 and 18 years ago, respectively. They were involved in two T. spiralis outbreaks in Serbia, at the village of Kumane and the city of Belgrade (nine and three patients, respectively). Results indicated the presence of specific anti-Trichinella antibodies in 83% of the total number of patients. However, while the humoral immune response to Trichinella lasted for more than a decade reaching almost two decades after the acute infection phase (7/9 and 3/3 respectively, in two outbreaks), persistence of chronic muscular pain, as the most prolonged symptom of trichinellosis, could be found in the majority of patients from the Kumane outbreak (7/9). As a consequence, these patients suffered from limitations in daily living activities for the same period of time. The results presented in this paper are our contribution to the view that trichinellosis as a chronic disease with symptoms exists and may be related to the severity of the disease in the acute phase.

A Bead-Based Assay for the Detection of Antibodies against Trichinella spp. Infection in Humans

Human trichinellosis can be diagnosed by a combination of medical history, clinical presentation, and laboratory findings, and through detection of anti-Trichinella IgG in the patient's sera. ELISA using excretory-secretory (E/S) antigens of Trichinella spiralis larvae is currently the most used assay to detect Trichinella spp. antibodies. Bead-based assay can detect antibodies to multiple antigens concurrently; the ability to detect antibody to T. spiralis using a bead assay could be useful for diagnosis and surveillance. We developed and evaluated a bead assay to detect and quantify total IgG or IgG4 Trichinella spp. antibodies in human serum using T. spiralis E/S antigens. The sensitivity and specificity of the assay were determined using serum from 110 subjects with a confirmed diagnosis of trichinellosis, 140 subjects with confirmed infections with other tissue-dwelling parasites, 98 human serum samples from residents of the United States with no known history of parasitic infection, and nine human serum samples from residents of Egypt with negative microscopy for intestinal parasites. Sensitivity and specificity were 93.6% and 94.3% for total IgG and 89.2% and 99.2% for IgG4, respectively. Twelve percent of sera from patients with confirmed schistosomiasis reacted with the IgG Trichinella bead assay, as did 11% of sera from patients with neurocysticercosis. The Trichinella spp. bead assay to detect IgG total antibody responses has a similar performance as the Trichinella E/S ELISA. The Trichinella spp. bead assay shows promise as a method to detect trichinellosis with a possibility to be used in multiplex applications.

Trichinella infectivity and antibody response in experimentally infected pigs

The objective of the present study was to investigate the infectivity and antibody response of four Trichinella species (Trichinella spiralis, Trichinella britovi, Trichinella pseudospiralis and Trichinella murrelli) in experimentally infected pigs. A total of 120 Large White pigs (30 animals per group) were inoculated with 10,000 muscle larvae (ML) of T. spiralis, T. britovi, T. pseudospiralis, and T. murrelli. The pigs were sacrificed at 12-21 days post-infection (dpi) to examine the viability and infectivity of ML. A total of 54 Large White pigs (6 animals per group) were inoculated with 25, 50, 100, 200, 400, 600, 800, 1000 and 10,000 T. spiralis ML. The pigs were sacrificed, and the average numbers of larvae per gram (lpg) from six different muscle tissues were calculated at 120 dpi. The results showed that the larvae first be detectable for T. spiralis, T. britovi, and T. pseudospiralis at 16 dpi, 17 dpi, and 16 dpi, respectively. Viable larvae and average lpg were significantly increased with time from 17 to 21 dpi. The T. spiralis ML burden was dependent of the inoculation dose with an average lpg of 0.003, 0.005, 0.007, 0.17, 0.82, 2.89, 4.90, 28.30 and 226.18, respectively. The IgG antibody response was dose-dependent to generate and increased throughout the experimental period. And the IgG1 isotype was significantly higher than IgG2a, which meant that T. spiralis infection induced the Th2 immune response. The time of detecting IgM antibodies was significantly earlier than IgG antibody detection. These results provide important information in the primary characterization of pigs infected with Trichinella.

