Transfusion-acquired cytomegalovirus infection in children in a hyperendemic area

Thirty-nine children without previous cytomegalovirus (CMV) infection received blood transfusion in the National Taiwan University Hospital. The overall transfusion-acquired CMV infection rate was 36% (14/39). Donor CMV seropositive rate was 70%. None of the nine children who had received seronegative blood became infected, in contrast to 14 of the 21 children (67%) who had received seropositive blood (P = 0.002). Another significant risk factor associated with CMV infection was the use of fresh blood: 13 of 15 (87%) with fresh seropositive blood were infected, in contrast to one of six (17%) with "old" seropositive blood (P = 0.01). Most of the fresh blood was used within 24 hours. This blood processing method was shown to account for the extremely high rate of CMV infection in those who had received fresh seropositive blood. The results indicated that the incidence of CMV infection can be reduced by avoiding the use of fresh blood, especially blood less than 24 hours old. For such a population in Taiwan with high prevalence of positive CMV antibody, this approach was more applicable than screening donor blood for CMV antibody.

Isolation and typing of herpes simplex virus from clinical specimens collected at National Taiwan University Hospital, 1981-1990

From 1981 to 1990, 10,167 clinical specimens were collected at National Taiwan University Hospital from the cases with suspected viral infections. Three hundred of herpes simplex virus (HSV) were isolated from these samples (isolation rate; 3.0%). One hundred and fifty-one strains were isolated from non-genital, and 149 strains from genital areas. HSV strains were typed by direct immunofluorescence staining technique. The type specific monoclonal antibodies were used in the test. Most of the HSV strains isolated from non-genital areas were type 1 (HSV-1) (147/151, 97.4%) whereas most of the strains from genital areas were type 2 (HSV-2) (140/149, 94.0%). All nine strains of HSV-1 isolated from genital areas were from female patients. The predominance of HSV-1 in non-genital area infections, and of HSV-2 in genital area infections, did not change during the ten years under review.

Aggressive peripheral T-cell lymphomas containing Epstein-Barr viral DNA: a clinicopathologic and molecular analysis

The Epstein-Barr virus (EBV) has been shown to be associated with posttransplant lymphoma, Hodgkin's disease, and T-cell lymphoma, in addition to African Burkitt's lymphoma. In a retrospective study of 56 consecutive cases of T-cell lymphoma, EBV DNA was found by Southern blot and in situ DNA hybridization in 10 (20%) of 50 peripheral T-cell lymphomas, but in none of six cases of T-lymphoblastic lymphoma. Peripheral T-cell lymphomas containing EBV DNA could be subclassified into three categories according to histology and immunophenotypic studies: (1) T-cell lymphoma of the helper phenotype, five cases. Two cases had histologic features resembling angioimmunoblastic lymphadenopathy (AILD). (2) T-cell lymphoma of the cytotoxic/suppressor phenotype, four cases. AILD-like features could also be recognized in two cases. Reed-Sternberg-like giant cells were identified in three cases designated Hodgkin-like T-cell lymphoma. (3) Angiocentric T-cell lymphoma or lymphomatoid granulomatosis in one case, initially affecting the skin and nose; no T-cell subset could be defined. Six of the eight EBV DNA-positive patients tested for serum EBV antibodies had elevated titers of IgG antiviral capsid antigen (greater than 640) and/or early antigen (greater than 10). From combined studies of Southern blot hybridization by using EBV termini fragment probe and in situ DNA hybridization, the EBV genomes appeared to be clonotypically proliferated in the neoplastic T cells. The patients in all three groups usually had prolonged fever preceding the diagnosis, hepatosplenomegaly, an aggressive clinical course, and poor response to chemotherapy; nine died with a median survival of only 8 months. We propose that these EBV-associated aggressive T-cell lymphomas, like human T-cell leukemia/lymphoma virus-positive T-cell lymphoma, have characteristic clinicopathologic features and should be treated as a separate disease entity.

