title: IgG1,IgG2 and IgE intrathecal synthesis in Angiostrongylus cantonensis meningoencephalitis.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Laboratorio Central de Líquido Cefalorraquídeo (LABCEL), Facultad de Ciencias Médicas Dr. Miguel Enríquez, Calle Ramón Pintó No 202 Luyanó Ciudad Habana CP10700, Cuba. adorta@infomed.sld.cu
authors.forename: Alberto Juan
authors.initials: AJ
authors.lastname: Dorta-Contreras
authors.forename: Elena
authors.initials: E
authors.lastname: Noris-García
authors.forename: Xiomara
authors.initials: X
authors.lastname: Escobar-Pérez
authors.forename: Bárbara
authors.initials: B
authors.lastname: Padilla Docal
mesh_terms: D017185:Angiostrongylus cantonensis; D000818:Animals; D000909:Antibodies, Helminth / Q000096:biosynthesis / Q000134:cerebrospinal fluid* / Q000276:immunology; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D020275:Guillain-Barre Syndrome / Q000134:cerebrospinal fluid / Q000276:immunology; D006801:Humans; D005779:Immunodiffusion; D007070:Immunoglobulin A / Q000096:biosynthesis / Q000134:cerebrospinal fluid; D007073:Immunoglobulin E / Q000096:biosynthesis / Q000134:cerebrospinal fluid*; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000134:cerebrospinal fluid*; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid* / Q000276:immunology* / Q000469:parasitology; D017206:Strongylida Infections / Q000134:cerebrospinal fluid* / Q000276:immunology*
chemical_list: D000909:Antibodies, Helminth; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007073:Immunoglobulin E