Salivary diagnosis of rubella: a study of notified cases in the United Kingdom, 1991-4

Rubella infections, notified by general practitioners on the basis of a clinical diagnosis, were investigated by testing blood and saliva samples for specific IgM. Overall 52 (29%) of 178 cases with appropriately timed blood specimens were confirmed as recent rubella by IgM serology. Only 2 (3%) of 74 cases in children under 5 years were confirmed compared to 50 (48%) of 104 cases in older children and adults. The confirmation rate was lower (6%) in those with documented vaccination history than in those without (42%). The specificity of saliva rubella IgM testing compared to testing corresponding blood samples was 99%. The overall sensitivity of saliva rubella IgM testing was 81%. This rose to 90% if results from inappropriately timed specimens and specimens taking more than 1 week to reach the laboratory were excluded. A corresponding saliva rubella IgG test was 98% sensitive and 100% specific. Of 126 rubella IgM negative cases, 25 (20%) were positive for parvovirus B19 IgM. This study confirmed that rubella surveillance based on clinical reports is not specific. It also demonstrated that saliva samples, if taken 7-42 days after onset of illness and transported rapidly to the laboratory, are a feasible alternative to blood samples for rubella surveillance.

Role of type specific herpes simplex virus serology in the diagnosis and management of genital herpes

OBJECTIVES

To investigate the indications for the use of a type specific antibody test for herpes simplex virus in a department of genitourinary medicine in the United Kingdom.

METHOD

Retrospective analysis of case records of 127 patients who accepted the test during a 20 month period.

RESULTS/CONCLUSION

The test contributed to patient management in 79% of patients with recurrent genital ulceration of unknown cause. It was also useful for counselling a number of patients with initial episodes of disease and the asymptomatic partners of some patients when the partners were shown to possess antibodies specific to herpes simplex virus type 2. When evaluating sexual partners, the test was difficult to interpret if an isolate from the index case had not been typed. Access to viral typing may therefore be a greater priority than serological testing. As adverse psychological sequelae may follow the identification of an asymptomatic chronic infection, guidelines for the use of a type specific serological test are proposed.

The role of environmental contamination with small round structured viruses in a hospital outbreak investigated by reverse-transcriptase polymerase chain reaction assay

In May 1994 an outbreak of vomiting and diarrhoea occurred in a 28-bed long-stay ward for the mentally infirm. The predominant symptoms were vomiting, diarrhoea, malaise and abdominal pain lasting for approximately 12 h in most cases. The attack rate was 62% (13/21) for patients and 46% (16/35) for staff members. Infection control measures were implemented (containment of infectious individuals, hand hygiene among staff and environmental decontamination) and the ward was closed to admissions. Affected staff were excluded from contact with patients and their food until asymptomatic for 72 h. The outbreak lasted for 17 days. Faecal samples from nine symptomatic persons were negative for bacterial enteric pathogens, Giardia, Cryptosporidium and group A rotavirus. Electron microscopy of 12 faecal samples and one sample of vomitus revealed small round structured virus (SRSV) particles in one faecal sample. A further 30 faecal samples and seven vomitus samples were tested by reverse transcription polymerase chain reaction (RT-PCR) for SRSV of which 12 (40%) and 1 (14%) were positive respectively. Twenty-eight throat swabs from symptomatic and asymptomatic patients were collected, three (9.5%) of which were positive for SRSV by RT-PCR. Thirty-six environmental swabs were collected on the affected ward, and 11 (30%) were positive by RT-PCR. Positive swabs were from lockers, curtains and commodes and confined to the immediate environment of symptomatic patients. The distribution of contamination supports the rationale of cohorting sick patients.

Genetic and antigenic characterisation of the haemagglutinin protein of measles virus strains recently circulating in the UK

The complete nucleotide sequence of the H protein gene of seven measles virus (MV) strains, representing three MV genotypes circulating in the UK in recent years, was determined. Compared to the MV vaccine strain Moraten (Mor-v), the divergence of the coded H gene (aal-600) of the seven UK strains was between 1.8% and 2.8%. Representative isolates from each of the genotypes were tested by radio-immunoprecipitation using a panel of H protein-specific MAbs. Different patterns of MAb reactivity were shown between the three genotypes and between the wild-type strains and the vaccine strain. Plaque reduction neutralising antibody titres against strains UK350/94 (genotype I) and UK226/94 (genotype III) were measured in sera from 11 vaccinees. Vaccine derived antibody neutralised both strains and the GMTs were not significantly lower against the wild-type strains than against strain Mor-v.

