ANA testing in the presence of acute and chronic infections

Litwin, Christine M.; Binder, Steven R.

doi:10.1080/15321819.2016.1174136

Cited by 51 publications

(43 citation statements)

References 78 publications

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“…Remarkably, we did not detect any association of ANAs with female gender or with age in our cohort, even though it is generally known that ANAs occur more frequently in women and in the elderly [40]. Therefore, our data support the hypothesis that the occurrence of these unspecific autoantibodies represents a para-infectious phenomenon, caused mainly by a misdirected immune response, and that it should not be seen as the initial step in the development of de novo autoimmune diseases [41,42]. This phenomenon should trigger tests to determine HEV-RNA in any patients with acute hepatitis [15,16,18], in order to prevent potential false diagnosis of AIH, due to high ANA rates among HEV infected patients.…”

Section: Discussionsupporting

confidence: 57%

Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection

et al. 2020

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Background: Hepatitis E virus (HEV) has been associated with immunological phenomena. Their clinical significance, however, still needs to be clarified, that is, whether cryoglobulins or autoantibodies impact overt disease in HEV-infected individuals. To better understand, we analyzed these different immune phenomena in three cohorts, each representing different types of HEV infection. Methods: The cohorts included: (i) immunocompetent patients with acute hepatitis E, (ii) immunosuppressed patients with chronic hepatitis E, and (iii) individuals with asymptomatic HEV infection. Together, they consisted of 57 individuals and were studied retrospectively for the presence of anti-nuclear antibodies (ANAs), cryoglobulins, and serum total IgG. They were then compared with a control cohort of 17 untreated patients with chronic hepatitis B virus (HBV) infection or hepatitis C virus (HCV) infection. Results: Thirteen (23%) were immunocompetent patients with acute hepatitis E (median alanine aminotransferase (ALT) = 872 U/L), 15 (26%) were immunosuppressed patients with chronic hepatitis E (median ALT = 137 U/L), and 29 (51%) were blood donors with asymptomatic HEV infection (median ALT = 35 U/L). Overall, 24% tested positive for elevated ANA titers of >1:160, and 11% presented with a specific ANA pattern. ANA detection was not associated with the type of HEV infection, IgG levels, sex, or age. All individuals tested negative for anti-mitochondrial antibodies, anti-neutrophil cytoplasmic antibodies, liver-kidney microsomal antibodies, anti-myeloperoxidase-, and anti-proteinase-3 antibodies. Five patients (9%) tested positive for cryoglobulins. Notably, cryoglobulinemia was present in overt hepatitis E (Groups (i) and (ii); one acute and four chronic HEV infections), but was not present in any of the asymptomatic blood donors (p = 0.02). The frequency of cryoglobulins and elevated ANAs did not differ significantly between HEV and HBV/HCV patients. Conclusion: In line with findings on HBV and HCV infections, we frequently observed detection of ANAs (24%) and cryoglobulins (9%) in association with HEV infections. The presence of cryoglobulins was limited to patients with overt hepatitis E. We add to the findings on the immune phenomena of hepatitis E.

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Section: Discussionsupporting

confidence: 57%

Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection

et al. 2020

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“…This phenomenon is not unexpected, as similar behavior has been frequently reported for ANA testing after infection [33]. Also, ANA positivity is not infrequent in healthy individuals [34]; some results will move from positive to negative based on statistical variation and methodological imprecision.…”

Section: Transient Versus Persistent Antibodiesmentioning

confidence: 57%

Anti-phospholipid Antibodies and Smoking: An Overview

Binder

Litwin

2016

Clinic Rev Allerg Immunol

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Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies, specifically lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein-I antibodies. Antiphospholipid syndrome can occur on its own or in association with other autoimmune diseases, most commonly systemic lupus erythematosus (SLE). A connection between cigarette smoking and anti-phospholipid antibodies (aPL) was first reported in the late1980s. Systemic lupus erythematosus patients with aPL are more likely to be smokers than those without aPL. These patients have a particularly high frequency of vascular events. Recently, a potential link between periodontitis, tobacco, and aPL has been proposed. Research has also suggested that periodontitis and Porphyromonas gingivalis infection are associated with citrullination through the action of peptidylarginine deiminase. A strong correlation between smoking and the presence of citrillunated autoantibodies, which are characteristic of rheumatoid arthritis, has also been observed. While many studies have investigated possible links between infection and aPL in patients with autoimmune diseases, the association of smoking with aPL has not been systematically examined. The fact that both aPL and tobacco are risk factors for thrombosis has complicated efforts to evaluate these factors separately. Also, there has been great variability in measurement techniques, and laboratories lack routine methods for differentiating transient and persistent aPL; both of these factors can make interpretation of autoantibody results quite challenging. This review summarizes the clinical evidence supporting a posited link between aPL and smoking, both in patients with a systemic autoimmune disease and in patients with other medical conditions.

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“…Although the pathophysiology of effusive pericarditis in COVID-19 is unknown, it is hypothesized that it occurs secondary to the systemic inflammatory response and the subsequent cytotoxic and immune-mediated effects related to SARS-CoV-2 [7][8]10]. Importantly, inflammatory markers and autoantibody testing are frequently abnormal in the setting of acute infection and often require clinical findings for the determination of underlying etiology [11]. Pericardial effusion and tamponade secondary to COVID-19 infection remain a plausible explanation for our patient's findings given the absence of other etiologic findings, the temporal relationship to his preceding illness, and positive COVID-19 testing.…”

Section: Discussionmentioning

confidence: 99%