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Steininger C, Graninger W, Zoufaly A, Zöllner B, Feucht HH, Kundi M, Stahmer I, Stellbrink HJ, van Lunzen J. Aymptomatic CMV viremia is associated with increased levels of serum amyloid A in patients with advanced HIV-infection. Eur J Med Res 2008; 13:304-308. [PMID: 18558558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE We evaluated assays for the measurement of acute phase protein levels in plasma for their usefulness to identify sensitively an inflammatory response to active cytomegalovirus CMV infection in HIV-infected patients. METHODS Plasma samples were collected from 28 CMV-seropositive patients with advanced HIV-infection (CD4-cell count <200/microl) before commencement of antiretroviral therapy. Sensitivity, specificity, and area under receiver operating characteristic curve for the selected acute phase protein assays (haptoglobin, fibronectin, high-sensitivity C-reactive protein (hs-CRP), human interleukin-6, serum amyloid A (SAA), and human lipopolysacharide binding protein) were compared with results of a CMV-specific PCR assay. RESULTS CMV viremia was detectable in 8/28 patients. Levels of SAA correlated well with those of hs-CRP (r' = 0.439, P = 0.019 (Spearman rank correlation)). Levels of SAA >3 mg/L discriminated with 100% sensitivity and 40% specificity between HIV-infected patients with and without active CMV infection. Sensitivity of fibronectin was 100% and specificity 15% at a threshold-value corresponding with the lower limit of normal values as defined by the manufacturer of the assay (>29 mg/dL). Levels of the other acute phase proteins evaluated did not correlate with detection of CMV-DNA in plasma. CONCLUSION Increased levels of SAA indicate sensitively an inflammatory response to active CMV infection. Use of a CMV-specific virological assay is required to confirm the specificity of a high SAA-level but may be limited to samples with high SAA-levels. Hence, screening for increased levels of SAA in patients with advanced HIV-infection may allow early identification of active CMV infection.
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Affiliation(s)
- Christoph Steininger
- Medical University of Vienna, Department of Medicine I, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Zöllner B, Sterneck M, Wursthorn K, Petersen J, Schröter M, Laufs R, Feucht HH. Prevalence, incidence, and clinical relevance of the reverse transcriptase V207I mutation outside the YMDD motif of the hepatitis B virus polymerase during lamivudine therapy. J Clin Microbiol 2005; 43:2503-5. [PMID: 15872296 PMCID: PMC1153772 DOI: 10.1128/jcm.43.5.2503-2505.2005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The reverse transcriptase V207I mutation within the hepatitis B virus (HBV) polymerase is associated with resistance to lamivudine in vitro. The prevalence of this mutation in treatment-naive patients was 1% (1/96). A follow-up of the patient carrying this mutation prior to treatment revealed no loss of sensitivity of HBV to lamivudine in vivo.
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Affiliation(s)
- B Zöllner
- Institute for Infectious Diseases, University Hospital Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
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Tsokos M, Zöllner B, Feucht HH. Fatal influenza A infection with Staphylococcus aureus superinfection in a 49-year-old woman presenting as sudden death. Int J Legal Med 2004; 119:40-3. [PMID: 15322829 DOI: 10.1007/s00414-004-0472-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 07/12/2004] [Indexed: 10/26/2022]
Abstract
A fatal case of influenza A infection with Staphylococcus aureus superinfection in a previously healthy 49-year-old woman presenting as sudden, unexpected death is reported. Autopsy revealed severe necrotizing tracheobronchitis and hemorrhagic pneumonia. Microscopic examination of the trachea and bronchi showed mucosal necrosis and a dense lympho-monocytic infiltration of all layers. The lungs showed focal hemorrhagic pneumonia. No pathological changes were detectable in the myocardium. Influenza A virus was detected in bronchi and lung samples obtained during autopsy by the polymerase chain reaction (PCR) and bacterial superinfection with Staphylococcus aureus was shown by culturing from tracheal, bronchial and pulmonary swabs obtained during autopsy. PCR assays for the detection of Panton-Valentine leukocidin performed from all samples were negative. This case demonstrates the need for an interdisciplinary approach towards an organism-specific diagnosis of potentially infection-related deaths undergoing a medico-legal autopsy. With improved diagnostic possibilities such as PCR and DNA sequencing, forensic pathologists can, in close association with the field of microbiology, make a significant contribution to the detection of highly infectious agents which must be notified to the authorities. This will increase particularly the knowledge about the influence of these agents on sudden, unexpected deaths in outpatients.
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Affiliation(s)
- M Tsokos
- Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany.
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Schröter M, Laufs R, Zöllner B, Knödler B, Schäfer P, Sterneck M, Fischer L, Feucht HH. Prevalence of SENV-H viraemia among healthy subjects and individuals at risk for parenterally transmitted diseases in Germany. J Viral Hepat 2002; 9:455-9. [PMID: 12431209 DOI: 10.1046/j.1365-2893.2002.00390.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The prevalence of a newly described DNA virus (SENV-H) was examined in a population of 599 individuals by polymerase chain reaction (PCR). All individuals were assigned to a nonrisk or a risk group depending on the presence of historical or serological factors indicating an increased risk for parenterally transmitted diseases. In a group of 226 healthy blood donors, 38 (16.8%) were found to be SENV-H viraemic. The highest prevalence of SENV-H viraemia was observed among patients infected by HIV (28 of 63; 44.4%). Contrarily, of 78 individuals on maintenance haemodialysis, only 10 (12.8%) were found positive in the SENV-H PCR. Our results demonstrate that SENV-H viraemia is widespread in the general population. Therefore, it seems to be questionable if parenteral transmission is the main route for spreading SENV-H. The hepatitis-inducing capacity of SENV-H is unclear. However, taking our clinical and epidemiological data into account it seems unlikely that this virus is responsible for hepatitis.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Laufs R, Polywka S, Feucht HH, Schröter M, Zöllner B, Oehler G. [Hepatitis C. Virology, transmission modes, clinical aspects, prevention and therapy]. Anaesthesist 2002; 51:884-9. [PMID: 12434261 DOI: 10.1007/s00101-002-0411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Of the various forms of chronic viral hepatitis, in Germany 60-70% are caused by the hepatitis C virus (HCV). The virus arrives inconspicuously, i.e. an acute infection only leads to an increase in transaminases in 40% of cases and to an increase in bilirubin in only 20%. However, approximately 90% of infections take a chronic course and in 20% this leads to cirrhosis after only 20 years. The infection rate of medical personnel is not significantly higher than in the general population. The transmission of HCV from patients to medical personnel, e.g. by needle stick injuries, is very rare and the risk of infection is less than 1%. Even less frequently transmission of HCV in the reverse direction from medical personnel to patients occurs. An active or passive prophylactic immunization is not possible and protective immunization is not yet foreseeable. Recently, progress has been made with chemotherapeutical treatment of HCV. The present state-of-the-art is pegylated interferon-a in combination with ribavirin. The success rate in HCV genotypes 2 and 3 is clearly higher with 70-80% than in genotypes 1 and 4 with approximately 40%. Both drugs have significant side-effects but better forms of medication are not yet available.
