Immune complex in dengue hemorrhagic fever.
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Biomedical subjects
Publications and source records attributed to S Boonpucknavig.
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We undertook a correlative study between the frequency and patterns of immunoglobulin deposits at the dermoepidermal junction of clinically normal skin and the morphologic features (histopathologic and immunopathologic) of the glomerular lesions and various immunologic measurements in 38 patients with systemic lupus erythematosus. Thirty-five (92.1%) showed a positive immunoglobulin band at the skin. A statistically significant (P less than .001) correlation was observed between the pattern of deposit and the duration of disease. The stippled pattern was found to be more common in those cases of less than one year's duration, while the thready pattern was more common in those cases lasting longer than one year. There seemed to be no significant relationship between either the frequency (P greater than .100) and pattern (P greater than 0.25) of the immunoglobulin band and the glomerular pathologic or other immunologic measurements.
Swiss albino mice infected with Plasmodium berghei berghi showed the serum-soluble malarial antigen and antibody on day 10 of infection onward. Immune complex nephritis in these mice developed on the seventh day after inoculation. The infected kidneys revealed the deposition of mouse gamma globulin, mouse beta1C globulin and malaria antigen along the capillary wall of the glomeruli. Proteinuria was detected on seventh day of infection. Serum-soluble malaria antigen in probably responsible for forming the soluble immune complex which causes glomerulonephritis in infected mice.
Immunofluorescent staining of lymphocytes suspensions from 55 of 62 patients with dengue hemorrhagic fever was positive for dengue antigen and human beta1C/a-globulin on the surface, from the second ay before shock or subsidence of fever. The percentages of positive staining of both components gradually increased to a maximum on the day of shock or subsidence of fever. B lymphocytes increased during the course of the disease. Neither dengue antigen nor human beta1C/a-globulin was detected on the surface of the lymphocytes from normal controls or patients with other diseases. By double immunofluorescent staining with different colors of fluorochromes, antidengue antibody with fluorescein isothiocyanate and antihuman gamma -globulin or antihuman beta1C/a-globulin with lissamine rhodamine B on the same lymphocytes revealed dengue antigen appearing only on B lymphocytes. The human beta1C/a-globulin and dengue antigen were located on the surface of the same lymphocytes. The pattern of the staining by both components showed fine and coarse irregular granules over the lymphocyte surface. The fluorescent granules seemed to be on the surface but not in the intracellular vacuoles of the lymphocytes.
Percutaneous needle biopsies were performed on the kidneys of 20 patients who had dengue hemorrhagic fever with some clinical manifestation of renal impairment. In ten cases IgG or IgM, or both, and C3 could be localized in the glomeruli, using the fluorescent antibody technique. In those cases in which immune complex was found, the biopsy had been done in the second week after the onset of fever. Electron microscopy showed focal thickening of the glomerular basement membrane, with hypertrophy of mesangial cells at the sites where the immune complex was shown. Dense, spherical particles, 40 to 50 nm in diameter, were found in 12 cases. Those particles were carried into the glomeruli by monocyte-like cells.
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One hundred eighty-three sera from two groups of children with dengue hemorrhagic fever and 37 control sera were examined for antibody against dengue virus by an indirect immunofluorescent method. When the reciprocal titer of 16 or higher was used as the diagnostic level, positive tests could be obtained in 80% of Group I and 100% of Group II sera after 3--6 days of fever. Positive tests were obtained in 100% of both groups after the first week of fever. There was no false-positive among the control sera. Preparation of the antigen is relatively easy, and the antigen may be stored for at least 3 months. The immunofluorescent method is rapid and simple, and is recommended for routine detection of serum antibody in dengue hemorrhagic fever.
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