Development of molecular-based techniques for the detection, identification and quantification of food-borne pathogens

La presencia de microorganismos patógenos en alimentos es uno de los problemas esenciales en salud pública, y las enfermedades producidas por los mismos es una de las causas más importantes de enfermedad. Por tanto, la aplicación de controles microbiológicos dentro de los programas de aseguramiento de la calidad es una premisa para minimizar el riesgo de infección de los consumidores. Los métodos microbiológicos clásicos requieren, en general, el uso de pre-enriquecimientos no-selectivos, enriquecimientos selectivos, aislamiento en medios selectivos y la confirmación posterior usando pruebas basadas en la morfología, bioquímica y serología propias de cada uno de los microorganismos objeto de estudio. Por lo tanto, estos métodos son laboriosos, requieren un largo proceso para obtener resultados definitivos y, además, no siempre pueden realizarse. Para solucionar estos inconvenientes se han desarrollado diversas metodologías alternativas para la detección identificación y cuantificación de microorganismos patógenos de origen alimentario, entre las que destacan los métodos inmunológicos y moleculares. En esta última categoría, la técnica basada en la reacción en cadena de la polimerasa (PCR) se ha convertido en la técnica diagnóstica más popular en microbiología, y recientemente, la introducción de una mejora de ésta, la PCR a tiempo real, ha producido una segunda revolución en la metodología diagnóstica molecular, como pude observarse por el número creciente de publicaciones científicas y la aparición continua de nuevos kits comerciales. La PCR a tiempo real es una técnica altamente sensible -detección de hasta una molécula- que permite la cuantificación exacta de secuencias de ADN específicas de microorganismos patógenos de origen alimentario. Además, otras ventajas que favorecen su implantación potencial en laboratorios de análisis de alimentos son su rapidez, sencillez y el formato en tubo cerrado que puede evitar contaminaciones post-PCR y favorece la automatización y un alto rendimiento. En este trabajo se han desarrollado técnicas moleculares (PCR y NASBA) sensibles y fiables para la detección, identificación y cuantificación de bacterias patogénicas de origen alimentario (Listeria spp., Mycobacterium avium subsp. paratuberculosis y Salmonella spp.). En concreto, se han diseñado y optimizado métodos basados en la técnica de PCR a tiempo real para cada uno de estos agentes: L. monocytogenes, L. innocua, Listeria spp. M. avium subsp. paratuberculosis, y también se ha optimizado y evaluado en diferentes centros un método previamente desarrollado para Salmonella spp. Además, se ha diseñado y optimizado un método basado en la técnica NASBA para la detección específica de M. avium subsp. paratuberculosis. También se evaluó la aplicación potencial de la técnica NASBA para la detección específica de formas viables de este microorganismo. Todos los métodos presentaron una especificidad del 100 % con una sensibilidad adecuada para su aplicación potencial a muestras reales de alimentos. Además, se han desarrollado y evaluado procedimientos de preparación de las muestras en productos cárnicos, productos pesqueros, leche y agua. De esta manera se han desarrollado métodos basados en la PCR a tiempo real totalmente específicos y altamente sensibles para la determinación cuantitativa de L. monocytogenes en productos cárnicos y en salmón y productos derivados como el salmón ahumado y de M. avium subsp. paratuberculosis en muestras de agua y leche. Además este último método ha sido también aplicado para evaluar la presencia de este microorganismo en el intestino de pacientes con la enfermedad de Crohn's, a partir de biopsias obtenidas de colonoscopia de voluntarios afectados. En conclusión, este estudio presenta ensayos moleculares selectivos y sensibles para la detección de patógenos en alimentos (Listeria spp., Mycobacterium avium subsp. paratuberculosis) y para una rápida e inambigua identificación de Salmonella spp. La exactitud relativa de los ensayos ha sido excelente, si se comparan con los métodos microbiológicos de referencia y pueden serusados para la cuantificación de tanto ADN genómico como de suspensiones celulares. Por otro lado, la combinación con tratamientos de preamplificación ha resultado ser de gran eficiencia para el análisis de las bacterias objeto de estudio. Por tanto, pueden constituir una estrategia útil para la detección rápida y sensible de patógenos en alimentos y deberían ser una herramienta adicional al rango de herramientas diagnósticas disponibles para el estudio de patógenos de origen alimentario.