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Affiliation(s)
- R Laufs
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Germany.
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Fischer L, Sterneck M, Meier D, Zöllner B, Rogiers X. The use of antiviral monotherapy and combination therapy for patients with hepatitis B virus infection after liver transplantation. Transplant Proc 2002; 34:2283-4. [PMID: 12270400 DOI: 10.1016/s0041-1345(02)03237-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Fischer
- Department of Hepatobiliary Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
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Zöllner B, Schäfer P, Feucht HH, Schröter M, Petersen J, Laufs R. Correlation of hepatitis B virus load with loss of e antigen and emerging drug-resistant variants during lamivudine therapy. J Med Virol 2001; 65:659-63. [PMID: 11745928 DOI: 10.1002/jmv.2087] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It remains unclear whether sequential assessment of hepatitis B virus (HBV) load during lamivudine therapy can predict the loss of hepatitis B e antigen or emergence of drug-resistant variants. Therefore, a longitudinal study was carried out in 28 consecutive patients with chronic hepatitis B who started lamivudine therapy for a median of 12 months (range, 6-31). HBV DNA copy numbers were determined at 3-month intervals. From month 6 onward, HBV viral load below the detection limit of the PCR was predictive of the loss of envelope antigen (P = 0.043). Continuously detectable HBV DNA during the first 12 months of treatment indicated emergence of drug-resistant variants (P = 0.034). These data suggest that the goal of lamivudine therapy should be complete suppression of serum HBV DNA.
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Affiliation(s)
- B Zöllner
- Institute for Medical Microbiology and Immunology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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8
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Schröter M, Zöllner B, Schäfer P, Laufs R, Feucht HH. Comparison of three HCV genotyping assays: a serological method as a reliable and inexpensive alternative to PCR based assays. J Clin Virol 2001; 23:57-63. [PMID: 11595584 DOI: 10.1016/s1386-6532(01)00186-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Determination of hepatitis C virus (HCV) genotypes and subtypes is of rising clinical importance. In times where also an increasing need for cost effectiveness can be observed, the demand for fast and easy performable assays grows. OBJECTIVES To evaluate and compare different genotyping methods regarding their reliability, practicability, and expense in the daily routine. METHODS Sera of 39 patients infected with different HCV subtypes were examined by a serological genotyping assay (NS-4 IBA), by the widely used INNO-LiPA HCV II, and by a nucleotide sequencing method. RESULTS The tests performed equally well in terms of HCV subtyping and no different results were obtained. However, the serotyping assay provided the results in less than half the time needed by the other two assays. Significant differences were also observed regarding the 'hands on' times and the costs. The technical equipment which was necessary to perform the assays is significantly reduced using the serological assay. CONCLUSION Our study demonstrates that the serological test offers the opportunity to determine HCV genotypes and subtypes reliably, fast, easy, and cost effective.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Schäfer P, Tenschert W, Cremaschi L, Schröter M, Zöllner B, Laufs R. Area under the viraemia curve versus absolute viral load: utility for predicting symptomatic cytomegalovirus infections in kidney transplant patients. J Med Virol 2001; 65:85-9. [PMID: 11505448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A novel approach to predicting symptomatic cytomegalovirus (CMV) infections combines the level and the duration of viraemia in a single parameter. Sixty-four kidney transplant recipients were monitored by quantitative shell vial culture, pp65 antigenaemia, and polymerase chain reaction (PCR) of leucocytes. The area under the curve (AUC) of each parameter was determined from the onset of viraemia to the beginning of antiviral treatment. The AUC values were significantly higher in symptomatic than in asymptomatic patients. For antigenaemia and PCR, optimal AUC thresholds for predicting symptomatic CMV infections were determined. They were superior to standard cutoff levels of absolute viral load in sensitivity, specificity, and positive and negative predictive value. In 8 of the 23 patients who became symptomatic, impending clinical features were indicated earlier by the AUC thresholds than by standard viral load. In conclusion, the concept of the AUC should facilitate identification of patients at risk of symptomatic CMV infection.
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Affiliation(s)
- P Schäfer
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Schröter M, Schäfer P, Zöllner B, Polywka S, Laufs R, Feucht HH. Strategies for reliable diagnosis of hepatitis C infection: the need for a serological confirmatory assay. J Med Virol 2001; 64:320-4. [PMID: 11424121 DOI: 10.1002/jmv.1053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of the study was to examine whether the diagnosis of Hepatitis C (HCV) infection can be obtained reliably without using an immunoblot-based confirmation assay. 1,708 EIA-reactive serum samples were examined retrospectively for (i) optical density value in the screening assay, (ii) reactivity in an immunoblot assay, and (iii) result by RT PCR. In 1,394 (81.0%) samples positive results were obtained by both the HCV EIA and the confirmation assay. OD-values > or = 2.2 were observed in 1026 of these samples, but covered the range from 0.4 to 2.1 in the other 368 samples. The combination of HCV EIA reactivity and indeterminate immunoblot assay was observed in 134 (7.8%) serum samples. HCV RNA was detected in 58 cases by PCR. The OD-values of these 58 samples ranged from 0.4 to >2.2. Especially reactivity against the core recombinant protein was indicative of PCR positivity. The reactivity by the HCV EIA could not be confirmed by immunoblot assay or PCR in 180 (10.5%) sera. These false reactive sera showed OD values by EIA from 0.3 to 2.1. It is concluded that no threshold values can be defined which would allow differentiation between positive, indeterminate, and false reactive result by HCV EIA without producing an unacceptably high number of false negative diagnoses. Not using immunoblot-based confirmation would result in many additional PCR examinations. Therefore, confirmation of reactive HCV EIA results by a serological confirmatory assay must remain an essential part of the diagnostic procedure.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrabetae 52, 20246 Hamburg, Germany
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Zöllner B, Feucht HH, Schröter M, Schäfer P, Plettenberg A, Stoehr A, Laufs R. Primary genotypic resistance of HIV-1 to the fusion inhibitor T-20 in long-term infected patients. AIDS 2001; 15:935-6. [PMID: 11399967 DOI: 10.1097/00002030-200105040-00015] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B Zöllner
- Institut für Medizinische Mikobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Sera from 2,148 patients were tested with a third-generation microparticle enzyme immunoassay (MEIA), a confirmatory assay, and a reverse transcription-PCR. Overall, 85.6% of reactivities were confirmed, 13.2% were shown to be unspecifically reactive, and 1.2% were indeterminate. The rate of confirmed MEIA reactivities clearly depended on the strength of the reactivity.