Homotypic and heterotypic IgG and IgM antibody responses in adults infected with small round structured viruses

Antibody responses to recombinant Norwalk (rNV) and Mexico (rMXV) viral capsid proteins were studied in 39 adults involved in outbreaks of gastroenteritis associated with genogroup 2 small round structured viruses (SRSVs). Nineteen individuals were involved in outbreaks associated with MXV-like strains and 20 in outbreaks associated with four other genogroup 2 SRSVs. IgG antibodies were measured in acute and convalescent sera using indirect enzyme-linked immunosorbent assay (ELISA), and IgM was measured by indirect and capture ELISAs. Nineteen (49%) patients demonstrated a significant rise in IgG to rMXV with four (10%) patients also showing anamnestic responses to rNV. Fourteen patients were positive in the rMXV IgM-capture ELISA, representing 74% of patients demonstrating IgG rises. IgG and IgM responses to rMXV were observed in both groups, although higher levels of responses were seen in adults infected with MXV-like strains than those infected with non-MXV genogroup 2 viruses. No significant IgM responses were observed to rNV. These results indicate that, following SRSV infection, adults show a rise in antibody which is broadly reactive to viruses within but not between genogroups, although greater homotypic than heterotypic responses are produced. These findings have implications for interpretation of seroepidemiological studies and serodiagnosis of SRSV infections using recombinant capsids.

A nested reverse transcriptase PCR assay for detection of small round-structured viruses in environmentally contaminated molluscan shellfish

We describe the evaluation of a nested reverse transcriptase PCR (RT-PCR) procedure for the detection of small round-structured viruses (SRSVs) in molluscan shellfish and the application of this assay for the detection of SRSVs in commercially produced shellfish and in shellfish implicated in outbreaks of gastroenteritis. The range of virus strains detected and the sensitivity of detection were evaluated by using a representative panel of 21 well-characterized SRSV strains. The nested RT-PCR detected 15 of 21 SRSVs, demonstrating that the assay detects a broad range of SRSVs including strains from both genogroup I and genogroup II. Seeding experiments showed the nested RT-PCR assay to be 10 to 1,000 times more sensitive than the single-round RT-PCR assay for the detection of SRSV in shellfish. SRSV-contaminated samples were identified by nested RT-PCR for shellfish grown in polluted harvesting areas and for shellfish associated with outbreaks of gastroenteritis which were negative by a previously described single-round RT-PCR. The assay was shown to be effective for investigation of virus elimination during commercial shellfish processing procedures such as depuration and relaying and has potential applications for monitoring at-risk shellfish harvesting areas, for investigation of SRSV contamination in shellfish from producers linked to gastroenteritis outbreaks, and for the direct detection of virus in shellfish implicated in outbreaks.

Epidemiology of Epstein-Barr virus infection in pre-adolescent children: application of a new salivary method in Edinburgh, Scotland

STUDY OBJECTIVE

To describe the epidemiology of Epstein-Barr virus (EBV) among primary school children by testing saliva with a new EBV capsid antigen "G" antibody capture radioimmunoassay (GACRIA).

DESIGN

A population based sample of 7 year old schoolchildren were followed up at age 11.

SETTING

30 randomly chosen primary schools in Edinburgh, Scotland.

PARTICIPANTS

552 schoolchildren.

MEASUREMENTS

Data on risk factors for infection were collected by questionnaire at ages 7 and 11. Saliva samples collected at age 11 were examined by GACRIA for evidence of previous infection with EBV. For 102 subjects, a second salivary specimen collected approximately one month after the first sample was available for testing as a measure of the repeatability of the method.

MAIN RESULTS

Unequivocal results were found in 91% of samples and the repeatability of the test was good (kappa = 0.71). Fifty six per cent of children had antibodies to EBV. In a logistic regression analysis, independent risk factors for infection were sharing a room (odds ratio 1.78, 1.14, 2.79), head of household's social class IV/V compared with I (odds ratio 2.87, 1.08, 7.34), and schools serving predominantly rented housing estates (odds ratio 2.3, 1.09, 4.84).

