Antibody and cytokine serum levels in patients submitted to anti-rabies prophylactic treatment with serum vaccination
THESIS. J. Ayres submitted this thesis for his Doctorate in Tropical Diseases at Botucatu School of Medicine, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil, 2002.
Advisor: Professor Benedito Barraviera
Co-advisor: Professor Maria Teresinha Serrão Peraçoli
ABSTRACT. Rabies is considered a fatal disease once clinical symptoms develop in humans and animals. The aim of this study was to evaluate the epidemiological aspects and immune response in patients attacked by domestic and wild animals submitted to post-exposure rabies treatment with equine serum with vaccine. Thirty-three patients aged from 13 to 65 years old were evaluated; 75.8% were males and 24.2% females from the Botucatu region. Twenty healthy individuals with the same age range were studied as controls. Group 1 consisted of 13 patients: 9 exposed to bovine biologic materials (69.2%), three wounded by domestic animals (23.1%), and one by wild animals (7.7%) with evaluation 14 days of treatment. Group 2 consisted of 20 patients: 12 wounded by domestic animals (60%), 6 had contact with bovine biologic materials (30%), and two wounded by wild animal (10%) with evaluation 28 days of treatment. Specific antibodies to equine immunoglobulins and IFN-g, IL-2, IL-4, and IL-10 production were evaluated by ELISA. Serum levels of IgM, IgE, IgG and subclass and antibodies to rabies virus were determined by nephelometry and serum-neutralization methods, respectively. No anaphylactic type or serum sickness allergic reactions were observed in patients after treatment. The results showed significantly higher levels of IgG anti-horse immunoglobulins in relation to IgM after 14 and 28 days of treatment. Protective antibodies to rabies virus > 0.5 UI/mL were detected in 84.6% and 75% of the patients evaluated 14 and 28 days during vaccinal schedule, respectively. IFN-g, IL-2, and IL-10 levels detected in patients before and 48 h after treatment were significantly higher in comparison to controls and suggest that both Th1 and Th2 cells were activated in the studied patients. Serum immunoglobulins were evaluated and showed higher levels of IgM at 14 days and of IgG2 and IgE at 28 days of treatment. The results suggest that the post-exposure rabies treatment in humans induce significant alterations in the patients immune response characterized by increase in cytokine and serum levels of specific antibodies to rabies virus and to equine serum components used in the treatment.
KEY WORDS: Cytokines, immunoglobulins, serum-vaccination, anti-rabies prophylaxis, equine immunoglobulin.
Publication in this collection
09 Dec 2003
Date of issue