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Affiliation(s)
- S Polywka
- for Medical Microbiology and Immunology, University Hospital Eppendorf, 20246 Hamburg, Germany
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Zöllner B, Feucht HH, Weitner L, Adam A, Schröter M, Schäfer P, Laufs R. Application of HIV-1 genotypic-resistance testing prevents the evolution of further resistance mutations in heavily pretreated patients. J Clin Virol 2001; 21:37-45. [PMID: 11255096 DOI: 10.1016/s1386-6532(00)00183-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Resistance-associated mutations in HIV-1 evolve even under highly active antiretroviral therapy. OBJECTIVE To evaluate the clinical efficacy of genotypic-resistance testing (GRT), to estimate the potential of a given antiretroviral therapy for prevention of further resistance mutations. STUDY DESIGN Ten patients were treated prospectively with drugs, according to the results of a GRT. Five patients were allocated to group I in which antiretroviral therapy could be switched to an effective regimen (consisting of at least three sensitive drugs, from at least two different classes of antiretroviral substances). Five patients (group II) had no option for effective therapy, and continued to be treated non-effectively (at least one applicated substance class only intermediately sensitive, or resistant). GRT and quantitative viral cultures were performed longitudinally for 8 months. Also, plasma HIV-1 RNA, total CD4+ cells, and rates of productively infected CD4+ cells were determined. RESULTS All the patients in group I showed a significant decrease of HIV-RNA of >1 log/ml (mean, -1.35 log/ml, P=0.025). The mean increase of CD4+ cells was 46 (not significant). The rate of productively infected CD4+ cells decreased significantly (mean, -16 productively infected CD4+ cells per 10(6) total CD4+ cells, P=0.04). In this group no further resistance mutations were detected after 8 months. In group II, none of the patients showed a significant decrease of HIV-1 RNA (mean, +0.05 log/ml), total CD4+ cells decreased (mean, -35, not significant), the rate of productively infected CD4+ cells increased significantly (mean, +124 productively infected CD4+ cells per 10(6) total CD4+ cells, P=0.04), and 4 of 5 patients had additional mutations in the RT gene conferring multi-drug resistance within 8 months (P=0.048). CONCLUSIONS GRT is predictive of the efficacy of a therapeutic regimen, in particular regarding evolution of further resistance mutations.
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Affiliation(s)
- B Zöllner
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätskrankenhaus Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Abstract
We investigated subtype-dependent development of lamivudine resistance in hepatitis B virus (HBV) longitudinally in 26 consecutive patients (13 adw and 13 ayw carriers) during antiviral treatment of chronic hepatitis B. Lamivudine resistance developed in seven adw carriers and one ayw carrier. Risk of lamivudine resistance was significantly higher for adw carriers than for ayw carriers (p=0.03). We believe that the adw subtype of HBV is associated with a high risk of lamivudine resistance, which might be linked to simultaneous changes of the HBsAg that occurs with the emergence of resistance.
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Schröter M, Zöllner B, Schäfer P, Laufs R, Feucht HH. Quantitative detection of hepatitis C virus RNA by light cycler PCR and comparison with two different PCR assays. J Clin Microbiol 2001; 39:765-8. [PMID: 11158147 PMCID: PMC87816 DOI: 10.1128/jcm.39.2.765-768.2001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The new Light Cycler technology was adapted to the detection of hepatitis C virus (HCV) RNA in clinical samples. Sera from 81 patients were tested by Light Cycler PCR, AMPLICOR HCV Monitor assay, and in-house PCR. Our data demonstrate that Light Cycler is a fast and reliable method for the detection and quantitation of HCV RNA.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Schröter M, Feucht HH, Zöllner B, Schäfer P, Laufs R. Prevalence of a novel DNA virus (TTV) among patients on maintenance hemodialysis. Nephron Clin Pract 2001; 87:139-42. [PMID: 11244308 DOI: 10.1159/000045902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS A recently detected DNA virus (TTV) has been assumed to be responsible for posttransfusion hepatitis in humans. Until now it is unclear whether patients on maintenance hemodialysis are at increased risk of acquiring TTV. METHODS Serum samples derived from 143 chronically hemodialyzed patients were examined for TTV viremia by nested PCR. All serum specimens were also investigated for viremia and for the presence of antibodies of hepatitis C virus (HCV) and GB virus C/hepatitis G virus (GBV-C/HGV) by PCR and serological assays, respectively. RESULTS The prevalence of TTV was determined to be 18.8% (n = 27), for HCV a prevalence of 15.4% (n = 22) and for GBV-C/HGV of 8.4% (n = 12) could be demonstrated. Parallel infection by TTV and HCV was detected in only 1.4% (n = 2) of the patients. In no serum sample could TTV and GBV-C/HGV be detected in parallel. None of the solely TTV-viremic individuals had clinical or biochemical signs of liver disease. CONCLUSION From our data we conclude that TTV viremia is widespread among hemodialysis patients and can be detected in 18.8%. Since no viremic patient had clinical or biochemical signs of liver disease, the hepatitis-inducing capacity of TTV remains unclear.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Deutschland
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Affiliation(s)
- L Fischer
- Department of Hepatobiliary Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
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Werkmeister R, Zöllner B, Kiattavorncharoen S, Joos U. [Evaluating form and function of the nose after open rhinoplasty in unilateral lip-maxillopalatal clefts]. Mund Kiefer Gesichtschir 2000; 4:270-3. [PMID: 11092177 DOI: 10.1007/s100060000223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Secondary septorhinoplasty in patients with cleft lip and palate (CLP) is performed to improve nasal form and function. The purpose of this study was to compare the initial findings and the surgical outcome in 30 patients with unilateral CLP. Open rhinoplasty was carried out to correct nasal deformity. Nasal soft tissue analysis was done by measurement of standardized raster photographs of the nose and lateral teleradiography. Deviations from the ideal form regarding nasal symmetry, nasal width, and alar base line were determined. The nasal profile was assessed by measuring the nasofacial and nasolabial angle, the angle between the upper lip and the Frankfurt horizontal plane (FHP), and the angle between the columella and the FHP. Nasal patency was evaluated by rhinomanometry. The overall flow (cm3/s) was determined and the flow of the cleft side and non-cleft side compared. Evaluations were made immediately before and 6 months after surgery. In the frontal plane, nasal symmetry was significantly improved and the alar form adjusted. The deep position of the columella was corrected. The acute nasofacial angle and the drooping ala were not significantly improved. An increase in the overall flow and correction of the quotient cleft/non-cleft side was achieved by the surgical procedure. In this study, aesthetically and functionally relevant findings were objectified and can be used for quality control.
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Affiliation(s)
- R Werkmeister
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Westfälische Wilhelms-Universität Münster.