CONCLUSION

This study is the first application of EBV viral capsid GACRIA to salivary samples. The method was successfully used to describe the epidemiology of EBV. In this study, characteristics of the home seemed to be more important than those of the school in determining the likelihood of infection with EBV.

Prevalence and correlates of herpes simplex virus type 2 infection: evaluation of behavioural risk factors

OBJECTIVE

To examine the prevalence and correlates of infection with herpes simplex virus type 2 (HSV-2) among sexually transmitted disease (STD) clinic attenders, we studied the prevalence of antibodies to HSV-2 and their association with risk behaviour.

METHODS

Data were collected in a cross-sectional study among STD clinic attenders in Amsterdam. Seropositivity for HSV-2 was determined in 1798 serum samples by means of a monoclonal antibody-blocking enzyme-linked immunoassay.

RESULTS

The prevalence of HSV-2 antibodies was higher than expected: 32.3% in a population in which 3% had current genital herpes and 8% gave a history of genital herpes. Of those with HSV-2 antibodies, only 18% had a history of genital herpes. A strong independent association with the presence of HSV-2 antibodies was found for sexual behaviour, more specifically: homosexual orientation, increasing number of years of sexual activity, increasing number of lifetime partners, number of past gonococcal infections, having receptive anal and (or) vaginal contact.

CONCLUSION

The presence of HSV-2 antibodies had a strong association with past sexual behaviour and, for both sexes, with receptive anal intercourse. HSV-2 antibodies may be used as a surrogate marker of sexual risk behaviour in comparing different populations over time.

Adrenomedullin has mitogenic effects on human oral keratinocytes: involvement of cyclic AMP

The effects of the novel vasoactive regulatory peptide, adrenomedullin, on human oral keratinocytes was investigated. Adrenomedullin, acting via its specific receptor, stimulated a dose-dependent increase in DNA synthesis, and, in addition, stimulated further changes in the cell cycle resulting in the proliferation of keratinocytes. When cells were incubated in the presence of increasing concentrations of adrenomedullin, there was a rapid and dose-dependent rise in intracellular cyclic AMP levels. Stimulation of mitogenesis and cell proliferation in these cells were mimicked by the cell permeable cAMP analogue, dibutyryl cAMP. Adrenomedullin-stimulated mitogenesis was attenuated by the adenylyl cyclase inhibitor SQ22,536, but was unaffected by inhibitors of PKC, tyrosine kinase or the CGRP receptor antagonist, CGRP(8-37). These data identify adrenomedullin as a new mitogenic regulatory peptide of keratinocytes acting via the cAMP cascade.

Threat to Humans from Virus Infections of Non-human Primates

Several hundred distinct non human primate species are recognised, and they are likely to harbour a similar range of viruses to humans. Simians such as cynomolgus and rhesus macaques, African green monkeys, and marmosets are widely used for biomedical research, but despite this extensive close contact very few simian viruses have been shown to pose a threat of infection or illness to humans. Herpesvirus Simiae is the best recognised zoonotic hazard of simians. It is an alphaherpes virus of Asiatic macaques, which causes a mild or subclinical primary infection followed by latency in its natural host. It can be acquired by humans following a bite and causes an ascending meningoencephalitis. Less than 40 human cases have been described and the mortality rate in untreated human infections is 70%. The infection is treatable with acyclovir and extensive guidelines for managing simians and potential exposures have been developed. Ebola virus and Marburg virus have caused epizootics in cynomolgus macaques and vervet monkeys respectively, which have resulted in human infection and fatalities. However, non human primates are unlikely to be their natural host. More recently simian immunodeficiency virus and simian foamy virus have infected researchers, but infection has not been linked to illness. Simian viruses also pose a direct threat to humans through the use of primary monkey tissue cultures in laboratory work and vaccine manufacture, indeed a significant exposure of the human population occurred when cells contaminated with SV40 a polyomavirus of rhesus monkeys were used for polio vaccine production. New medical interventions such as xenotransplantation using primate organs pose a potential risk which requires careful assessment. Copyright 1997 by John Wiley & Sons Ltd.

