The anti Bordetella antibodies (Indirect diagnosis)

multiple sclerosis amyotrophic lateral sclerosis pseudobulbar syndrome motoneuron disease neurogenous muscolar dystrophy hemiparkinson spastic tetraparesis balo's concentric sclerosis

Dr. Domenico FIORE
V.le Madonna delle Grazie, 17
35028 Piove di Sacco (Padova)

AETIOLOGIC DIAGNOSIS (Bordetella Pertussis infection)

The Bordetella Pertussis (BP) infection diagnosis could be demonstrated, or excluded, with absolute certainty, asking the Laboratory to search the anti Bordetella antibodies (Aetiologic diagnosis):

· IgA and IgG antibodies anti Filamentous Haemo Agglutinin (FHA) and anti Pertussis Toxin (PT), with the relative optical density (D.O.)

· The total IgG and IgM antibodies anti Bordetella Pertussis, with the D.O. of the sample and of the cut-off.

The total IgG and IgM are mesured with the formula:

D.O. of the patient

------------------------- x 10 = EV (EV = Extinction Velocity, or, Absorbance).

D.O. cut off

In the MS and in the "organ-specific autoimmune diseases", the anti Bordetella IgG titles ³ 8 units EV and/or the IgM titles ³ 2 units EV are demonstrations of infection. In adults the IgM are to be considered positive from EV ³ 2 this is because the eventual anti BP antibodies surely express a secondary immune reponse, where normaly, the IgM are not produced; in adults the anti BP IgM could be produced (in association or even in alternative to IgG) only by specific action of the Lipopolysaccharide (LPS): demonstrating pertussis infection in act.

In the Neurophaties Without Patches (Amyotrophic Lateral Sclerosis) and in the

“non-organ specific autoimmunity”, the circulating immune complexes do not precipitate in various organs and apparates. In this way their ematic level grows up to inhibit the antibodies production (of IgM); in these forms the IgM titre often results £ 2 units EV. When the recent re-infection and/or mucosa eventual stable colonization (positive IgM) is demonstrated, with the IgA optical density, it can be proved if the infective Bordetella is in S-phase (fimbriae) or in R-phase (no fimbriae):

- IgA anti Filamentous H.A. ³ 0.30 D.O. show an infection in act or very recent by Bordetella Pertussis in S-phase;

- with negative IgA anti FHA, the anti Pertussis Toxin IgA ³ 0.30 D.O. show an infection in act or very recent by Bordetella Pertussis in R-phase.

To avoid "mistakes", that would damage the Patient, his Family and the whole Society, I would like to remember that ^{1
- 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9}:

- the immunity from the disease is local, aspecific (it is not immune-mediate) and it lasts if the ciliary mucus barrier is undamaged; after the disease the IgG (Immunoglobulins G) can be produced for a period of time that can last maximum 10-12 years;

- the humoral, not protective immunity (production of IgG), from a vaccine lasts at the latest 3-5 years;

- if the antigenic stimulus stops, the IgA (Immunoglobins A) are produced only for 6-7 months;

- the IgM (Immunoglobins M) are produced only in primary reactions (and only for 3-4 months) or for the extended transit of Pertussis Lipopolysaccharide (LPS) and Pertussis Toxin (PT) in blood [after the sensitization induced with one first dose of antigen (primary immune reaction), after a recall injection, the Thymus-Independent antigens (LPS and PT) do not produce a secondary immune reaction (IgG): they always stimulate the production of IgM in association, or sometimes as an alternative, to IgG].

For these reasons in an adult: neither the total antibodies (especially the IgM) nor the IgA anti Filamentary H.A. and/or anti Pertussis Toxin can be considered “anamnestic" (in other words they cannot be referred to a previous childish pertussis or to a vaccine done by the patient some years before).

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Bibliography

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Bactériologie Médicale. Flammarion. Paris,1982. 128-129.

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3. Davis B.D. - Dulbecco R. et Altri: Microbiology. Harper International Edition. 1980. 427

4. Schaechter M. et Altri: Microbiologia Medica. Editrice Ambrosiana. Milano, 1994. 126-127, 129..

5. Roitt I. M.: Principi di Immunologia. 7^a Edizione. (Edizione italiana "Poli"). Milano, 1991. 114-115.

6. Fudenberg et Altri: Immunologia genehale e clinica. Piccin Editore. Padova, 1978. 40.

7. Fougereau M.: Introduzione alla immunologia fondamentale. Mondadori. Milano, 1976, 204.

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