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Zöllner B, Stoehr A, Plettenberg A, Feucht H, Schröter M, Schäfer P, Laufs R. In vivo dynamics and pathogenicity of wild-type and resistant Hepatitis B virus during long-term lamivudine monotherapy - a clinical note. J Clin Virol 2000; 17:183-8. [PMID: 10996115 DOI: 10.1016/s1386-6532(00)00092-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Genotypic resistance of Hepatitis B virus (HBV) against lamivudine evolves within months after onset of therapy. OBJECTIVES To determine the longitudinal order in which resistance mutations appear and to compare the kinetics and pathogenicity of wild-type and resistant HBV. STUDY DESIGN In a longitudinal study, consecutive samples were drawn over a period of 28 months from a patient with chronic hepatitis B, and resistance mutations were followed by sequencing a part of the polymerase region of HBV. These data were compared with HBV copy numbers, HBsAg and ALT levels, and results of consecutive liver biopsies. RESULTS After 21 weeks of treatment, a silent mutation at codon 528 (CTG to TTG) occurred. Significant genotypic resistance was detectable after 68 weeks, indicated by a substitution of isoleucine for methionine at residue 552 (M552I). Nineteen weeks later, the virus exhibited additional resistance-associated mutations (L528M and I552V). The resulting high-level resistance was reflected by an increase of serum HBV copies of 4.7 log(10). The turnover of wild-type and resistant HBV was 2.6x10(6) and 1.8x10(6) virions/day, respectively. HBsAg and ALT levels were lower within the period when resistant HBV was detectable. During treatment the progress of liver fibrosis was arrested. CONCLUSIONS The in vivo replicative capacities and dynamics of wild-type and resistant HBV were similar. However, resistant HBV seemed to exhibit reduced pathogenicity.
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Affiliation(s)
- B Zöllner
- Institute for Medical Microbiology and Immunology, University Hospital Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Eggers C, Stuerenburg HJ, Schafft T, Zöllner B, Feucht HH, Stellbrink HJ, van Lunzen J. Rapid clearance of human immunodeficiency virus type 1 from ventricular cerebrospinal fluid during antiretroviral treatment. Ann Neurol 2000; 47:816-9. [PMID: 10852550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
To understand the pathogenesis of human immunodeficiency virus-induced neuropathology, it is critical to know the dynamics of viral replication in the central nervous system. Viral decay kinetics were mathematically analyzed from multiple serial specimens of ventricular cerebrospinal fluid and plasma during antiretroviral therapy in a patient with asymptomatic human immunodeficiency virus infection and an external ventricular catheter for hydrocephalus. A rapid exponential decay of virus with an elimination half-life of 4.2 days in ventricular cerebrospinal fluid and 2.3 days in plasma was found. Sequencing the V3 loop-encoding envelope gene of virus in both compartments revealed high sequence homology. The combined data suggest that virus in ventricular cerebrospinal fluid is at least partly contributed by rapidly replicating virus-producing cells recruited from the circulation.
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Affiliation(s)
- C Eggers
- Department of Neurology, University Hospital Hamburg, Germany
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21
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Schröter M, Polywka S, Zöllner B, Schäfer P, Laufs R, Feucht HH. Detection of TT virus DNA and GB virus type C/Hepatitis G virus RNA in serum and breast milk: determination of mother-to-child transmission. J Clin Microbiol 2000; 38:745-7. [PMID: 10655378 PMCID: PMC86193 DOI: 10.1128/jcm.38.2.745-747.2000] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/1999] [Accepted: 11/22/1999] [Indexed: 11/20/2022] Open
Abstract
To investigate the vertical transmission of the newly described TT virus (TTV), serum and breast milk samples from 46 women as well as sera from their 47 newborns were examined for the presence of TTV DNA by PCR. TTV DNA was detected in 47.8% (n = 22) of the women. All but one child born to these women were also viremic for TTV from the first sample onward. TTV DNA was found in 73.9% (n = 17) of the breast milk samples derived from TTV viremic mothers. The one TTV-negative child born to a viremic mother remained negative during follow-up, although it was breast-fed. Our data show that TTV is highly effectively transmitted from mothers to their children during pregnancy. Although the majority of breast milk samples from viremic mothers are positive by TTV PCR, there is no need to discourage women from breast-feeding, because most children are TTV viremic even before breast-feeding begins.
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MESH Headings
- Animals
- Breast Feeding
- Child, Preschool
- DNA Virus Infections/complications
- DNA Virus Infections/transmission
- DNA Virus Infections/virology
- DNA Viruses/genetics
- DNA Viruses/isolation & purification
- DNA, Viral/blood
- Female
- Flaviviridae/genetics
- Flaviviridae/isolation & purification
- Hepatitis C/complications
- Hepatitis C/virology
- Hepatitis Viruses/genetics
- Hepatitis Viruses/isolation & purification
- Hepatitis, Viral, Human/transmission
- Hepatitis, Viral, Human/virology
- Humans
- Infant
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Milk/virology
- Pregnancy
- Pregnancy Complications, Infectious/virology
- RNA, Viral/blood
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, 20246 Hamburg, Germany.
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22
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Abstract
To evaluate the risk of hepatitis C virus (HCV) transmission via breast milk, we collected 76 samples of breast milk from 73 chronically HCV-infected women and serum samples from their 76 perinatally HCV-exposed children. Enzyme immunoassay and strip immunoblot assay were used for detection of antibodies to HCV, and reverse transcriptase-polymerase chain reaction analysis was used for detection of HCV RNA. None of the 76 samples of breast milk contained HCV RNA, whereas 37 (59.7%) of 62 mothers tested for HCV RNA had HCV viremia. Only 1 of the 76 breast-fed infants had evidence of HCV infection. Because HCV infection in this child was detected 1 month after birth, it seems unlikely that it was transmitted by breast-feeding. These results indicate that HCV infection in pregnant women should not be a contra-indication for breast-feeding.
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Affiliation(s)
- S Polywka
- Institute for Medical Microbiology and Immunology, University Hospital Eppendorf, 20246 Hamburg, Germany.
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23
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Schröter M, Feucht HH, Schäfer P, Zöllner B, Laufs R. Serological determination of hepatitis C virus subtypes 1a, 1b, 2a, 2b, 3a, and 4a by a recombinant immunoblot assay. J Clin Microbiol 1999; 37:2576-80. [PMID: 10405404 PMCID: PMC85286 DOI: 10.1128/jcm.37.8.2576-2580.1999] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/1998] [Accepted: 05/04/1999] [Indexed: 11/20/2022] Open
Abstract
Serological determination of hepatitis C virus (HCV) subtypes has been hampered by the lack of suitable assays. Therefore, a recombinant immunoblot assay has been established for serological differentiation of HCV subtypes 1a, 1b, 2a, 2b, 3a, and 4a. It consists of recombinant HCV proteins from the NS-4 region propagated in Escherichia coli. To confirm the serotyping assay results, the results were compared with those obtained by nucleotide sequencing of the NS-5 region. Sera from 157 patients with chronic HCV infection were examined by this assay, and specific antibodies could be detected in 86% (n = 135) of them. The HCV genotype was determined correctly in all but one sample, and the subtypes determined by the serotyping assay corresponded to the HCV subtypes detected by nucleotide sequencing for 95% (n = 128) of the samples. These data indicate that HCV subtypes can be distinguished serologically. The assay that is described provides an easier means of identification of infection with different HCV subtypes for wider clinical and epidemiological applications.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, 20246 Hamburg, Germany.