Modelling of Johne's disease control options in beef cattle: a decision support approach

Johne's disease in cattle is a contagious wasting disease caused by Mycobacterium avium subspecies paratuberculosis (MAP). Johne's infection is characterised by a long subclinical phase and can therefore go undetected for long periods of time during which substantial production losses can occur. The protracted nature of Johne's infection therefore presents a challenge for both veterinarians and farmers when discussing control options due to a paucity of information and limited test performance when screening for the disease. The objectives were to model Johne's control decisions in suckler beef cattle using a decision support approach, thus implying equal focus on ‘end user’ (veterinarian) participation whilst still focusing on the technical disease modelling aspects during the decision support model development. The model shows how Johne's disease is likely to affect a herd over time both in terms of physical and financial impacts. In addition, the model simulates the effect on production from two different Johne's control strategies; herd management measures and test and cull measures. The article also provides and discusses results from a sensitivity analysis to assess the effects on production from improving the currently available test performance. Output from running the model shows that a combination of management improvements to reduce routes of infection and testing and culling to remove infected and infectious animals is likely to be the least-cost control strategy.

Aspectos epidemiológicos da paratuberculose bovina no Rio Grande do Sul

Descrevem-se os achados clínicos e patológicos da paratuberculose em uma criação intensiva de bovinos de leite no municí pio de Capela de Santana, RS. Os sinais clínicos foram observados em oito de um total de 345 bovinos, consistindo em diarréia crônica refratária aos tratamentos, emagrecimento progressivo e queda na produção de leite. As principais lesões macroscópicas, observadas nos oito animais necropsiados, incluíam intestino delgado com acentuado espessamento da parede e superfície mucosa de aspecto reticulado, semelhante às circunvoluções cerebrais, lesão essa perceptível, através da serosa. A luz intestinal estava preenchida com conteúdo fluido e de aspecto leitoso. Os vasos linfáticos do mesentério mostravam-se mais evidentes sendo que alguns tinham aspecto varicoso. Os linfonodos mesentéricos estavam aumentados de volume e, ao corte, fluía grande quantidade de líquido leitoso. Focos de mineralização foram observados na íntima das artérias, nas válvulas cardíacas e na serosa do rúmen. As principais lesões macroscópicas incluíam enterite, linfadenite e linfangite granulomatosa caracterizada por infiltrado inflamatório com macrófagos, células gigantes de Langhans que continham grande quantidade de bacilos álcool-ácido-resistentes. As lesões vasculares consistiam em degeneração e mineralização das túnicas í ntimas e média das artérias de grande calibre associada a proliferação de colágeno. Havia calcificação da serosa do rúmen atrofia hepatocelular difusa e hepatite granulomatosa multifocal. O M. avium subsp. paratuberculosis (Map) foi isolado em amostras de intestino e linfonodos de 8 vacas Holandesas (3,5%) com doença de Johne, dentre 229 amostras cultivadas provenientes de um rebanho leiteiro. Amostras inoculadas em HEYM com micobactina produziram colônias identificadas como Map, segundo as caracterí sticas fenotí picas próprias como: crescimento lento, coloração álcool-ácido-resistente (A.A.R.) e dependência a micobactina. O laboratório de Referência da OIE confirmou a amostra isolada. O M. avium subsp. paratuberculosis (Map) foi isolado em amostras de intestino e linfonodos de 8 vacas Holandesas (3,5%) com doença de Johne, dentre 229 amostras cultivadas provenientes de um rebanho leiteiro Amostras inoculadas em HEYM com micobactina produziram colônias identificadas como Map, segundo as caracterí sticas fenotí picas próprias como: crescimento lento, coloração álcool-ácido-resistente (A.A.R.) e dependência a micobactina. O laboratório de Referência da OIE confirmou a amostra isolada. Não houve isolamento do agente em 221 amostras intestinais quando processadas, após 2 anos de sua colheita. O teste de IDGA aplicado como “screening”, detectou 26 vacas (11,4%) positivas, dentre 228 animais testados e sacrificados em matadouro. O teste de ELISA adsorvido, utilizando o antí geno PPA-3 detectou 125 (39,8%) amostras positivas. O ELISA não adsorvido detectou mais 32 (10,1%) reagentes positivos, dentre os 314 bovinos testados. A prevalência da infecção causada pelo Map em 36 rebanhos leiteiros procedentes de 25 municí pios do Rio Grande do Sul foi estimada em 44,6% das 1316 amostras testadas. A infecção foi identificada em 35 (97,2%) dos 36 rebanhos testados e presentes em todos os municí pios incluí dos. A ocorrência da doença de Johne foi enfatizada, tanto a forma clí nica quanto a infecção subclí nica no Rio Grande do Sul, sugerindo a adoção de medidas de controle sejam aplicadas na proteção dos rebanhos leiteiros nacionais.