The Disease Ecology, Epidemiology, Clinical Manifestations, and Management of Trichinellosis Linked to Consumption of Wild Animal Meat

Historically, human trichinellosis was caused by Trichinella spiralis and transmitted to humans by consumption of undercooked domestic pork. Today, most cases of trichinellosis are caused by other Trichinella species and transmitted by consumption of raw or undercooked wild game meats. Given the increasing global prevalence of wild animal meat-linked trichinellosis, the objectives of this review are: 1) to describe the life cycle and global distribution of Trichinella worms; 2) to describe the changing epidemiology of trichinellosis; 3) to describe the clinical phases of trichinellosis; 4) to recommend the latest diagnostic tests; and 5) to recommend treatment and prevention strategies. Internet search engines were queried with keywords as subject headings to meet the objectives of this review. Although trichinellosis surveillance systems and laws regulating commercial pork production have limited T spiralis-caused trichinellosis in Europe and the United States, trichinellosis due to consumption of raw and undercooked wild boar and feral hog meat continues to occur throughout Southeast Asia. Trichinellosis due to consumption of raw or undercooked meats of other infected game, such as bear, deer, moose, and walrus, continues to occur worldwide. Only adherence to hygienic practices when preparing wild game meats and cooking wild game meats to recommended internal temperatures can prevent transmission of trichinellosis to humans. Wilderness medicine clinicians should be prepared to advise hunters and the public on the risks of game meat-linked trichinellosis and on how to diagnose and treat trichinellosis to prevent fatal complications.

The unique contribution of a local response group in the field investigation and management of a trichinellosis outbreak in Nunavik (Québec, Canada)

SETTING

Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak.

INTERVENTION

Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat.

OUTCOMES

Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation.

IMPLICATIONS

Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members' mobilization and empowerment with respect to local food safety issues.

Neurotrichinellosis

Trichinellosis is a parasitic zoonosis caused by the nematode Trichinella spp. Neurotrichinellosis represents one of the most important complications of severe trichinellosis in humans and is sometimes fatal, especially when Trichinella spiralis is involved. There are numerous mechanisms responsible for the involvement of the nervous system through direct or indirect involvement of the parasite. In the latter, inflammatory cells, especially eosinophils, appear to play a crucial role. Encephalopathy, neuromuscular disturbances, and ocular involvement represent the most frequent presentations of neurotrichinellosis, with the first being the most responsible for fatalities. The diagnosis is based on imaging (CT or MRI), which shows nodular multifocal hypodensities in serologically positive individuals with relevant epidemiological factors (e.g., consumption of raw pork). However, only direct diagnosis by muscle biopsy can give the absolute certainty of infection. Albendazole and mebendazole are the anthelminthic of choice and should be used with corticosteroids to prevent allergic manifestations.

Outbreak of human trichinellosis in Northern California caused by Trichinella murrelli

In October of 2008, an outbreak of trichinellosis occurred in northern California that sickened 30 of 38 attendees of an event at which meat from a black bear was served. Morphologic and molecular testing of muscle from the leftover portion of bear meat revealed that the bear was infected with Trichinella murrelli, a sylvatic species of Trichinella found in temperate North America. Clinical records revealed a high attack rate for this outbreak: 78% for persons consuming any bear meat and 100% for persons consuming raw or undercooked bear meat. To our knowledge, this report is the first published report of a human trichinellosis outbreak in the United States attributed to T. murrelli, and it is the second such outbreak reported worldwide.

Epidemiology, diagnosis, treatment, and control of trichinellosis

SUMMARY

Throughout much of the world, Trichinella spp. are found to be the causative agents of human trichinellosis, a disease that not only is a public health hazard by affecting human patients but also represents an economic problem in porcine animal production and food safety. Due to the predominantly zoonotic importance of infection, the main efforts in many countries have focused on the control of Trichinella or the elimination of Trichinella from the food chain. The most important source of human infection worldwide is the domestic pig, but, e.g., in Europe, meats of horses and wild boars have played a significant role during outbreaks within the past 3 decades. Infection of humans occurs with the ingestion of Trichinella larvae that are encysted in muscle tissue of domestic or wild animal meat. Early clinical diagnosis of trichinellosis is rather difficult because pathognomonic signs or symptoms are lacking. Subsequent chronic forms of the disease are not easy to diagnose, irrespective of parameters including clinical findings, laboratory findings (nonspecific laboratory parameters such as eosinophilia, muscle enzymes, and serology), and epidemiological investigations. New regulations laying down rules for official controls for Trichinella in meat in order to improve food safety for consumers have recently been released in Europe. The evidence that the disease can be monitored and to some extent controlled with a rigorous reporting and testing system in place should be motivation to expand appropriate programs worldwide.