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25
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Feucht HH, Zöllner B, Schröter M, Polywka S, Buggisch P, Nolte H, Laufs R. High rate of chronicity in HCV infection determined by antibody confirmatory assay and PCR in 4110 patients during long-term follow-up. J Clin Virol 1999; 13:43-51. [PMID: 10405891 DOI: 10.1016/s1386-6532(99)00005-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND It is still unclear how many patients with hepatitis C virus (HCV) antibodies have viremia and hence are infectious. OBJECTIVES To determine the chronicity of HCV infection by correlation of HCV antibodies with presence of viremia in long-term follow-up. STUDY DESIGN In a longitudinal study sera of 4110 patients were analyzed with second generation HCV-enzyme immunoassay (EIA) and polymerase chain reaction (PCR). Only those patients were included in this study in whom sequential serum samples over a period of 2 years were available. To avoid preanalytical and analytical failures, we used a transport solution to prevent RNA degradation and a four-antigen recombinant immunoblot assay, established in our laboratory, for confirmation of antibody reactivity. RESULTS Of 2815 patients with confirmed HCV antibodies 2784 (98.9%) were also positive in HCV-PCR assay. False reactive EIA results were detected in 177 (13.7%) individuals as shown by confirmatory assay and PCR. Only one patient (0.04%) spontaneously lost detectable HCV viremia and subsequently HCV-specific antibodies. CONCLUSIONS Our study clearly demonstrates that presence of confirmed HCV-specific antibodies correlates significantly (98.9%; P < 0.001) with HCV viremia, and that spontaneous loss of viremia is a very rare event in HCV infection. We also found that elimination of HCV infection is not sufficiently predicted by the loss of detectable viremia in PCR, but can be concluded from the disappearance of virus-specific antibodies.
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Affiliation(s)
- H H Feucht
- Institute of Medical Microbiology and Immunology, Universitätskrankenhaus Eppendorf (UKE), Hamburg, Germany
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26
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Meyer U, Benthaus S, Du Chesne A, Wannhof H, Zöllner B, Joos U. [Examining patients with facial skull fractures from an etiological and legal perspective]. Mund Kiefer Gesichtschir 1999; 3:152-7. [PMID: 10414114 DOI: 10.1007/s100060050120] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Maxillofacial traumas are common and often associated with other injuries. From a forensic point of view, it is often necessary to relate the traumatic event to the subsequent injuries. The aim of this study was to explore the etiology of maxillofacial injuries due to objective signs and the anamnestic history of patients. In a prospective study over a 1-year period, all patients presenting with mandibular and midface fractures seeking treatment at the University Medical Center in Münster. Germany, were investigated. Demographic data, patient history, and pattern and etiology of injury were recorded, along with evaluations of the patients' descriptions. Thorough clinical and radiological investigation was performed and photographic records were taken. In our study, 122 patients, with a male to female ratio of 2:1 were included. The mean age was 30.7 +/- 13.4 years. Assault was the most common etiology (40%), followed by traffic accidents (29%) and falls (17%). Alcohol was reported to play a role in 40% of all injuries. There was no difference in the number of patients with mandibular or midface fractures. In 75%, maxillofacial fractures were associated with other injuries. The patients' descriptions of the orofacial traumas seemed to be highly. For age, anatomical location, concomitant injuries, and other signs of trauma, we found no statistical association with the underlying etiology.
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Affiliation(s)
- U Meyer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Münster
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27
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Feucht HH, Schröter M, Zöllner B, Polywka S, Laufs R. Age-dependent acquisition of hepatitis G virus/GB virus C in a nonrisk population: detection of the virus by antibodies. J Clin Microbiol 1999; 37:1294-7. [PMID: 10203473 PMCID: PMC84755 DOI: 10.1128/jcm.37.5.1294-1297.1999] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Until now there have been few seroepidemiological data for hepatitis G virus/GB virus type C (HGV/GBV-C). A four-antigen HGV/GBV-C immunoblot was established to examine 446 serum specimens from healthy individuals without risk factors for parenteral viral transmission. These individuals were divided into seven groups according to age. Seroprevalence rates were low for children and adolescents (5.6%) and increased for the age groups assumed to be the most sexually active (15.3 to 26.8%). Remarkably, none of the 80 individuals who tested positive for HGV/GBV-C antibodies were simultaneously positive for HGV/GBV-C viremia. From our data we conclude that HGV/GBV-C infection is widespread in the general population (16 to 25%). The development of an antibody response is associated with clearance of HGV/GBV-C viremia. Due to the lack of risk factors for HGV/GBV-C infection of blood, other efficient transmission routes must exist. It must be assumed that HGV/GBV-C transmission may be linked to sexual activity.
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Affiliation(s)
- H H Feucht
- Institute of Medical Microbiology and Immunology, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany.
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28
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Schröter M, Feucht HH, Schäfer P, Zöllner B, Laufs R. GB virus C/hepatitis G virus infection in hemodialysis patients: determination of seroprevalence by a four-antigen recombinant immunoblot assay. J Med Virol 1999; 57:230-4. [PMID: 10022792 DOI: 10.1002/(sici)1096-9071(199903)57:3<230::aid-jmv3>3.0.co;2-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
GB Virus C/Hepatitis G Virus (GBV-C/HGV) was identified recently and only two assays, consisting of a single recombinant protein, have been described for determination of the seroprevalence of this virus. An immunoblot assay was devised, which contains four recombinant GBV-C/HGV proteins. In this study, serum samples from 154 patients on maintenance hemodialysis were examined to assess the rate of seroreactivity against GBV-C/HGV. All sera were tested for the presence of antibodies by an in-house recombinant immunoblot assay, for GBV-C/HGV viremia by RT-PCR, and for HCV infection by PCR and by serological assays. Antibody reactivity against GBV-C/HGV was detected in 20.8% (n = 32) and viremia was found in 6.5% (n = 10) of the patients. In no case were viremia and GBV-C/HGV antibodies detected in parallel. HCV infection was observed in 15.6% (n = 24) by RT-PCR. In 20 of these patients, HCV antibodies were detected by enzyme immuno assay (EIA) and immunoblot assay. However, four of the HCV PCR-positive patients were negative by both serological tests. Only two patients were viremic for GBV-C/HGV and HCV in parallel. It is concluded that antibody reactivity against GBV-C/HGV is common among patients on maintenance hemodialysis. In contrast to HCV, parallel occurrence of GBV-C/HGV viremia and GBV-C/HGV seroreactivity was not observed. This suggests that GBV-C/HGV infection might be self-limiting.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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29
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Schröter M, Feucht HH, Schäfer P, Zöllner B, Polywka S, Laufs R. Definition of false-positive reactions in screening for hepatitis C virus antibodies. J Clin Microbiol 1999; 37:233-4. [PMID: 9854100 PMCID: PMC84219 DOI: 10.1128/jcm.37.1.233-234.1999] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/1998] [Accepted: 10/13/1998] [Indexed: 11/20/2022] Open
Abstract
The rate of false-positive hepatitis C virus enzyme immunoassay results was determined to be at least 10% among 1,814 reactive serum samples based on (i) negative results in an independent confirmation assay, (ii) negative PCR results, and (iii) no patients developing clinical or biochemical signs of hepatitis during a 1-year follow-up.
