title: Intrathecal immune response and virus-specific immunoglobulin M antibodies in laboratory diagnosis of acute poliomyelitis.
abstract: The intrathecal immune response in 114 patients with clinically diagnosed acute poliomyelitis was studied by measuring poliovirus-specific immunoglobulin M (IgM) antibodies in cerebrospinal fluid (CSF) by a mu-capture immunoassay and by assessing the ratio between levels of poliovirus-neutralizing antibodies in serum and CSF. Fecal specimens were used for attempts to isolate the causative agents. Eighty-five percent of CSF specimens collected during the first 15 days of disease contained virus-specific IgM antibodies. Forty-five of 48 tested children (94%) also showed virus-specific IgM responses in their sera. Later on, the antibody levels decreased, and positive results after 30 days of onset of paralytic symptoms were rare. If the presence of poliovirus-specific IgM antibodies in the CSF was considered diagnostic, more cases were confirmed by this test than by virus isolation. A relative increase in poliovirus-neutralizing antibodies in the CSF was observed in about one-third of the cases; in all but three cases the increase was observed together with the presence of virus-specific IgM antibodies. A systemic virus-specific response can be seen and poliovirus can be isolated from a subclinically infected individual suffering from a concomitant poliomyelitis-like disease, while positive results by the two methods demonstrating an intrathecal immune response are likely to indicate a true causal relationship between infection and disease. Demonstration of poliovirus-specific IgM antibodies in the CSF thus appears to be a sensitive and specific method for laboratory confirmation of clinically diagnosed poliomyelitis.
authors.affiliation: Enterovirus Laboratory, KTL National Public Health Institute, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Roivainen
authors.forename: M
authors.initials: M
authors.lastname: Agboatwalla
authors.forename: M
authors.initials: M
authors.lastname: Stenvik
authors.forename: T
authors.initials: T
authors.lastname: Rysä
authors.forename: D S
authors.initials: DS
authors.lastname: Akram
authors.forename: T
authors.initials: T
authors.lastname: Hovi
mesh_terms: D000208:Acute Disease; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid*; D002675:Child, Preschool; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid*; D007223:Infant; D011051:Poliomyelitis / Q000175:diagnosis*; D017955:Poliovirus / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M