Validation of an enzyme-linked immunosorbent assay for diagnosis of human trichinellosis

Trichinellosis is a zoonotic disease caused by the consumption of raw or semiraw meat from different animals harboring Trichinella larvae in their muscles. Since there are no pathognomonic signs, diagnosis can be difficult; for this reason, serology is important. The objective of this study was to validate an enzyme-linked immunosorbent assay (ELISA) using excretory/secretory antigens to detect anti-Trichinella immunoglobulin G antibodies in human sera. A total of 3,505 human serum samples were tested. A receiver-operator characteristic (ROC) curve analysis was performed. The accuracy of the test was determined by calculating the area under the curve, which was equal to 0.999, indicating high accuracy. The coefficient of variation calculated for data from four serum samples in eight working sessions was no higher than 5% for the positive sera or 14% for the negative sera. Moreover, the analysis of the differences in optical density between duplicates indicated a high repeatability for the ELISA. At the ROC optimized cutoff, the sensitivity and specificity of the test were, respectively, 99.2% and 90.6% (specificity of 95.6% when excluding the samples from multiparasitized persons from Tanzania). The validated ELISA showed good performance in terms of sensitivity, repeatability, and reproducibility, whereas the specificity was limited. These results suggest that this test is suitable for detecting anti-Trichinella antibodies in human sera for diagnostic purposes, whereas its use in epidemiological surveys could be questionable.

Serological detection of Trichinella spiralis in swine by ELISA (enzyme-linked immunosorbent assay) using an excretory-secretory (E/S) antigen

The enzyme-linked immunosorbent assay (ELISA) method is recommended for farm surveillance programs and may be useful for epidemiological studies in wildlife or for establishing Trichinella-free areas. In this study, our interest was to compare the specificity and the time of seroconversion of excretory-secretory (E/S) antigens prepared from Trichinella spiralis. A group of eight pigs was inoculated with 500 T. spiralis larvae per animal, and blood sampling was performed at 3 and 4-day intervals during all experiments. The numbers of muscle larvae were determined in four different muscles groups. The larvae per gram burden shows that the most heavily parasitized muscles were the diaphragm [mean = 43.7 larvae per gram (lpg)] and the tongue (mean = 16.9 lpg). Antibody responses were detected by any of eight infected pigs of T. spiralis. Using the ELISA method with E/S antigen, antibodies to T. spiralis were first found on the day 21st p.i. The initial detection of antibodies varied from 21st to 31st day p.i., and the peak was reported 42nd day p.i. Dynamic of antibodies was stable or increased slightly throughout the experimental period (60 days post-inoculation). Our results represent important data for validation of a serological test, especially if blood samples are taken during early stages of infection.

Human antibody recognition of Anisakidae and Trichinella spp. in Greenland

High levels of total IgE are observed among children in Greenland. To evaluate the extent to which Anisakidae and Trichinella spp. contribute to the high total IgE level, an ELISA and a western blot were developed for the detection of IgG antibodies to Anisakidae, based on excretory/secretory antigens from Anisakidae larvae. Western blots with Anisakidae and Trichinella antigens discriminated between Anisakidae and Trichinella infections, enabling cross-reactivity between the two parasite infections to be eliminated. Serum samples from 1012 children in Greenland were analysed for specific antibodies to Anisakidae and Trichinella. Eleven children were IgG-positive for Trichinella and nine were IgG-positive for Anisakidae, indicating a relatively low prevalence of both infections among children in Greenland. Faecal samples from 320 children were also examined for other intestinal parasites. Enterobius vermicularis was found in one sample and Blastocystis hominis in 32 samples, but no other intestinal parasites were identified. In total, 304 children had elevated total IgE levels. There was a significant association between Trichinella seropositivity and high levels of total IgE, but not between Anisakidae seropositivity and total IgE. The data indicate that parasitic infections alone do not explain the high level of total IgE observed among children in Greenland.

