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Unexplained Fever Associated With Hypersensitivity and Auto-Immune Diseases
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Anti-DNA antibodies — Two techniques are usually performed. The radioimmuno-logical Farr test (which uses immunoglobulin (IgG) precipitation by ammonium sulfate) is a sensitive detector of all antibodies capable of binding to DNA, independent of their biological properties. It is positive in 80 to 98% of SLE cases, in 0 to 6% of patients with rheumatoid arthritis and in 0 to 2% of normal subjects.2 The second technique used in the routine clinical detection is an immunofluorescent method detecting antibodies to double-stranded DNA employing the kinetoplast of the flagellate Crithidia luciliae as a substrate. It allows determination of the antibodies according to their nature (IgG, IgM, IgA) and their complement fixing ability (IgGl, IgG3); it may give false-positive results; it is positive in up to 96% of SLE sera.2 Then the diagnosis of SLE relies on the association of evocative clinical lesions with immune abnormalities.
Diagnostic applications of immunology
Published in Gabriel Virella, Medical Immunology, 2019
Ajay Grover, Virginia Litwin, Gabriel Virella
Crithidia luciliae is a single-cell hemoflagellate that can be used as a substrate in immunofluorescence for the detection of anti-dsDNA antibodies. The C. luciliae kinetoplast, a large mitochondrion with a network of interlocking circular dsDNA molecules, binds anti-dsDNA antibodies, and when fluorescent-labeled antihuman Ig antibodies are added, the kinetoplast will fluoresce (Figure 15.6). The lack of other nuclear antigens in this organelle means that using C. luciliae as a substrate allows for the specific detection of anti-dsDNA antibodies.
Systemic lupus erythematosus presenting as non-resolving pneumonia: a case report
Published in Acta Clinica Belgica, 2022
Sofie Stappers, Denise van der Graaff, Ilse Hoffman, Walter Moorkens, Inge Hantson, Inge Stappaerts, Vicky Nowé, Liesbeth Vervliet
Upon hospitalization for further management, a more thorough medical history of our patient was obtained. We specifically asked if she suffered from photosensitivity, Raynaud’s phenomenon, alopecia, sicca and joint pain. All of these symptoms were denied, except for the arthralgias: in 2011, our patient consulted a rheumatologist for swollen and painful joints in both hands. At the time, she had been diagnosed with therapy-resistant, seronegative (rheumatoid factor and anti-CCP negative), non-erosive rheumatoid arthritis. In chronological order, she was treated with Methotrexate, then Sulfasalazine and at last Leflunomide. All three of these remedies had a limited clinical effect and they all resulted in hepatotoxicity, which forced the attending physician to end these treatments. Interestingly, the laboratory results back then already showed positive ANA (1:320) and anti-dsDNA antibodies (1:10) with a normal lymphocyte count. Due to the lack of symptoms suggestive of SLE and the fact that 3% of ‘healthy’ individuals has an ANA titer of 9]. Captivatingly, the technique used to detect these anti-dsDNA antibodies was the Crithidia luciliae-based indirect immunofluorescence test (CLIFT), which is very specific for the diagnosis of SLE [10–12]. Haugbro et. al state that the specificity of positive anti-dsDNA antibodies for SLE, meaning a titer of ≥1:10, is 99% [10]. Moreover, in the last 8 years, our patient has not received any therapy for rheumatoid arthritis and still, upon this day, she has not developed any articular bone erosions nor joint deformities. Taking all these insights into account, we suspect that she was wrongfully diagnosed with rheumatoid arthritis and that these arthralgias were in fact the first manifestation of SLE.
Clinical use of anti-histone antibodies in idiopathic and drug-induced lupus
Published in Immunological Medicine, 2022
AHAs may refer to either total histones or histone subunits; although the latter is more often seen in the research laboratory. AHAs may be noted on indirect immunofluorescence that screens for ANAs. On the commonly-used HEp-2 substrate, AHAs commonly appear as a homogenous pattern; but is not specific for these autoantibodies [20]. Some false positives have also been noted on the Crithidia luciliae immunofluorescence test (CLIFT) (which normally detects anti-dsDNA antibodies) in some patients that produce AHA that can bind Chrithidia luciliae kinetoplast [21].
The predictive value of crescents in the disease progression of lupus nephritis based on the 2018 International Society of Nephrology/Renal Pathology Society Revision System: a large cohort study from China
Published in Renal Failure, 2020
Juan Tao, Hui Wang, Su-Xia Wang, Feng Yu, Ming-Hui Zhao
The demographic data collected included age and gender at the time of biopsy. Clinical parameters were within 3 months of date of biopsy. The clinical disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) [8,9]. Serum antinuclear antibodies and anti-double-stranded DNA were detected using indirect and Crithidia luciliae indirect immunofluorescence assay respectively (EUROIMMUN, Lübeck, Germany). Serum C3 was determined using rate nephelometry assay (Beckman-Coulter, IMMAGE, USA, normal range >0.85 g/L).