Rods and Rings Antinuclear Antibody Pattern in Non Hepatitis C Patients: A Series of Five Cases with Review of Literature

Antinuclear Antibody (ANA) is commonly found in various Autoimmune Diseases (AD) and their pattern help in narrowing down the differential diagnosis. International Consensus on ANA Pattern (ICAP) has recently introduced Rods and Rings (RR) pattern in their reporting guideline. Since its first identification, it has been considered to be exclusively associated with hepatitis C and its associated treatment {Ribavirin/Interferon-α (INF-α)}. However, later on, a few reports have described its association with other diseases and even in healthy population. In the present series, out of 25,242 clinical samples, five cases of RR-ANA pattern in non hepatitis patients were found and they were further investigated for their disease associations. We are documenting association of RR-ANA pattern with amoebiasis, hepatitis B, idiopathic thrombocytopenic purpura, Rheumatoid Arthritis (RA) and undifferentiated connective tissue disease. Documentation of such reports may help in better understanding of pathobiology and clinical relevance of this pattern.

LOW CONCENTRATIONS OF HEPATITIS C VIRUS RNA IN SEROLOGICALLY MILD INFECTION

Occult HCV infection (OCI) provides significant interest recently. HCV RNA in this case can be detected not in plasma, but in blood cells and/or in liver tissue. In case of antibody genesis impairment anti-HCV detection may lead to negative or “uncertain” result. The aim of the study was to estimate infection type in blood donors and patients with hematological diseases by exploration of samples with uncertain anti-HCV detection results. Blood samples of 30 180 potential blood donors’ and 4322 patients with hematological diseases were tested. Comparative analysis of wide pattern of HCV markers was performed. 33 blood donors and 42 patients were enrolled in follow-up examination. Uncertain results of Anti-HCV detection in donors’ samples were in 0.18% of cases. Follow-up examination of 33 donors provided discordant results using immunochemiluminescence assay and ELISA. 15.2% donors’ samples contained HCV RNA in low concentration. Follow-up observation of 42 patients with incomplete antiviral antibody pattern showed HCV RNA presence in 40.5% cases (21.4% high viremia and 19.0% low viremia). Samples with low RNA concentration contained low titers of anti-core antibodies. Samples with high titers of anti-core antibodies contained high HCV RNA level. Uncertain results of anti-HCV in 15.2% of potential blood donors’ samples were confirmed by detection of HCV RNA in low concentration. It proved OCI presence in these individuals and called for testing for wide pattern of HCV markers in addition to routine screening. Patients with hematological diseases showed low level of HCV RNA along with low titers of antibodies against one or two viral antigens.

Dynamics of differential count in dengue

Background: Dengue can occur as epidemics in India. Early diagnosis reduces mortality. Differential white cell count can aid in diagnosing and prognosticating Dengue in resource limited areas. Aim and objectives of this study were to assess patterns and utility of Differential counts in Dengue.Methods: A total of 132 serologically positive Dengue cases were analysed over the month of November 2016. Hematology data obtained from analysers and Leishman smears were tabulated and analysed.Results: The study showed lymphocytosis as the predominant pattern (65%) followed by neutropenia (30%), neutrophilia (11%), eosinophilia (5%), monocytosis (5%) and basophilia (4%). Atypical lymphocytosis ≥ 15% were noted in 65% of the cases with 83% showing Plasmacytoid lymphocytes, 8% apoptotic lymphocytes and 43% showed other atypical lymphocytes. Also, 52% of lymphocytosis and 33% of neutrophilia cases showed severe thrombocytopenia (≤ 0.5 lakhs per cu mm). Lymphocytosis was noted to be an early event but was established in later stages as seen with serology pattern association, 28% associated with NS1 antigen test (non-structural protein 1) and 42% with antibody pattern. However, neutrophilia with 60% of cases seen in antibody pattern was a late event. Plasmacytoid lymphocytosis was noted uniformly through all serology patterns in contrast with other atypical lymphocytosis which was seen mostly (48%) in antibody pattern. Apoptotic lymphocytosis was also a late event associated mainly with antibody pattern (55%).Conclusions: The Differential white cell count can be a useful supplementary test along with serology in resource limited peripheral areas. It additionally serves to drastically reduce morbidity and mortality.

Usefulness of immunohistochemical indicators for diagnosis and prognosis of poorly differentiated tumours

Immunohistochemical studies have become an indispensable element of establishing the correct histopathological diagnosis of poorly differentiated lesions, proving particularly suitable, and occasionally indispensable, for diagnosis of poorly differentiated neoplastic tumours. Knowledge of the mechanism of action and normal reaction of individual proteins is required in selection of the antibody pattern for a given tissue and in evaluation of the obtained results. This paper aims to promote the application of immunohistochemical techniques in routine diagnosis, especially in cases of poorly differentiated or undifferentiated tumours.

Detection of Epstein-Barr virus in autoimmune and Thalassemia patients using new Immunoblot assay

A new immunoblot assay, composed of five Epstein-Barr virus (EBV)-encoded recombinantproteins virus capsid antigen [VCA] gp125, p19, p22, early antigen [EA], and EBNA-1 IgG, wasused to manifest the EBV infection and look at the antibody pattern to EBV proteins in the serumof both autoimmune disorders and Thalassemia patients and compare the observations with thosein normal healthy controls. Serum samples from 35 rheumatoid arthritis patients, 20 SLE, 20autoimmune hypothyroid diseases, 35 Thalassemia patients and 20 healthy controls were testedfor EBV IgG antibodies by an immunoblot assay (Euroline). The results showed that the highpercentage recorded was 50% in acute infection. Followed by 30% at late infection, while latephase with loss EBNA-1 and reactivated infection were 10% compared to the normal healthycontrols. Our study showed an increased EBV activation among the autoimmune patient groupscompared to the normal healthy controls. Further studies are required to delineate the associationbetween the etiology of autoimmune disorders and EBV.

Progression of Nailfold Microvascular Damage and Antinuclear Antibody Pattern in Systemic Sclerosis

Objective.This study evaluates possible correlations between the pattern of antinuclear antibodies (ANA) on indirect immunofluorescence (IIF) testing and nailfold microangiopathy stage (early, active, and late stage) in systemic sclerosis (SSc). Patients with SSc were followed prospectively to monitor progression of microvascular damage.Methods.The ANA pattern on IIF was searched in 42 patients with SSc showing an early pattern of nailfold microangiopathy at baseline, and was followed using nailfold videocapillaroscopy (NVC) for a median time of 91 months.Results.Among patients whose microangiopathy showed a rapid progression from early to late pattern on NVC, the IIF pattern was fine-speckled + nucleolar (Scl-70+) in 44%, centromeric in 33%, nucleolar in 11%, and homogeneous in 11% of patients with SSc. Antitopoisomerase I antibodies were significantly more frequent (57%) in patients with late pattern of microangiopathy on NVC. The median time of progression from early to active disease was significantly lower in patients with both fine-speckled + nucleolar and nucleolar ANA positivity. The severity of microangiopathy was higher in patients with the nucleolar pattern on IIF. Patients already showing a slight reduction of capillary number at baseline were likely to have either the nucleolar or the fine-speckled + nucleolar pattern on IIF. Of note, 37% of patients still showing the early microangiopathy pattern on NVC at the end of the followup were ANA-negative.Conclusion.ANA-negative patients with SSc display a slower progression of nailfold microangiopathy characterized by the early pattern on NVC. Progression to the late NVC pattern (more advanced stage of microvascular damage) seems to be associated with a different autoantibody pattern on IIF (fine-speckled + nucleolar pattern being the most prevalent).