Atividade anti - Mycobacterium tuberculosis intra e extra celular e citotoxicidade dos complexos de coordenação de metais

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Diagnóstico da paratuberculose em bovinos de corte do estado do Pará - Brasil

514 amostras de sangue bovino foram analisadas para detecção de anticorpos anti-Mycobacterium avium (subsp.) paratuberculosis, utilizando um kit comercial do teste ELISA indireto. Os animais eram todos mestiços, machos e fêmeas, classificados em dois grupos, de acordo com a idade, menores ou iguais a 36 meses e maiores de 36 meses, provenientes de 23 municípios do Estado do Pará. Além deste teste, também foram colhidas 100 amostras de fragmentos de intestino delgado e de linfonodo mesentérico para análise bacteriológicaatravés da coloração de Ziehl-Neelsen, a fim de identificar o Mycobacterium avium (subsp.) paratuberculosis. As amostras foram colhidas aleatoriamente em matadouro da região metropolitana de Belém. No teste ELISA indireto, das 514 amostras de sangue bovino 182 (35,4%) foram reagentes para anticorpos anti-Mycobacterium avium (subsp.) paratuberculosis e 332 (64,6%) foram não-reagentes. Em todas as mesorregiões encontraramse animais soropositivos. As fêmeas com idade superior a 36 meses mostraram maior respostas ao teste , 92,06% de animais soropositivos. Entre os machos, a maior prevalência (76,79%), foi obtida nos mais novos, com idade abaixo de 36 meses. Das 100 lâminas coradas através do método de Ziehl-Neelsen, nenhum Mycobacterium sp. foi identificado. Conclui-se assim, que o elevado número de animais com anticorpos anti-Mycobacterium avium (subsp.) paratuberculosis indica a presença da doença em todas as mesorregiões estudadas, devendo-se atentar aos riscos desta enfermidade, através de pesquisas mais abrangentes sobre a Paratuberculose, com aplicação de métodos diagnósticos diretos e indiretos.

Diagnóstico de paratuberculose por biópsia retal em búfalos

Foram realizadas biópsias retais de 140 búfalos, machos e fêmeas, das raças Murrah e mestiços de Murrah com Mediterrâneo, com idade acima de três anos, em uma propriedade no município de São Mateus, Maranhão, Brasil. Adicionalmente foram realizadas necropsias de 11 búfalos, para realizar um estudo comparativo entre os achados das biópsias retais e de tecidos de íleo e linfonodo mesentérico. A propriedade apresentava histórico de animais com emagrecimento progressivo e diarreia não responsiva a antimicrobianos. Os búfalos apresentavam sinais clínicos caracterizados por diarreia, estado nutricional regular a ruim, desidratação e edema submandibular. Nas biópsias retais seis búfalos apresentaram lesões sugestivas da paratuberculose na Hematoxilina-Eosina (HE), sendo estas caracterizadas por inflamação granulomatosa multifocal moderada na lâmina própria com macrófagos epitelioides. Em quatro animais foram observadas adicionalmente células gigantes do tipo Langhans. Em 15 búfalos foi observado infiltrado linfocitário multifocal leve na lâmina própria. Pela coloração de Ziehl-Neelsen (ZN), 4,3% (6/140) apresentaram bacilos álcool-ácido resistentes (BAAR) e na PCR em tempo real (qPCR), 5,71% (7/140) tiveram amplificação do material genético. Foram necropsiados 11 búfalos, à necropsia foram observados aumento de linfonodos mesentéricos com áreas esbranquiçadas na superfície de corte; intestino delgado e grosso com dobras transversais evidentes, mucosa espessada e irregular, de aspecto reticulado, placas de Peyer evidentes e conteúdo líquido e marrom. Ainda se viam áreas espessadas em torno da válvula ileocecal e vasos linfáticos evidentes. As lesões histológicas localizadas no intestino delgado e linfonodos mesentéricos de quatro búfalos foram compatíveis com lesões já descritas na literatura, e apresentaram BAAR e amplificação de material genético na qPCR. A concordância entre a biópsia retal e a análise dos tecidos de íleo e linfonodo mesentérico, segundo o teste Kappa (K=0,792), foi alta. A biópsia retal realizada demonstrou ser promissora e pode ser empregada, juntamente com outras técnicas, para auxiliar no diagnóstico ante mortem em búfalos de rebanhos com suspeita de paratuberculose; pela mesma foi possível detectar animais positivos através da coloração de ZN e qPCR. Os resultados obtidos podem ser utilizados no controle da enfermidade para selecionar e eliminar animais positivos do rebanho, diminuindo gradualmente, a disseminação do agente no ambiente, e a consequente contaminação de outros animais.