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Affiliation(s)
- M Schröter
- Institut fur Medizinische Mikrobiologie und Immunologie, Universit äts-Krankenhaus Eppendorf, 20246 Hamburg, Germany.
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30
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Schröter M, Feucht HH, Schäfer P, Zöllner B, Laufs R, Knödler B. TT virus viremia and liver transplantation: no significant increase of the prevalence. Blood 1998; 92:4877-8. [PMID: 9988547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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31
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Anastassov GE, Joos U, Zöllner B. Evaluation of the results of delayed rhinoplasty in cleft lip and palate patients. Functional and aesthetic implications and factors that affect successful nasal repair. Br J Oral Maxillofac Surg 1998; 36:416-24. [PMID: 9881782 DOI: 10.1016/s0266-4356(98)90456-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.
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Affiliation(s)
- G E Anastassov
- Department of Cranio-Maxillofacial and Plastic and Reconstructive Surgery, University of Münster, Germany
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32
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Zöllner B, Stellbrink HJ, Feucht HH, Schröter M, Baumgartner EM, Laufs R. Transient dissociation between infectious HIV-1 titer and viral RNA during the early phase of AZT treatment. Microbiol Immunol 1998; 42:471-3. [PMID: 9688082 DOI: 10.1111/j.1348-0421.1998.tb02311.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The short-term kinetics of infectious HIV titers, HIV copy numbers and p24-antigen during the first 28 days of AZT monotherapy were evaluated. In three of four patients, infectious HIV was culturable and infectious titers rose 2- and 4-fold compared to baseline values. This increase was neither associated with mutations conferring resistance to AZT nor a switch from NSI to SI phenotypes. Two patients showed an increase of plasma infectivity associated with a reduction of HIV copies and p24-antigen. We conclude that transient dissociations of plasma infectivity and HIV copy numbers occur during early AZT monotherapy.
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Affiliation(s)
- B Zöllner
- Institute for Medical Microbiology, University Hospital Eppendorf, Hamburg, Germany
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33
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Abstract
Until now, no serological assay has been available for the differentiation of HCV subtypes. Since there is evidence that the subtypes differently influence the clinical course of HCV infection and the outcome of interferon therapy, we established a strip immunoblot assay (NS-4 IBA) with recombinant HCV proteins of the nonstructural 4 (NS-4) region propagated in Escherichia coli. Using this NS-4 IBA, we were able to distinguish HCV subtypes 1a and 1b, which are the most prevalent subtypes in Europe and the U.S.A. The results of the serotyping assay were compared with those obtained by nucleotide sequencing from the NS-5 region. Concordant results were observed to match 94.9% (n=100) by the NS-4 IBA and nucleotide sequencing. Discrepant results were obtained in only 5.1% (n=6). These data indicate that HCV subtypes can be serologically distinguished, providing the possibility for easier identification of infection with different HCV subtypes.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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34
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Schröter M, Feucht HH, Schäfer P, Zöllner B, Laufs R. High percentage of seronegative HCV infections in hemodialysis patients: the need for PCR. Intervirology 1998; 40:277-8. [PMID: 9612730 DOI: 10.1159/000150558] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Among patients undergoing maintenance hemodialysis, a high prevalence of hepatitis C virus (HCV) infection can be observed. In a prospective study, sera of 273 patients were examined for the presence of HCV infection by serological tests and by PCR. Thirty-five patients (12.8%) were HCV antibody positive, and in 31 of them HCV RNA could be detected by PCR. Among the 238 seronegative patients HCV infection was detected in 12 cases (5.0%) exclusively by PCR. Only in 1 of these patients seroconversion could be observed within the 18-month follow-up period. These findings demonstrate that in hemodialysis patients PCR is necessary for the diagnosis of HCV infection.
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Affiliation(s)
- M Schröter
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Deutschland
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35
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Jurinke C, Zöllner B, Feucht HH, van den Boom D, Jacob A, Polywka S, Laufs R, Köster H. Application of nested PCR and mass spectrometry for DNA-based virus detection: HBV-DNA detected in the majority of isolated anti-HBc positive sera. Genet Anal 1998; 14:97-102. [PMID: 9526701 DOI: 10.1016/s1050-3862(97)10006-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
DNA preparations from three different groups of serum samples were examined for HBV-DNA via a nested polymerase chain reaction assay (lower detection limit: 10 viral genomes in 100 microliters serum): Group I consisted of 11 uninfected control sera, group II consisted of sera obtained from 11 HBV infected patients and group III consisted of 21 isolated anti-HBc positive samples. The 21 samples from group III were HBV-DNA negative according to a conventional non-nested PCR assay and hybridization with a 32P-labelled probe. Using nested PCR and mass spectrometry, HBV-DNA was detected in none of group I and in all of group II samples. In 11 out of 21 (52%) of the isolated anti-HBc positive sera from group III, HBV-DNA was detected. No correlation was observed between HBV-DNA positivity and anti-HBc titers. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry provided a fast, sensitive and non-radioactive assay for the detection of PCR products without the need for gel electrophoresis or hybridization with labelled probes.
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Affiliation(s)
- C Jurinke
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, University of Hamburg, Germany
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36
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Feucht HH, Zöllner B, Polywka S, Knödler B, Schröter M, Nolte H, Laufs R. Distribution of hepatitis G viremia and antibody response to recombinant proteins with special regard to risk factors in 709 patients. Hepatology 1997; 26:491-4. [PMID: 9252164 DOI: 10.1002/hep.510260234] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A new virus named hepatitis G virus (HGV) has been detected recently. Until now, no assays for the detection of antibodies against different HGV proteins have been commercially available. Therefore, a strip immunoblot assay has been established to investigate seroreactivity against recombinant structural (core) and nonstructural proteins (NS3 and NS4) of HGV produced in Escherichia coli. Seropositivity for HGV was evaluated and concordanced with HGV polymerase chain reaction (PCR) results in 709 subjects. These individuals were classified into a nonrisk or a risk group, on the basis of infection with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) or frequent parenteral exposure, including hemophilia, intravenous drug addiction, receipt of blood transfusion, or hemodialysis. The nonrisk group consisted of 257 healthy blood donors with normal alanine transaminase (ALT) levels (ALT < 30 U/L) and 154 patients with suspected non-A-E hepatitis (ALT > 45 U/L). In the group of healthy blood donors, 1.9% (5 of 257) had detectable HGV viremia and 15.9% (41 of 257) showed antibody response to HGV. In the collective of patients with suspected non-A-E hepatitis, results from 1.9% of patients (3 of 154) were positive by HGV PCR, and 15.6% of patients (24 of 154) showed seropositivity against the recombinant HGV proteins. In six groups of patients (n = 298) with different risk factors, the prevalence of both HGV viremia (V) and serological reactivity (SR) was higher compared with that of the nonrisk group: V, 6.80%-35.2%; serological reactivity (SR), 25.4%-52.9%. The following conclusions can be derived from our data. HGV infection is widespread in the general population. The prevalence of antibodies against HGV or detectable HGV viremia is higher in patients with risk factors for parenteral viral transmission than in those without risk factors. The majority of HGV infections (70.2%) is self-limiting and not persistent in our collective of patients. We found no correlation between HGV viremia and clinical or biochemical signs of hepatitis in individuals without risk factors for acquiring parenterally transmitted agents.