Trichinella spiralis: Macrophage activity and antibody response in chronic murine infection

The role of macrophages, their products, and the specific antibody response were examined during chronic Trichinella spiralis infection in BALB/c mice. Adult T. spiralis in intestines were detected from 5 to 20 dpi. Muscle larvae numbers peaked at 45 dpi and thereafter a reduction was noted. The highest numbers of macrophages in the peritoneal cavity of infected mice were obtained up to 30 dpi. The production of NO by macrophages in infected mice was suppressed at 5 dpi, and then NO release increased until 45 dpi. The levels of NO in plasma and urine were lower in infected mice during the entire experiment in comparison to control. The production of O(2)(-) in peritoneal macrophages was inhibited during the first two weeks after infection and then increased until 90 dpi. Circulating T. spiralis antigens in plasma and urine were detected from 5 to 30 dpi. Specific IgM and IgA in serum increased until 20 dpi. IgG, IgG(1), and IgG(2) levels in serum increased until 60 dpi.

Acute trichinellosis in children compared with adults

OBJECTIVES

Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults.

METHODS

We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat.

RESULTS

In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscular enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P < 0.01), facial and/or eyelid edema (57% versus 86%, P < 0.05), eosinophilia (52% versus 96%, P < 0.01) and increased serum creatine kinase (38% versus 79%, P < 0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant.

CONCLUSIONS

T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat.

IgE: a question of protective immunity in Trichinella spiralis infection

The best-known function of immunoglobulin E (IgE) is the initiation of allergic reaction. However, it does not make sense that IgE exists only for allergy, which is harmful for the body and does not have a beneficial role. In this article, we focus on IgE in Trichinella spiralis infection in rodents and humans, and discuss the possible roles of IgE in protection and pathogenesis.

Opinion on the diagnosis and treatment of human trichinellosis

The clinical diagnosis of trichinellosis is difficult because there are no pathogenic signs or symptoms and in diagnosing the infection epidemiological data are of great importance. Trichinellosis usually begins with a sensation of general discomfort and headache, increasing fever, chills and sometimes diarrhoea and/or abdominal pain. Pyrexia, eyelid or facial oedema and myalgia represent the principal syndrome of the acute stage, which can be complicated by myocarditis, thromboembolic disease and encephalitis. High eosinophilia and increased creatine phosphokinase activity are the most frequently observed laboratory features and the parasitological examination of a muscle biopsy and the detection of specific circulating antibodies will confirm the diagnosis. The medical treatment includes anthelmintics (mebendazole or albendazole) and glucocorticosteroids. Mebendazole is usually administered at a daily dose of 5 mg/kg but higher doses (up to 20 - 25 mg/kg/day) are recommended in some countries. Albendazole is used at 800 mg/day (15 mg/kg/day) administered in two doses. These drugs should be taken for 10 - 15 days. The use of mebendazole or albendazole is contraindicated during pregnancy and not recommended in children aged < 2 years. The most commonly used steroid is prednisolone, which may alleviate the general symptoms of the disease. It is administered at a dose of 30 - 60 mg/day for 10 - 15 days.

New aspects of human trichinellosis: the impact of new Trichinella species

Trichinellosis is a re-emerging zoonosis and more clinical awareness is needed. In particular, the description of new Trichinella species such as T. papuae and T. murrelli and the occurrence of human cases caused by T pseudospiralis, until very recently thought to occur only in animals, requires changes in our handling of clinical trichinellosis, because existing knowledge is based mostly on cases due to classical T spiralis infection. The aim of the present review is to integrate the experiences derived from different outbreaks around the world, caused by different Trichinella species, in order to provide a more comprehensive approach to diagnosis and treatment.

