title: Human African trypanosomiasis: quantitative and qualitative assessment of intrathecal immune response.
abstract: Quantitative and qualitative techniques for assessment of the intrathecal humoral immune response in human African trypanosomiasis were compared, and their diagnostic potential for detection of the meningo-encephalitic stage of the disease was evaluated. Total and trypanosome specific immunoglobulin G (IgG) and IgM intrathecal synthesis were studied in paired cerebrospinal fluid (CSF) and blood samples of 38 trypanosomiasis patients and in three controls using Reiber's formulae. The presence of CSF-specific oligoclonal IgG and of trypanosome-specific antibodies was determined using iso-electric focusing followed by immunoblotting and antigen-driven immunoblots. The intrathecal IgG fraction (16% positive) and oligoclonal IgG detection (24% positive) were insensitive for detection of an intrathecal humoral immune response. Trypanosome-specific IgG synthesis, reflected by the IgG antibody index (AI) (26% positive), was confirmed by the presence of oligoclonal specific IgG (47% positive), but the latter was more sensitive. Although the detection technique failed for oligoclonal IgM, the intrathecal IgM fraction (42% positive) and the IgM AI (32% positive) indicated that the meningo-encephalitic stage of the disease is characterized by a dominant intrathecal IgM response, which was higher than the IgG response. The highest combination of diagnostic sensitivity and specificity for the meningo-encephalitic stage of trypanosomiasis was observed for quantitative IgM determinations.
authors.affiliation: Department of Parasitology, Institute of Tropical Medicine, Antwerpen, Belgium. vlejon@itg.be
authors.forename: V
authors.initials: V
authors.lastname: Lejon
authors.forename: C J M
authors.initials: CJ
authors.lastname: Sindic
authors.forename: M-P
authors.initials: MP
authors.lastname: Van Antwerpen
authors.forename: F
authors.initials: F
authors.lastname: Doua
authors.forename: N
authors.initials: N
authors.lastname: Djé
authors.forename: P
authors.initials: P
authors.lastname: Solano
authors.forename: V
authors.initials: V
authors.lastname: Jamonneau
authors.forename: I
authors.initials: I
authors.lastname: Wouters
authors.forename: P
authors.initials: P
authors.lastname: Büscher
mesh_terms: D000418:Albumins / Q000134:cerebrospinal fluid; D000818:Animals; D000917:Antibody Formation / Q000276:immunology; D000918:Antibody Specificity; D007560:Cote d'Ivoire; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D015151:Immunoblotting; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D010270:Parasite Egg Count; D014347:Trypanosoma brucei gambiense / Q000276:immunology; D014353:Trypanosomiasis, African / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000276:immunology*
chemical_list: D000418:Albumins; D007074:Immunoglobulin G; D007075:Immunoglobulin M