Effect of monovalent measles and trivalent measles-mumps-rubella vaccines at various ages and concurrent administration with hepatitis B vaccine

To determine the most suitable vaccination schedule in developing countries, a study was conducted to reevaluate the immunogenicity of monovalent measles vaccine and trivalent measles-mumps-rubella vaccine at different ages. The success rate of measles vaccination was 84% at 9 months, 88% at 12 months and 100% at 15 months of age. Vaccination with measles vaccines at 9 and 15 months of age was also 96% immunogenic. Most vaccinees (16 of 17) not responding to the first measles vaccine before 1 year of age developed measles antibody with another shot of vaccine after 15 months of age. Trivalent measles-mumps-rubella vaccine worked well in children ages 14 to 18 months. Administering trivalent vaccine and hepatitis B vaccine concurrently at 1 year of age, rubella and mumps antibodies developed in more than 95% of vaccinees, while measles antibody was detected in 88%. Responses to hepatitis B vaccine in this situation were good; 89% of vaccinees developed antibody against hepatitis B surface antigen (greater than or equal to 10 mIU/ml) and the geometric mean titer was 362.49 mIU/ml. In summary vaccination twice at 9 and 15 months is effective and is a useful regimen in developing countries where measles is still endemic. Trivalent vaccine and hepatitis B vaccine will not interfere with each other when given together at 1 year of age.

Rapid laboratory diagnosis of human cytomegalovirus infection using monoclonal antibody

The monoclonal antibody E. 13, recognized an early nonstructure antigen (68 KD) of human cytomegalovirus (HCMV), was used for early detection of HCMV in cell cultures. The virus antigen could be detected by the indirect immunofluorescence staining (IF) technique 6 hours after inoculation of HCMV AD169 and NTUH871233 strains into human embryonic lung fibroblast (HELF) cells growing in shell vials prepared by low speed centrifugation (700xg) at 25 degrees C for 1 hour. The intensity of fluorescence reached a peak 14 hours after virus inoculation and remained at the same level for 72 hours. The feasibility of application of this technique for rapid detection of HCMV in the clinical virology laboratory was tried. A total of 201 urine specimens requesting HCMV isolation were inoculated into HELF cells using the shell vial culture method. The virus growth in the shell vial cultures was detected by the indirect IF technique with the monoclonal antibody E.13 at 16 to 18 hours postinoculation. The results obtained were compared with those of the conventional tube culture method. The sensitivity and specificity of the test vs the conventional tube culture method for detection of HCMV in clinical specimens were 93.06% and 99.22%, respectively. The average time of virus isolation by the conventional culture method was 10.9 days, whereas final results with the shell vial culture method were obtained in only one day. The above results indicate that detection of HCMV early antigen in infected cells with monoclonal antibody E.13 is a sensitive and reliable method for rapid diagnosis of HCMV infections.

A fatal case of viral pneumonia in a child infected with adenovirus type 3

This report describes the clinical, roentgenologic, pathologic, and virologic findings in a 2 years and ten months old girl who died from a severe pneumonia. Initially, the patient presented with fever and cough for 2 days. Physically, the patient appeared lethargic, and breathing sounds revealed diffuse rales and wheezing. Hemogram showed mild leukocytosis and lymphocyte predominant. Chest X ray revealed diffuse interstitial infiltration of the right upper lung, left upper and left lower lung field. Bacteria infection was first impressed. Although treated with several antibiotics (ampicillin, cefuroxime, amikacin, penicillin, cephazolin, imipenem and vancomycin) in three different hospitals, the patient's condition went downhill and the patient died 2 weeks later. Finally, adenoviurs type 3 was isolated from sputum specimen taken before death and necropsy lung tissue. The lung pathology showed diffuse necrotizing inflammation with fibrinopurulent exudate, and eosinophilic intranuclear inclusion bodies were also noted in the alveolar cells. These data proved the diagnosis of adenovirus pneumonia. This case adds to the evidence that adenovirus type 3 infection during childhood may cause fatal disease.