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Affiliation(s)
- H H Feucht
- Institute of Medical Microbiology and Immunology, Universitätskrankenhaus Eppendorf, Hamburg, Germany
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37
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Stellbrink HJ, van Lunzen J, Hufert FT, Fröschle G, Wolf-Vorbeck G, Zöllner B, Albrecht H, Greten H, Racz P, Tenner-Racz K. Asymptomatic HIV infection is characterized by rapid turnover of HIV RNA in plasma and lymph nodes but not of latently infected lymph-node CD4+ T cells. AIDS 1997; 11:1103-10. [PMID: 9233456 DOI: 10.1097/00002030-199709000-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To study the kinetics of plasma viraemia and HIV-infected lymph-node cells in stable asymptomatic HIV infection with high CD4+ T-cell counts. METHODS Nine asymptomatic HIV-infected patients with stable CD4+ T-cell counts (510-1350 x 10(6)/l) were treated with a triple-drug combination. Plasma viraemia was determined at days 0, 3, 7, 10, 14, 21 and 28 of treatment [Roche polymerase chain reaction (PCR) and ultrasensitive PCR assay]. Sequential lymph-node biopsies were examined in four patients before and after 4 weeks of treatment. Productively infected cells were counted in lymph-node sections (in situ hybridization). The infection rates of FACS-sorted CD4+ lymph-node T cells and the expression of single-spliced, double-spliced and full-length HIV transcripts were determined. RESULTS HIV plasma RNA half-lives ranged from 1.4 to 2.7 days. Viral turnover varied between 0.07 and 7.54 x 10(8) copies per day. The number of productively infected lymph-node cells as well as the amount of extracellular virus in germinal centres was markedly reduced during treatment, paralleled by a clearance of single-spliced, double-spliced and full-length HIV transcripts from CD4+ lymph-node T cells. Plasma viraemia remained detectable with an ultrasensitive PCR assay in three out of four patients. The percentage of lymph-node CD4+ T cells harbouring proviral DNA decreased only slightly. CONCLUSIONS The kinetics of HIV replication are rapid in stable asymptomatic infection, and the magnitude of replication varies considerably. Productively infected lymph-node cells and extracellular virus in germinal centres undergo a rapid turnover, whereas latently infected CD4+ T cells have a lower rate of turnover. The latter may contribute substantially to viral persistence during therapy.
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Affiliation(s)
- H J Stellbrink
- Medical Department, Eppendorf University Hospital, Hamburg, Germany
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Martens H, Zöllner B, Zissel G, Burdon D, Schlaak M, Müller-Quernheim J. Anti-Borrelia burgdorferi immunoglobulin seroprevalence in pulmonary sarcoidosis: a negative report. Eur Respir J 1997; 10:1356-8. [PMID: 9192944 DOI: 10.1183/09031936.97.10061356] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aetiology of sarcoidosis is still unknown. An infectious microorganism as causal agent for this disease could not be identified, but high titres of antibodies against Borrelia burgdorferi were detected in Chinese studies implying a causality with this disease. These findings, however, could not be reproduced by other researchers. The aim of this study was, therefore, to evaluate the possible role of these spirochetes in the pathogenesis of sarcoidosis by serological examinations. Sixty sera of patients suffering from sarcoidosis were examined for anti-B. burgdorferi immunoglobulin by enzyme-linked immunosorbent assay (ELISA). ELISAs for these antibodies show a high sensitivity, but a low specificity; therefore, a specific immunoblot was used to confirm positive results. Initially, 8% of the patients were reactive in the ELISA, and 20% of these could be confirmed by immunoblot. Therefore, the prevalence for B. burgdorferi antibodies in sarcoidosis patients was 1.6%. This result did not differ significantly from the prevalence of B. burgdorferi antibodies in 1,000 regular blood donors of the city of Hamburg (7% reactive in the ELISA, 38% confirmed via immunoblot, prevalence 2.7%). The hypothesis of causality between a B. burgdorferi infection and sarcoidosis cannot be confirmed by this data.
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Affiliation(s)
- H Martens
- Medical Hospital, Research Centre Borstel, Germany
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Zöllner B, Feucht HH, Helling-Giese G, Mattner UM, Schartl W, Polywka S, Laufs R. Threshold of HIV-1 copy numbers for vertical transmission. AIDS 1997; 11:542-3. [PMID: 9084807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Feucht HH, Schröter M, Zöllner B, Polywka S, Nolte H, Laufs R. The influence of age on the prevalence of hepatitis C virus subtypes 1a and 1b. J Infect Dis 1997; 175:685-8. [PMID: 9041344 DOI: 10.1093/infdis/175.3.685] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The distribution of hepatitis C virus (HCV) genotypes was determined in isolates of 447 chronically HCV-infected German patients by nucleotide sequencing. Of these, 206 (46.1%) were infected with the subtype 1a, 215 (48.1%) with subtype 1b, 2 (0.4%) with subtype 1c, 9 (2.0%) with subtype 3a, and 15 (3.4%) with subtype 4a. Subtype 1a was predominant in those < 40 years old (62.6%) and was associated with the risk factor of intravenous drug addiction and with shorter duration of disease. Conversely, subtype 1b was more frequent in patients > 50 years old (84.7%; P < .001) and was associated with the risk factor of blood transfusions and with longer duration of disease. These data suggest that a shift from subtype 1b to subtype 1a occurred in the population studied. An increase in HCV infection with subtype 1a and a diminution of subtype 1b in the future can be expected.
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Affiliation(s)
- H H Feucht
- Institute of Medical Microbiology and Immunology, Universitatskrankenhaus Eppendorf, Hamburg, Germany
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Feucht HH, Zöllner B, Polywka S, Knödler B, Schröter M, Nolte H, Laufs R. Prevalence of hepatitis G viremia among healthy subjects, individuals with liver disease, and persons at risk for parenteral transmission. J Clin Microbiol 1997; 35:767-8. [PMID: 9041431 PMCID: PMC229669 DOI: 10.1128/jcm.35.3.767-768.1997] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of hepatitis G virus (HGV) and hepatitis C virus (HCV) infection was determined by reverse transcription-PCR in 777 individuals with and without risk factors for viral transmission via blood. From our results we conclude that transmission of HGV and that of HCV are favored by similar risk factors.