Isolamento e identificação das micobactérias em águas tratadas provenientes do sistema de abastecimento de Araraquara-SP

Water quality is very important for the health and the population welfare, and the public supply system must provide water quality and suffi cient quantity for the entire population. Water treatment stations, are the main way to obtain water quality. When this doesn’t occur, several problems can affect the population, in this case, using water with poor quality is a constant risk of emergence causing various diseases. The elimination of microorganisms in treated water reduces competition, encouraging the multiplication of chlorine resistant bacteria as Mycobacterium genus frequently isolated from treated and chlorinated water. Considering the lack of indication from examinations of mycobacteria routine laboratory for quality control of drinking water and other human uses, the objective was to verify the presence isolate and identify the environmental mycobacteria in the system water source surface of Araraquara - SP. We analyzed 40 water samples, distributed as follows: ten water gross collected at Station Water Treatment Plant (WTP), harvested after ten fi ltration; ten collected in the reservoir after chlorination and ten in the network distribution. Were recovered 43 isolates of mycobacteria. All isolates were subjected to PCR-PRA. The mycobacteria were identifi ed as M. lentifl avum, M. parafortuitum, M. genavense, M. gordonae, M. fortuitum, M. confl uent, M. duvalii, M. avium subspecies paratuberculosis and M. szulgai. With these results, was concluded that water is an important source of environmental mycobacteria probably related to several human diseases, suggesting the carrying out continuous monitoring of the microorganisms in the system drinking water.

Animal-side serologic assay for rapid detection of Mycobacterium Bovis infection in multiple species of free-ranging wildlife

Numerous species of mammals are susceptible to Mycobacterium bovis, the causative agent of bovine tuberculosis (TB). Several wildlife hosts have emerged as reservoirs of M. bovis infection for domestic livestock in different countries. In the present study, blood samples were collected from Eurasian badgers (n = 1532), white-tailed deer (n = 463), brushtail possums (n = 129), and wild boar (n = 177) for evaluation of antibody responses to M. bovis infection by a lateral-flow rapid test (RT) and multiantigen print immunoassay (MAPIA). Magnitude of the antibody responses and antigen recognition patterns varied among the animals as determined by MAPIA; however, MPB83 was the most commonly recognized antigen for each host studied. Other seroreactive antigens included ESAT-6, CFP10, and MPB70. The agreement of the RT with culture results varied from 74% for possums to 81% for badgers to 90% for wild boar to 97% for white-tailed deer. Small numbers of wild boar and deer exposed to M. avium infection or paratuberculosis, respectively, did not cross-react in the RT, supporting the high specificity of the assay. In deer, whole blood samples reacted similarly to corresponding serum specimens (97% concordance), demonstrating the potential for field application. As previously demonstrated for badgers and deer, antibody responses to M. bovis infection in wild boar were positively associated with advanced disease. Together, these findings suggest that a rapid TB assay such as the RT may provide a useful screening tool for certain wildlife species that may be implicated in the maintenance and transmission of M. bovis infection to domestic livestock.

Comparison of Gross Pathology, Histopathology, and Mycobacterial Culture for the Diagnosis of Tuberculosis in Elk (Cervus elaphus)

Using the isolation of Mycobacterium bovis as the reference standard, this study evaluated the sensitivity, specificity and kappa statistic of gross pathology (abattoir postmortem inspection), histopathology, and parallel or series combinations of the two for the diagnosis of tuberculosis in 430 elk and red deer. Two histopathology interpretations were evaluated: histopathology I, where the presence of lesions compatible with tuberculosis was considered positive, and histopathology II, where lesions compatible with tuberculosis or a select group of additional possible diagnoses were considered positive. In the 73 animals from which M. bovis was isolated, gross lesions of tuberculosis were most often in the lung (48), the retropharyngeal lymph nodes (36), the mesenteric lymph nodes (35), and the mediastinal lymph nodes (16). Other mycobacterial isolates included: 11 M. paratuberculosis, 11 M. avium, and 28 rapidly growing species or M. terrae complex. The sensitivity estimates of gross pathology and histopathology I were 93% (95% confidence limits [CL] 84,97%) and 88% [CL 77,94%], respectively, and the specificity of both was 89% [CL 85,92%]). The sensitivity and specificity of histopathology II were 89% (CL 79,95%) and 77% (CL 72,81%), respectively. The highest sensitivity estimates (93- 95% [CL 84,98%]) were obtained by interpreting gross pathology and histopathology in parallel (where an animal had to be positive on at least one of the two, to be classified as combination positive). The highest specificity estimates (94-95% [CL 91-97%]) were generated when the two tests were interpreted in series (an animal had to be positive on both tests to be classified as combination positive). The presence of gross or microscopic lesions showed moderate to good agreement with the isolation of M. bovis (Kappa = 65-69%). The results show that post-mortem inspection, histopathology and culture do not necessarily recognize the same infected animals and that the spectra of animals identified by the tests overlaps.