Atopic status and level of bronchial responsiveness in parents of children with acute bronchiolitis

To examine whether children with a genetic predisposition to asthma are more likely to be afflicted with bronchiolitis, we studied 122 parents of infants who were hospitalized with the diagnosis of acute bronchiolitis (index group) and 120 parents of children who had never suffered from this disease (control group). The parents underwent bronchial challenge testing with methacholine and skin prick testing with common airborne allergens, and gave blood specimens for measurement of serum total IgE. There was no difference in atopic status, as assessed by the prevalence of atopy (at least one positive response to the allergens tested) or by serum total IgE levels, between index and control parents. The prevalence of bronchial hyperresponsiveness (BHR) (concentration of methacholine causing a 20% reduction in forced expiratory volume in 1 sec [PC20] < 18 mg/mL) was higher in index parents than in control parents (17.2% vs. 7.5%, p = 0.02). Bronchial responsiveness (BR) index was significantly higher in index parents than in control parents (1.135 +/- 0.088 vs. 1.104 +/- 0.071, p < 0.01). Parents of children who were hospitalized with acute bronchiolitis showed a higher level of BR, but not atopy. This suggests that in terms of BHR, there may be a genetic predisposition to the development of bronchiolitis.

Trichinellosis: human disease, diagnosis and treatment

In this review, the pathological mechanisms of human trichinellosis are presented, including a discussion on organ pathology, with particular attention paid to intestinal and muscular invasion. The clinical pattern in the acute stage of trichinellosis is presented, together with a classification of trichinellosis relative to severity of the disease. In turn, complications and diagnostic criteria are discussed. Drugs employed in the contemporary treatment of trichinellosis are presented (mainly those of the benzimidazole group and glucocorticosteroids) as well as indications for administering them, as related to severity of the disease.

Immunodiagnosis of human trichinellosis and identification of specific antigen for Trichinella spiralis

Crude antigens obtained from the infective stage larvae of Trichinella spiralis were used in an ELISA for detecting IgG antibodies to T. spiralis in serum samples collected from three groups of individuals. The individuals of the first group were parasitologically confirmed trichinellosis patients, while those of group 2 were patients with other helminthiasis and group 3 were healthy, parasite-free individuals. The specificity of the assay was 96.8% when performed on sera of groups 2 and 3. Cross-reaction was observed with the sera of patients with capillariasis, gnathostomiasis, opisthorchiasis, and strongyloidiasis and opisthorchiasis with hookworm infection. The sensitivity of the test was 100% when performed on sera of group 1, which were collected 57 days after infection. Western blot analysis revealed that a specific antigen for T. spiralis was a component of M(r) 109.

Human humoral immune responses against Trichinella spiralis

The analysis of trichinellosis patients' sera was performed by Western blot against a crude extract of Trichinella spiralis. Eight distinctive bands from 38 to 104 kDa were present in most of the patients' sera as a striking homogeneous response. Some of these characteristic bands were found to be recognized by the serum of infected rodents and of an immunized rabbit in this work, and have also been reported to be recognized by monoclonal and polyclonal antibodies from T. spiralis infected or immunized rats, mice, swine or rabbits. Our data indicate that different animal species as well as humans recognize unique immunodominant epitopes of T. spiralis.

Immunodiagnosis of human trichinellosis using excretory-secretory (ES) antigen

Infective first stage larvae of Trichinella spiralis were recovered from muscles of laboratory infected mice by digesting the muscles with 1% HC1-1% pepsin and collecting the larvae by modified Baerman's method. The larvae were cultivated in a serum-free medium for 18 h. The ES antigen obtained from the culture medium was used in an enzyme-linked immunosorbent assay (ELISA) for detecting IgG antibodies to T. spiralis in serum samples collected from three groups of individuals. The individuals of the first group were parasitologically confirmed trichinellosis patients, while those of group 2 were patients with other helminthiasis and group 3 were healthy, parasite-free individuals. The specificity of the assay was 100%. The sensitivity of the test was also 100% when performed on sera of group 1 collected at days 57 and 120 after infection. Sera collected earlier (day 23) and those collected 700 days after infection had negligible reactivity. Thus IgG-ELISA using ES antigen of the L1 was useful not only for diagnosis but also in evaluation of cure. Western blot analysis revealed that specific antigens of T. spiralis were 94, 67, 63, and 39 kilodalton components.