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Affiliation(s)
- H H Feucht
- Institute of Medical Microbiology and Immunology, Universitätskrankenhaus Eppendorf, Hamburg, Germany
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Polywka S, Feucht H, Zöllner B, Laufs R. Hepatitis C virus infection in pregnancy and the risk of mother-to-child transmission. Eur J Clin Microbiol Infect Dis 1997; 16:121-4. [PMID: 9105838 DOI: 10.1007/bf01709470] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The risk of vertical transmission of the hepatitis C virus (HCV) from infected mothers to their children during pregnancy and delivery was determined in 120 children born to HCV-positive mothers. Methods included enzyme immunoassay and immunoblot for detection of HCV antibodies and reverse transcription polymerase chain reaction (RT-PCR) for detection of viral RNA. Six (5%) children were perinatally infected with HCV as shown by RT-PCR. None of the infected children had clinical signs of hepatitis. None of the pregnancies was complicated by abortion, stillbirth, premature birth, or malformation of the child. Special concern was given to the possibility of HCV transmission via breast milk. In no breast milk sample obtained from 34 HCV-infected mothers was HCV RNA detected. These observations indicate that HCV infection is not necessarily a contraindication for breast-feeding.
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Affiliation(s)
- S Polywka
- Institute for Medical Microbiology and Immunology, University Hospital Eppendorf, Hamburg, Germany
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Zöllner B, Feucht HH, Mattner UM, Helling-Giese G, Baumgartner EM, Laufs R. Better prediction of vertical HIV-1 transmission from maternal blood at delivery compared with cord blood samples. AIDS 1996; 10:1600-1. [PMID: 8931801 DOI: 10.1097/00002030-199611000-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Jurinke C, Zöllner B, Feucht HH, Jacob A, Kirchhübel J, Lüchow A, van den Boom D, Laufs R, Köster H. Detection of hepatitis B virus DNA in serum samples via nested PCR and MALDI-TOF mass spectrometry. Genet Anal 1996; 13:67-71. [PMID: 8931993 DOI: 10.1016/1050-3862(95)00151-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a blind study, nested polymerase chain reaction (PCR) was performed with control DNA and DNA preparations from serum samples of six patients. The detection limit was determined to be 100 molecules of template in 1 ml of serum. Hepatitis B virus (HBV) related products of nested PCR were purified by ultrafiltration and immobilisation on streptavidin coated magnetic beads. The immobilized PCR products were denatured from the beads and analyzed via matrix assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. The results of MALDI-TOF MS analysis were in agreement with the results obtained by polyacrylamide gel electrophoresis (PAGE) and with the data obtained by serological analysis. The detection strategy introduced here has a high potential for automation and represents a fast and reliable method of detection for HBV DNA in serum without the need for time consuming gel electrophoresis and labeling or hybridization procedures.
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Affiliation(s)
- C Jurinke
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, University of Hamburg, Germany
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Feucht HH, Zöllner B, Schröter M, Hoyer A, Sterneck M, Polywka S. Distribution of genotypes and response to alpha-interferon in patients with hepatitis C virus infection in Germany. Eur J Clin Microbiol Infect Dis 1996; 15:128-32. [PMID: 8801084 DOI: 10.1007/bf01591485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To determine the distribution of hepatitis C virus (HCV) genotypes in German isolates, nucleotide sequences of the viral nonstructural 5 (NS5) genome domains were analyzed in isolates from 107 chronically HCV-infected patients. Of these 107 patients, 46 (43.0% were infected with subtype 1a and 47 (43.9%) with subtype 1b. Six patients (5.6%) with a history of intravenous drug abuse were infected with subtype 3a. Eight patients (7.5%) who had acquired their HCV infection in Egypt carried subtype 4a. Forty-three of the 107 patients were treated with alpha-interferon. Of these 43 patients, 16 (37.2%) were infected with subtype 1a and 27 patients (62.8%) with subtype 1b. Three patients infected with HCV-subtype 1a (18.7%) and four patients infected with subtype 1b (14.8%) showed a sustained complete response after interferon therapy. The HCV genotype 1 with its subtypes 1a and 1b was the most common source of HCV infection in this group of patients. There was no significant difference in response to alpha-interferon treatment of HCV infection with the subtypes 1a or 1b.
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Affiliation(s)
- H H Feucht
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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Feucht HH, Zöllner B, Laufs R. Comparison of conventional autoradiography with a new DNA enzyme immunoassay for the detection of hepatitis C virus-polymerase chain reaction amplification products. J Virol Methods 1995; 55:105-10. [PMID: 8576299 DOI: 10.1016/0166-0934(95)00049-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The detection of HCV-PCR amplification products by DNA enzyme immunoassay (DEIA) was compared with conventional hybridization carried out with a 32P-labelled oligonucleotide probe. The detection limit of both methods was shown to be between 100 pg and 1 ng of amplicon. All serum samples of 40 HCV-seropositive patients were positive after PCR in autoradiography, but only 38 with the DEIA technique (sensitivity 95%). There were no false-positive reactions by either method. The advantage of the DEIA method was the fast and non-radioactive detection of HCV amplicons. DEIA combines the specificity of the hybridization event with the speed of an ELISA procedure and is suitable for HCV-PCR.
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Affiliation(s)
- H H Feucht
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Eppendorf, Hamburg, Germany
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Abstract
For up to 20 to 40% of patients chronically infected with hepatitis C virus (HCV), the mode of transmission is still unknown. We demonstrate that tear fluid contains HCV RNA-carrying material with the properties of infectious virus and conclude that smear infection with tear fluid may play a role in HCV transmission.
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Affiliation(s)
- H H Feucht
- Institut für Medizinische Mikrobiologie und Immunologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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Abstract
The serodiagnosis of hepatitis C virus (HCV) infection was analyzed by a recombinant immunoblot assay (RIBA) with recombinant proteins encoded by the viral RNA isolated from our patients in Hamburg, Germany. The HCV RNA was amplified by PCR, and proteins encoded by the viral core and the NS3, NS4, and NS5 regions were expressed subsequently in Escherichia coli. The results obtained with our UKE RIBA were compared with the results of the Abbott HCV second-generation enzyme immunoassay (EIA). Serum samples from 270 patients, which were sent to us on the suspicion of HCV hepatitis and which were negative for hepatitis A virus and hepatitis B virus antibodies, were examined. In 227 cases (84.1%), there were identical positive (204 cases, 75.6%) or negative (23 cases, 8.5%) results in both tests. In 32 cases (11.9%), the reactive Abbott second-generation HCV EIA results could not be confirmed by the UKE RIBA and the HCV PCR. In follow-up studies conducted over 1 year, these results did not change. In three cases (1.1%), the UKE RIBA presented a positive result while the Abbott second-generation HCV EIA was negative. All three cases were positive in the HCV PCR and showed seroconversion in an HCV EIA 4 to 6 weeks later. In addition, 33 patient serum samples were examined by UKE RIBA in parallel with the Ortho RIBA 2.0. In three cases (9.1%), a positive Ortho RIBA 2.0 result could not be confirmed by the UKE RIBA and the HCV PCR. All three patients were free of complaints. The UKE RIBA showed also a smaller number of indeterminate results (3.0%) than the Ortho RIBA 2.0 (24.2%). This comparison study demonstrates that the commercially available HCV antibody tests should be further improved.
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Affiliation(s)
- H H Feucht
- Institute for Medical Microbiology and Immunology, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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