Demonstration of Yellow Fever and Dengue Antigens in Formalin-Fixed Paraffin-Embedded Human Liver by Immunohistochemical Analysis

William C. HallPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Thomas P. CrowellPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Douglas M. WattsPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Vera L. R. BarrosPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Hever KrugerPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Francisco PinheiroPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Clarence J. PetersPathology Associates, Inc., Instituto Evandro Chagas, Department of Pathology, Centro Medico Naval, Pan American Health Organization, Disease Assessment Division, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, Brazil

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Two immunohistochemical techniques to determine the presence of yellow fever and dengue antigens in fixed tissue samples were developed for the purpose of making retrospective diagnoses of these viral diseases in humans. A horseradish peroxidase label was used for one technique and an alkaline phosphatase label for the other. In the former technique, acid hematin was removed from the tissues, iron-containing pigments were counterstained with Prussian blue, and the product of the diaminobenzidine reaction was enhanced with a dilute solution of osmium tetroxide that differentiated antigen from lipofuscin. In the latter technique, alkaline phosphatase was used as the enzyme labeling system with a red chromagen that contrasted nicely with the pigments in the tissues, as mentioned above. Thus, pigment removal or differentiation from antigen was not required. Replicate sections were cut and mouse polyclonal antibodies for yellow fever and all dengue types were applied to individual sections. On samples positive for dengue antigen, monoclonal antibodies were applied to additional replicate sections to demonstrate antigen of dengue types 1 and 4. In order to test the assay, samples of formalin-fixed liver tissue from Brazilian and Peruvian individuals who had died from a variety of causes as long as eight years earlier were received in a blinded fashion for immunohistochemical analysis. The techniques appeared to be highly reliable for yellow fever diagnosis; however, not enough cases were observed to adequately evaluate the procedures for dengue diagnosis. Both procedures appeared to have similar sensitivity.

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