Diagnostic tests for Trichinella spiralis infection in pigs. A comparative study of ELISA for specific antibody and histamine release from blood cells in experimental infections

A study on the histamine release test (HR) for the demonstration of infections with Trichinella spiralis in pigs was carried out on 18 pigs, six infected with 200 larvae, six infected with 5000 larvae and six non-infected (control group). The results obtained by HR during a 7 week infection were compared with those of the enzyme-linked immunosorbent assay (ELISA). All inoculated pigs were found to be positive on Day 40 post-inoculation (p.i.) by necropsy examination of selected muscle groups, with mean recoveries of 7.9 and 225 larvae g-1 of tissue in the low- and high-dose group, respectively. At this time, all animals of the high-dose group and five out of six animals of the low-dose group were antibody positive in ELISA with any of three coating antigens employed (a crude muscle larva extract, an excretory/secretory (ES) antigen and a purified 45 kDa antigen). HR performed on whole blood was positive in four out of six pigs of the high-dose group and one out of six pigs of the low-dose group. The earliest ELISA seroconversions took place at Day 15 p.i. with crude and ES antigens. The earliest measurable reaction in HR performed on whole blood was found on Day 19 p.i. There was considerable individual variation regarding which test was the most sensitive for the early detection of infection. Washing of the blood cells prior to antigen provocation led to a markedly improved sensitivity of HR, all animals of the high-dose and three out of six animals of the low-dose group being positive by Day 40 p.i. The time course of the development of ELISA titres and HR reactivity indicated that this effect is due to the removal of blocking antibodies.

A mouse monoclonal antibody that binds to an alpha-stichocyte of Trichinella spiralis

Monoclonal antibodies were generated for the isolation of specific antigens from Trichinella spiralis. A monoclonal antibody (TS32D12) of the IgG1 class was selected according to its reactivity and specificity by enzyme-linked immunosorbent assay and immunofluorescent technique. The TS32D12 antibody was purified from ascites by fast protein liquid chromatography. The purified antibody showed a sensitive reaction to the T. spiralis antigen, but not to any other heterologous parasite antigens so far examined. Western blot analysis showed that the monoclonal antibody bound to epitopes present on the 160-kDa molecule. The antigen molecule was fragmented into 56-kDa molecules by heat treatment. The epitopes seemed to be destroyed since the antibody could not bind to the 56-kDa molecule. Staining with the periodic acid-Schiff (PAS) reagent suggested that the two molecules of 160 kDa and 56 kDa were glycoproteins. The 160-kDa molecule was detected only in the alpha-stichocyte of T. spiralis muscle larvae.

[Standardization and evaluation of an immunoenzyme assay for the diagnosis and seroepidemiology of human trichinosis]

Se estandarizó un enzimoinmunoensayo (EIE) en fase sólida en el que se empleó un antígeno soluble total de T. spiralis y una dilución única de suero, y se evaluó la capacidad del sistema para detectar anticuerpos totales antitriquina con fines diagnósticos y seroepidemiológicos. Las curvas dosis respuesta mostraron que trabajando con una dilución de suero de 1:100 se obtenía una buena diferenciación entre sueros de indivíduos no infectados y pacientes de triquinosis con baja concentración de anticuerpos circulantes y la respuesta fue lineal entre valores de 0.15 y 0.64 unidades de densidad óptica (DO). El estúdio de 720 sueros de población general no infectada revelo una X k = 0.07 y una S = 0.03 unidades de DO. El 98,61% de esta población presentó valores de DO < X k + 3S; el 1,25% valores de DO entre > X k + 3S y < X k + 4S; y el 0.14% restante valores entre > X k + 4S y < X k + 5S. Se empleó un valor de DO = X k + 5S como nivel diagnóstico para estudiar 4 brotes de triquinosis humana, 80 sueros de pacientes de triquinosis con diferentes títulos en inmunofluorescencia indirecta (IFI) y 20 sueros de pacientes de hidatidosis. El EIE propuesto permitió diferenciar en forma confiable y eficiente población infectada de no infectada y tuvo una buena correlación con la IFI. Todos los sueros de pacientes hidatídicos presentaron valores de DO < X k + 4S.

