A highly specific pattern of immunofluorescence was noted when sera from Capillaria hepatica-infected rats were tested against the homologous worms and eggs present either in paraffin or cryostat sections from mouse liver. The pattern was represented by a combined apple green fluorescence of the internal contents of worms and eggs, which persisted in serum-dilutions of 1:400 up to 1:1600. Unequivocal fluorescent pattern was observed from 15 days up to 3 months following inoculation of rats with embryonated C. hepatica eggs and such result was confirmed by the ELISA. After the 4th month of infection, the indirect immunofluorescence test turned negative, probably revealing the extinction of parasitism, however the ELISA was contradictory, disclosing high levels of antibodies in this period. The IIF was also negative when control normal rat sera and sera from rats administered by gavage with immature C. hepatica eggs (spurious infection), or for reactions made against Schistosoma mansoni eggs, although a weakly positive pattern occurred with Fasciola hepatica eggs. The indirect immunofluorescence test may be recommended for use with human sera to detect early C. hepatica infection in special clinical instances and in epidemiological surveys, since it is a simple, inexpensive, and reliable test, presenting excellent sensitivity and specificity. Although the diagnosis is positive only during early infection, this is the period when the symptoms are usually more severe and the need for differential diagnosis is greater.
Non-organ-specific autoantibodies (NOSA) are well-recognized diagnostic markers of autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), but can also be observed in patients with viral hepatitis as well as in healthy subjects. The aim of this study was to evaluate the prevalence of NOSA in subjects living in a rural community in Brazil and to correlate their occurrence with the presence of liver disease. Seven hundred twenty-five apparently healthy subjects were randomly selected for assessment of antinuclear (ANA), anti-smooth muscle (SMA), antimitochondrial (AMA), anti-liver/kidney microsome type 1, and anti-liver cytosol type 1 antibodies. Subjects with those NOSA were evaluated for the presence of AIH, PBC, and viral hepatitis. Reactivities for all NOSA, SMA, ANA, and AMA were detected, respectively, in 14, 10, 4, and 0.1% of subjects, with a mean titer of 1:40. NOSA-positive subjects were significantly older and more frequently females. No correlation was observed between the occurrence of NOSA and PBC, AIH, or viral hepatitis. The prevalence of NOSA in Brazilians was 14%. They were usually low titer. NOSA were more frequently observed in females and older subjects and their presence was not correlated with the presence of AIH, PBC, or viral hepatitis.
Anticorpos antitransglutaminase (anti-TGt) e antiendomísio (AAE) são identificados em pacientes com hepatite auto-imune (HAI), assim como em pacientes com cirrose avançada. Contudo, a prevalência de doença celíaca (DC) em pacientes de HAI é desconhecida. A freqüência de anti-TGt IgA e AAE IgA foi determinada em 64 pacientes (54 mulheres,com media de idade de 19 anos [5-67]) com diagnóstico de HAI definido pelos critérios internacionais de HAI. Os pacientes anti-TGt IgA positive ou indeterminado e (ou) AAE IgA positivo foram submetidos à biópsia duodenal e determinou-se o tipo de HLA-DQ2 ou DQ8. Os anticorpos anti-TGt IgA e AAE IgA foram observados em 6 (9%) pacientes e em um paciente (1,6%) com HAI, respectivamente. Resultados positivos e borderline para anti-TGt IgA foram encontrados, respectivamente, em dois pacientes (3%) e quatro pacientes (6%). A DC foi confirmada pela biópsia duodenal (Marsh 3b) em um paciente com HLA-DQ2, anti-TGt IgA e AAE IgA. Outros dois pacientes apresentaram anti-TGt positivo ou bordeline e HLA DQ2 e a histologia duodenal mostrou-se sem alterações. Positividade para anticorpos anti-TGt IgA e (ou) AAE IgA foi observada em 9% dos pacientes com hepatite auto-imune, porém o diagnóstico foi confirmado em apenas um dos pacientes (1,6%). A ocorrência de anticorpo anti-TGt IgA nos outros pacientes pode ser atribuída à presença de doença hepática crônica, ou, ainda,a uma DC latente ou um paciente com potencial para DC.
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