An autopsy-proved case of AIDS in Taiwan

The first case of AIDS positively identified in a non-foreigner in Taiwan was a 25-year-old unmarried male who had practiced homosexuality for ten years. The patient began to have abdominal pain accompanied with loose stools and weight loss in June 1985, followed by fever, cough, headache, dizziness, and loss of memory. Facial hyperpigmentation and extensive oroesophageal candidiasis were noted. Laboratory studies showed severe lymphopenia with a reversed T-helper to T-suppressor ratio, cutaneous anergy and polyclonal gammopathy. Human immunodeficiency virus (HIV) antibodies were positive by ELISA and Western blot, and the virus was isolated from the blood. At autopsy, disseminated cytomegalovirus infection, extensive CNS toxoplasmosis and early lesions of Kaposi's sarcoma were demonstrated. The detection of HIV in the adrenal medulla supports the consensus that the virus is neurotropic.

Neonatal hepatitis: a follow-up study

Fifty-six patients with moderate to severe neonatal hepatitis were followed for 12 to 78 months. Two died from causes other than hepatitis itself and were free from liver disease at the time of death. Of the remaining 54 patients, seven died of hepatitis, two are living with chronic liver disease and psychomotor retardation, and 45 are living without liver disease. High peak bilirubin levels and liver histologic findings of periportal fibrosis, moderate to severe portal inflammation, and/or diffuse giant cell transformation appear to be major factors predictive for poor outcome. Cytomegalovirus (CMV) infection was a common associated infection. Evidence of CMV infection was found in 22 (49%) of the 45 patients studied. Three of them died, and one is still living with cirrhosis of the liver. Metabolic disorders such as alpha-1-antitrypsin deficiency, galactosemia, and aminoaciduria and/or aminoacidemia were carefully screened but were not found in these cases. A fatal case had a sibling who had died of a similar disease course. Chinese infants may have metabolic and familial cholestasis diseases requiring further investigation.

Differentiation of poliovirus type I isolates in the 1982 epidemic from Sabin-I strain by antigenic and temperature markers

Poliovirus type 1 strains recovered from patients with poliomyelitis during the epidemic of 1982, were distinct antigenically from Sabin-1 strain by comparing homologous and heterologous neutralization rate constants of Sabin-1 specific antiserum. With the reproductive capacity at 40 degrees C, these isolates could be easily differentiated from vaccine strain. It was suggested that the epidemic of poliomyelitis in 1982 was not caused by vaccine strain. The 24 isolates reacted with LSc and/or Sabin-1 antisera to the same extent. It was speculated that they might be antigenically similar if not identical. Three isolates which were collected from the later part of epidemic formed small plaques at 40 degrees C. Rabbit antisera against poliovirus strains 3844, Sabin-1, Mahoney and Brunhilde were produced. Antigenic relatedness among the strains was tested by kinetic neutralization. The strain 3844 was distinct from Brunhilde, Mahoney and Sabin-1. Asymmetric cross-reactions between Mahoney and Sabin-1 strains were clearly demonstrated.

Monoclonal antibodies for the rapid diagnosis of respiratory syncytial virus infection by immunofluorescence

Eight separate monoclonal antibodies to the Long strain of respiratory syncytial virus (RSV) were tested for their utility as rapid diagnostic reagents in immunofluorescence. Preliminary screening indicated that all 8 reacted with 11 field strains from three previous local RSV outbreaks and with 4 of 5 additional strains chosen because of their antigenic diversity by neutralization. Two monoclonal antibodies, one each directed against a surface glycoprotein and the nucleocapsid protein, were then compared, singly and combined, with a polyclonal antiserum as diagnostic reagents in 209 consecutive samples submitted to our diagnostic laboratory. Agreement between the two monoclonal antibodies was 100% and between them and the polyclonal serum was 98%. Sensitivity in relation to culture was 96-98%. Monoclonal antibodies are excellent immunofluorescent diagnostic reagents; antigenic diversity among RSV strains was not an impediment to their use in this study.