Partial overlap of anti-mycobacterial, and anti-Saccharomyces cerevisiae mannan antibodies in Crohn's disease

AIM: To test whether humoral immune reaction against mycobacteria may play a role in anti-Saccharomyces cerevisiae antibodies (ASCA) generation in Crohn's disease (CD) and/or whether it correlates with clinical subtypes. METHODS: The dominant ASCA epitope was detected by Galanthus nivalis lectin (GNL)-binding assay. ASCA and IgG against mycobacterial lysates (M avium, M smegmatis, M chelonae, M bovis BCG, M avium ssp. paratuberculosis (MAP)] or purified lipoarabinomannans (LAM) were detected by ELISA. ASCA and anti-mycobacterial antibodies were affinity purified to assess cross-reactivities. Anti-mycobacterial IgG were induced by BCG-infection of mice. RESULTS: GNL bound to different extents to mycobacterial lysates, abundantly to purified mannose-capped (Man) LAM from M tuberculosis, but not to uncapped LAM from M smegmatis. Fifteen to 45% of CD patients but only 0%-6% of controls were seropositive against different mycobacterial antigens. Anti-mycobacterial IgG correlated with ASCA (r = 0.37-0.64; P = 0.003-P < 0.001). ASCA-positivity and deficiency for mannan-binding lectin synergistically associated with anti-mycobacterial IgG. In some patients, anti-mycobacterial antibodies represent cross-reactive ASCA. Vice-versa, the predominant fraction of ASCA did not cross-react with mycobacteria. Finally, fistulizing disease associated with antibodies against M avium, M smegmatis and MAP (P = 0.024, 0.004 and 0.045, respectively). CONCLUSION: Similar to ASCA, seroreactivity against mycobacteria may define CD patients with complicated disease and a predisposition for immune responses against ubiquitous antigens. While in some patients anti-mycobacterial antibodies strongly cross-react with yeast mannan; these cross-reactive antibodies only represent a minor fraction of total ASCA. Thus, mycobacterial infection unlikely plays a role in ASCA induction.

Mycobacterium avium Subsp. avium infection in four veal calves: differentiation from intestinal tuberculosis

Mycobacterium avium subsp. avium (Maa) is an intracellular pathogen belonging to the Mycobacterium avium-intracellulare complex (MAC). Reservoirs of MAC are the natural environment, wildlife and domestic animals. In adult bovine, MAC infections are typically caused by Mycobacterium avium subsp. paratuberculosis (Map). Maa infections in bovine are rarely reported but may cause clinical disease and pathological lesions similar to those observed in paratuberculosis or those induced by members of the Mycobacterium tuberculosis complex (MTBC). Therefore, differentiation of MAC from MTBC infection should be attempted, especially if unusual mycobacterial lesions are encountered. Four veal calves from a fattening farm dying with clinical signs of otitis media, fever, and weight loss were submitted for necropsy. Samples from affected organs were taken for histologic investigation, bacteriologic culture, and bacterial specification using PCR. Macroscopic thickening of the intestinal mucosa was induced by granulomatous enteritis and colitis. Intracytoplasmic acid-fast bacteria were detected by Ziehl-Neelsen stains and PCR revealed positive results for Mycobacterium avium subsp. avium. Clinical and pathological changes of Maa infection in veal calves had features of Mycobacterium avium subsp. paratuberculosis and the MTBC. Therefore, Mycobacterium tuberculosis complex infection should be considered in cases of granulomatous enteritis in calves.