Mixed genogroup SRSV infections among a party of canoeists exposed to contaminated recreational water

Samples of faeces collected from a party of canoeists involved in a gastroenteritis outbreak were examined by electron microscopy and RT-PCR for evidence of infection with SRSVs. A broadly reactive primer pair was used to detect SRSVs followed by application of genogroup-specific primers to SRSV-positive specimens. Exposure data were collected by means of a questionnaire. SRSVs were detected in 1/4 specimens examined by EM and 3/4 by RT-PCR. Genogrouping, and sequencing of PCR products revealed two distinct strains: a genogroup I strain, related to the Desert Shield virus, and a genogroup II strain, related to the Lordsdale virus to be associated with the outbreak. Exposure data indicated that capsising and eating food before getting changed were associated with an increased risk of gastroenteritis and was consistent with infection following the consumption of contaminated water. This study confirms the greater sensitivity of RT-PCR for the diagnosis of SRSV infections and its utility, when incorporating genogroup-specific primers, in establishing more complex epidemiological data.

The diversity of measles virus in the United Kingdom, 1992-1995

Three distinct genotypes were identified amongst 50 measles virus (MV) strains characterized in the UK between 1992 and 1995 by direct sequencing of the RT-PCR products amplified from clinical specimens. All three genotypes were related to viruses previously reported in the United States or in continental Europe. Phylogenetic analyses of 255 and 152 nucleotide sequences from the N and M genes, respectively, generated very similar lineages. The degree of divergence between genotypes was 3.5-16% and 2.6-7.9% in the N and the M genes, respectively. MV genotypes which circulated during the 1970s and 1980s in the UK were not detected in this period. Comparison of the C-terminal regions of the N gene sequences of UK strains isolated or detected between 1974 and 1995 suggests that there have been multiple genotypes of MV circulating in the UK over the past 20 years.

Epidemiology of Mexico virus, a small round-structured virus in Yorkshire, United Kingdom, between January 1992 and March 1995

The epidemiology of the small round-structured virus, Mexico virus (MxV), was investigated in North and West Yorkshire, United Kingdom, between January 1992 and March 1995 using a type-specific antigen ELISA. The results indicate that an epidemic of MxV occurred during the winter of 1993-1994, when this strain was associated with 45 of 99 outbreaks and sporadic childhood cases of gastroenteritis. Only 4 MxV-like isolates were found during the 1992-1993 winter season and none in the 1994-1995 season. This descriptive epidemiologic study suggests that MxV has an epidemic pattern of infection.

Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction

Pain after arthroscopically assisted anterior cruciate reconstruction was examined during the first 5 postoperative days to evaluate its intensity and duration. One hundred consecutive patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft were examined. During surgery, ketorolac (60 mg) was given intravenously and 0.25% bupivicaine (1 ml/kg total) was injected into the joint space and the graft donor site. After surgery, all patients received scheduled doses of oral acetaminophen (650 mg) and ketorolac (10 mg) four times a day, and they were allowed to take oral oxycodone (5 to 10 mg) every 2 hours as needed. Pain scores at rest and with activity reached a maximum on the 2nd postoperative morning. Oxycodone consumption also peaked on the 2nd postoperative day. Eighty-nine (89%) patients reported overall pain as mild or moderate, and 95 patients (95%) reported either excellent or good overall relief of pain. The 5-day cumulative mean of visual analog scale pain scores for attempting straight leg raises was significantly higher for patients unable to successfully perform that activity than for patients who were able to perform it. The association between elevated pain scores and diminished ability to perform straight leg raises suggests that pain may inhibit function and therefore early rehabilitation.

Polio eradication: surveillance implications for the United Kingdom

The requirements for certification of elimination of wild virus poliomyelitis will pose particular problems for some industrialized countries, such as the United Kingdom, where there has been no case detected for at least a decade. Systems of surveillance of poliomyelitis have been reviewed and potential weaknesses identified. When oral polio vaccine is routinely used, the rate of vaccine-associated cases provides an indication of the likelihood that if they occurred, wild virus cases would be detected. Acute flaccid paralysis surveillance was done for 3 years, but rates were lower than reported elsewhere and were accepted for certification purposes. Alternative techniques, such as surveillance of polioviruses, either in clinical samples or from the environment, may be developed in such countries. The ability to identify enteroviruses and to distinguish between wild and vaccine strains of polioviruses will give assurance that silent transmission of wild viruses is unlikely.