Improvements in the serodiagnosis of helminthic zoonoses

Remarkable progress has been achieved in developing improved serodiagnostic assays for a group of diseases for which other diagnostic methods are often lacking. Toxocariasis, trichinellosis, dirofilariasis, Taenia solium cysticercosis and the cystic and alveolar forms of hydatid disease are occult infections in humans and sometimes in lower animal hosts. Although Strongyloides stercoralis achieves patency in humans, parasitologic diagnosis is often very difficult. Efforts to develop reliable immunodiagnostic methods have spanned several decades but progress had been slow until recently. The complexity and nonspecificity of helminth antigens were major problems which prevented the full realization of the benefits of the highly sensitive assay systems now available. Modern immunologic methods including hybridoma technology, immunoaffinity chromatography and immunoblotting, however, have yielded improved reagents and the means to characterize their nature and function. The outcome of this research has been more sensitive and specific serologic tests based on measurement of both circulating antigens and antibodies as well as improved understanding of the nature of host-parasite interactions. Although much remains to be done, many improved immunodiagnostic procedures are already being applied in clinical diagnosis, epidemiologic studies and control programs directed against the helminthic zoonoses.

Kinetics of humoral response during the acute and the convalescent phase of human trichinosis

After a common source outbreak of trichinosis in Bitburg, FRG, 107 patients, for whom time and source of infection were precisely known, were prospectively studied for a period of eight months in order to investigate the kinetics of the humoral immune response. Antibodies were assessed by IHA, and by ELISA to quantify IgG, IgM and IgE isotypes. For four different periods of the observation time sensitivity and predictive value of tests to identify acute or convalescent trichinosis were determined. The results demonstrated characteristic kinetics of the different antibody isotypes and varying diagnostic value of the tests. Only IgG-ELISA and double-sandwich IgM-ELISA reliably identified diseased patients shortly after onset of clinical illness and showed a negative predictive value of almost 100% from seven weeks to eight months after infection. IgE antibodies and elevation of total serum IgE occurred only in about 20% of patients and showed no consistent pattern during the course of the disease. Circulating immune complexes were moderately increased four weeks after infection. They rapidly returned to normal values, after the symptoms of the acute phase had disappeared.

Arctic trichinosis presenting as prolonged diarrhea

We describe an outbreak of trichinosis after the consumption of raw walrus meat in 10 Inuit inhabitants of a northern community. During the presentation of the illness, diarrhea was found in all subjects and was the dominant symptom in 8 of the 10 cases. Myalgia (60%) and muscle weakness (50%) were much less prominent complaints. The diarrhea was characteristically prolonged, lasting up to 14 wk (average 5.8 wk), as opposed to comparatively short episodes of myalgia (average 5.4 days) and muscle weakness (average 4.5 days). Prolonged diarrhea with little or no muscle symptomatology in an epidemic form represents a previously unrecognized clinical presentation of trichinosis. It remains to be determined whether this new clinical presentation is related to variant biological behavior of arctic Trichinella, to previous exposure to the parasite, or to other factors.

Study of acute trichinosis in Ghurkas: specificity and sensitivity of enzyme-linked immunosorbent assays for IgM and IgE antibodies to Trichinella larval antigens in diagnosis

The enzyme-linked immunosorbent assay (ELISA) was successfully applied to detect IgE antibodies against parasitic antigens by using an additional antibody layer to attain an amplification effect. The sera of 18 Gurkha patients with clinical manifestations of acute trichinosis and 35 Chinese with other parasitic infections were tested for antibodies to Trichinella spiralis by IgE-, IgM- and IgG-ELISA, IgG-radioimmunoassay (RIA) and indirect haemagglutination test (IHA). ELISAs for detection of IgE and IgM antibodies provided a 100% specific and sensitive diagnosis. Although IHA, IgG-RIA and IgG-ELISA detected antibodies in 94% of patients, non-specific reactions were also observed in the two last named methods. Muscle biopsies were positive in only 56% of patients.