Epithelial antibiotic induced in states of disease

Epithelial defensins provide an active defense against the external microbial environment. We investigated the distribution and expression of this class of antimicrobial peptides in normal cattle and in animals in varying states of disease. β-defensin mRNA was found to be widely expressed in numerous exposed epithelia but was found at higher levels in tissues that are constantly exposed to and colonized by microorganisms. We observed induction in ileal mucosa during chronic infection with Mycobacterium paratuberculosis and in bronchial epithelium after acute infection with Pasteurella haemolytica. It has been proposed that expression of antimicrobial peptides is an integral component of the inflammatory response. The results reported here support this hypothesis and suggest that epithelial defensins provide a rapidly mobilized local defense against infectious organisms.

On the etiology of Crohn disease.

Crohn disease (CD) is a chronic, panenteric intestinal inflammatory disease. Its etiology is unknown. Analogous to the tuberculoid and lepromatous forms of leprosy, CD may have two clinical manifestations. One is aggressive and fistulizing (perforating), and the other is contained, indolent, and obstructive (nonperforating) [Gi]-berts, E. C. A. M., Greenstein, A. J., Katsel, P., Harpaz, N. & Greenstein, R. J. (1994) Proc. Natl. Acad. Sci. USA 91, 12721-127241. The etiology, if infections, may be due to Mycobacterium paratuberculosis. We employed reverse transcription PCR using M. paratuberculosis subspecies-specific primers (IS 900) on total RNA from 12 ileal mucosal specimens (CD, n = 8; controls, n = 4, 2 with ulcerative colitis and 2 with colonic cancer). As a negative control, we used Myobacterium avium DNA, originally cultured from the drinking water of a major city in the United States. cDNA sequence analysis shows that all eight cases of Crohn's disease and both samples from the patients with ulcerative colitis contained M. paratuberculosis RNA. Additionally, the M. avium control has the DNA sequence of M. paratuberculosis. We demonstrate the DNA sequence of M. paratuberculosis from mucosal specimens from humans with CD. The potable water supply may be a reservoir of infection. Although M. paratuberculosis signal in CD has been previously reported, a cause and effect relationship has not been established. In part, this is due to conflicting data from studies with empirical antimycobacterial therapy. We conclude that clinical trials with anti-M. paratuberculosis therapy are indicated in patients with CD who have been stratified into the aggressive (perforating) and contained (nonperforating) forms.

Serum and salivary IgA antibody responses to Saccharomyces cerevisiae, Candida albicans and Streptococcus mutans in orofacial granulomatosis and Crohn's disease

Orofacial granulomatosis (OFG) is a condition of unknown aetiology with histological and, in some cases, clinical association with Crohn's disease (CD). However, the exact relationship between OFG and CD remains uncertain. The aim of this study was to determine whether OFG could be distinguished immunologically from CD by comparing non-specific and specific aspects of humoral immunity in serum, whole saliva and parotid saliva in three groups of patients: (a) OFG only (n = 14), (b) those with both oral and gut CD (OFG + CD) (n = 12) and (c) CD without oral involvement (n = 22) and in healthy controls (n = 29). Non-specific immunoglobulin (IgA, SigA, IgA subclasses and IgG) levels and antibodies to whole cells of Saccharomyces cerevisiae, Candida albicans and Streptococcus mutans were assayed by enzyme-linked immunosorbent assay (ELISA) in serum, whole saliva and parotid saliva. Serum IgA and IgA1 and IgA2 subclasses were raised in all patient groups (P < 0.01). Salivary IgA (and IgG) levels were raised in OFG and OFG + CD (P < 0.01) but not in the CD group. Parotid IgA was also raised in OFG and OFG + CD but not in CD. The findings suggest that serum IgA changes reflect mucosal inflammation anywhere in the GI tract but that salivary IgA changes reflect involvement of the oral cavity. Furthermore, the elevated levels of IgA in parotid saliva suggest involvement of the salivary glands in OFG. Serum IgA antibodies to S. cerevisiae were raised markedly in the two groups with gut disease while serum IgA (or IgG) antibodies to C. albicans were elevated significantly in all three patient groups (P < 0.02). No differences were found with antibodies to S. mutans. Whole saliva IgA antibodies to S. cerevisiae (and C. albicans) were raised in the groups with oral involvement. These findings suggest that raised serum IgA antibodies to S. cerevisiae may reflect gut inflammation while raised SIgA antibodies to S. cerevisiae or raised IgA or IgA2 levels in saliva reflect oral but not gut disease. Analysis of salivary IgA and IgA antibodies to S. cerevisiae as well as serum antibodies in patients presenting with OFG may allow prediction of gut involvement.