Detection of IgG antibody to Epstein-Barr virus viral capsid antigen in saliva by antibody capture radioimmunoassay

A 'G' antibody capture radioimmunoassay (GACRIA) to detect IgG to Epstein-Barr virus (EBV) viral capsid antigen (VCA) in saliva is described. The monoclonal antibody to EBV VCA used in the GACRIA bound non-specifically when testing saliva samples having a total IgG content of less than 2.0 mg/l, so giving false positive results. This problem was overcome by including 0.5% EBV-negative human serum in the monoclonal antibody diluent. The performance of the assay was then evaluated by comparing the GACRIA test on serum and saliva samples to indirect immunofluorescence assay (IFA) results on sera using a panel of paired serum/saliva samples. Compared to the corresponding serum IFA the saliva GACRIA had a sensitivity and specificity of 93.5 and 100%, respectively. Although less sensitive than IFA on serum samples, the saliva GACRIA is sufficiently sensitive to be used for epidemiological screening and will enable testing for anti-EBV VCA to be carried out easily and on a wide scale.

Aspergillus has distinct fatty acid synthases for primary and secondary metabolism

Aspergillus nidulans contains two functionally distinct fatty acid synthases (FASs): one required for primary fatty acid metabolism (FAS) and the other required for secondary metabolism (sFAS). FAS mutants require long-chain fatty acids for growth, whereas sFAS mutants grow normally but cannot synthesize sterigmatocystin (ST), a carcinogenic secondary metabolite structurally and biosynthetically related to aflatoxin. sFAS mutants regain the ability to synthesize ST when provided with hexanoic acid, supporting the model that the ST polyketide synthase uses this short-chain fatty acid as a starter unit. The characterization of both the polyketide synthase and FAS may provide novel means for modifying secondary metabolites.

Autism, Asperger's syndrome and the Crick-Mitchison theory of the biological function of REM sleep

Autism, Asperger's syndrome and other autistic syndromes are developmental brain disorders that cause serious impairments in communication, social interaction, empathy, mood and play. In addition to such deficits, the autistic syndromes involve pathologically high levels of repetitive, stereotypic, ritualistic, compulsive or obsessive behavior, together with extreme resistance to change. According to the Crick-Mitchison theory of the biological function of rapid eye movement sleep, normal brain development in the fetus and infant depends on undisrupted function of a 'reverse learning' mechanism during rapid eye movement sleep. Could abnormalities in this hypothetical reverse learning during rapid eye movement sleep in the fetus explain some aspects of the autistic syndromes? Does the Crick-Mitchison theory suggest if a drug could interfere with rapid eye movement sleep and cross the placental barrier, then that drug might cause developmental brain disorders in the fetus? Should all pregnant women completely avoid caffeine or any agent that might disrupt serotonergic or cholinergic systems?

Evaluation of a degenerate primer for the PCR detection of human caliciviruses

Numerous outbreaks of gastroenteritis have been associated with Norwalk virus and Small Round Structured Viruses (SRSVs). These single-stranded RNA viruses, recently classified in the Caliciviridae, have been divided into three genogroups. Antigenic relationships also have been established among the different strains. As both an in vitro culture system and an animal model are lacking for these viruses, virus detection depends primarily on electron microscopy, immunological assays or molecular detection. In this study we first analyzed the genetic homology of the RNA polymerase region for 40 SRSV strains. From a consensus sequence for these strains, we designed a degenerate oligonucleotide to prime cDNA synthesis from viral RNA. We evaluated the degenerate primer in combination with three previously described primers in PCR reactions. A panel of 15 stools containing SRSVs, typed when possible by solid phase immune electron microscopy (SPIEM), were selected to represent all three genogroups and four different SPIEM antigenic types. Serial dilutions of the purified viral nucleic acids were amplified using the three different primer sets. Virus-specific probes were used to characterize the amplicons obtained. Virus-specific amplicons were obtained with at least one primer pair for each strain, but apparent viral RNA titers differed as much as 1000-fold between primer sets. Amplicons from all but one of the 15 strains were confirmed as virus-specific using a panel of 10 different probes. Correlations between the most sensitive primer pair and SPIEM type were seen. This study showed that a single degenerate primer could be used in cDNA synthesis for a variety of SRSVs but that the sensitivity of the RT-PCR assay depended upon the second primer and virus-specific probes used.

Development of a dual target-PCR for detection and characterization of measles virus in clinical specimens

A polymerase chain reaction (PCR) method was developed for detecting measles virus (MV) RNA in a variety of clinical samples using primer pairs in the nucleocapsid (N) and matrix (M) genes in one reaction (dual target-PCR). The dual target-PCR detected MV RNA in tissue culture fluid containing 1 TCID50 of the MV Loss strain, and was as sensitive as a single target-PCR. Specificity was confirmed by the failure of the dual target-PCR to amplify products from the infected tissue culture containing related paramyxoviruses. Thirty-two of 35 (91.4%) samples collected from 23 patients with confirmed measles infection by the detection of measles specific IgM were found to be positive for MV RNA by PCR. Direct sequencing of the PCR amplicons revealed three different genotypes among the MV strains that were detected in 12 patients. The dual target-PCR method is suitable for the diagnosis of measles infection and, based on the sequencing of the PCR product DNA, for investigating the molecular epidemiology of MV strains.

Comparison of four RNA extraction methods for the detection of small round structured viruses in faecal specimens

Four methods for extraction of the RNA genome of small round structured viruses (SRSVs) from faecal specimens by reverse transcription polymerase chain reaction (RT-PCR) were evaluated. The efficiency of recovery of viral RNA and removal of amplification inhibitors were compared. RNA extraction using the metal chelating agent Chelex-100 and Sephadex G200 column chromatography were the most sensitive, detecting a 10(-4) dilution of a known SRSV positive specimen. Guanidinium thiocyanate (GTC) with adsorption of viral RNA onto silica was 10-fold less sensitive. The fourth method, based on PEG precipitation followed by phenol/chloroform extraction with the addition of the detergent cetyltrimethylammonium bromide (CTAB), only detected a 1 in 10 dilution of the positive specimen. The CTAB method was 2- to 50-fold less sensitive than the GTC/silica method when dilution series of three further SRSV positive specimens were tested. Thirty-six SRSV negative faecal specimens were spiked with virus and RT-PCR performed following RNA extraction by each of the four techniques in order to assess the ability of these methods to remove amplification inhibitors. The GTC/silica method successfully removed inhibitors from all samples whereas partial or complete inhibition was observed in seven (19%) specimens following extraction by the CTAB method, 17 (47%) by the Sephadex method, and 20 (56%) by the Chelex method. We conclude that, of these four methods, the GTC/silica method is the most appropriate for the extraction of viral RNA from faecal samples prior to RT-PCR for detecting SRSVs.

Twenty-five coregulated transcripts define a sterigmatocystin gene cluster in Aspergillus nidulans

Sterigmatocystin (ST) and the aflatoxins (AFs), related fungal secondary metabolites, are among the most toxic, mutagenic, and carcinogenic natural products known. The ST biosynthetic pathway in Aspergillus nidulans is estimated to involve at least 15 enzymatic activities, while certain Aspergillus parasiticus, Aspergillus flavus, and Aspergillus nomius strains contain additional activities that convert ST to AF. We have characterized a 60-kb region in the A. nidulans genome and find it contains many, if not all, of the genes needed for ST biosynthesis. This region includes verA, a structural gene previously shown to be required for ST biosynthesis, and 24 additional closely spaced transcripts ranging in size from 0.6 to 7.2 kb that are coordinately induced only under ST-producing conditions. Each end of this gene cluster is demarcated by transcripts that are expressed under both ST-inducing and non-ST-inducing conditions. Deduced polypeptide sequences of regions within this cluster had a high percentage of identity with enzymes that have activities predicted for ST/AF biosynthesis, including a polyketide synthase, a fatty acid synthase (alpha and beta subunits), five monooxygenases, four dehydrogenases, an esterase, an 0-methyltransferase, a reductase, an oxidase, and a zinc cluster DNA binding protein. A revised system for naming the genes of the ST pathway is presented.