THE INCIDENCE OF INFECTION WITH CYTOMEGALOVIRUS IN A NORMAL POPULATION. A SEROLOGICAL STUDY IN GREATER LONDON

Assignment of cytomegalovirus infection status in infants awaiting solid organ transplant: Viral detection methods as adjuncts to serology

Assignment of CMV infection status in infants awaiting SOT is challenging as passive maternal antibody can lead to false-positive serology. Since 2000, our protocol has recommended sending throat and urine samples for CMV viral detection, culture, or NAAT, for CMV-seropositive infants <18 months awaiting SOT. We reviewed pretransplant CMV serology for 152 infants and, for CMV seropositives, examined relationships between CMV IgG OD values, age, and CMV viral detection to explore time to clearance of maternal CMV IgG and evaluate viral detection in assignment of pretransplant CMV infection status. The proportion of CMV-seropositive infants decreased from 52% in infants 0-6 months of age to 28% in those 12-18 months. Among CMV-seropositive infants, median OD was significantly higher in the 6- to 12- and 12- to 18-month groups compared to the 0- to 6-month group. Distribution of OD by age group suggested that maternal antibody cleared before 12 months. Of 59 eligible CMV-seropositive infants, 49 (83%) had CMV viral detection studies and 18 of 49 (36.7%) had detectable CMV: 9 of 30 (30.0%) infants 0-6 months, 7 of 15 (46.7%) infants 6-12 months, and 2 of 4 (50.0%) infants 12-18 months. CMV viral detection studies are useful to confirm positive CMV infection status in CMV-seropositive infants awaiting SOT. Maternal CMV IgG likely clears before 12 months.

Correlation between anti-JC-virus and anti-cytomegalovirus, -Epstein-Barr virus and -measles/-rubella/-varicella-zoster-virus antibodies

Anti-JCV antibody status is used for PML-risk-stratification in MS patients before and during Natalizumab therapy. JCV antibodies can be detected in around 60% of MS patients, however, only a small proportion actually develop PML. As anti-viral antibodies tend to occur unspecifically, the aim of this study was to correlate JCV antibody status and index with other common anti-viral antibodies. A total of 123 samples of MS-patients were tested for anti-JCV antibodies by JCV-Stratify-ELISA at Unilabs, Denmark. The same samples were analyzed for measles, rubella, varicella zoster, EBV, and CMV IgG and IgM antibodies by ELISA, or chemiluminescence-microparticle immunoassay. For all antibody-titers correlations were calculated and group comparisons of JCV-positive and -negative patients were performed. Fifty-three patients (43.1%) were JCV negative and 70 (56.9%) positive. CMV-IgM antibodies were detected in six patients. Otherwise no IgM antibodies were detected. IgG antibodies against measles, rubella, varicella zoster, and EBV were detected in ≥97% of patients and 47 samples (38.2%) tested positive for CMV-IgG. There was no significant correlation between any of the antibody titers including JCV index, however, a significantly higher prevalence (P = 0.003) of CMV-IgG in JCV positive compared to JCV negative patients, whereas no difference was detected for measles, rubella, varicella zoster, and EBV IgG. In conclusion, the JCV antibody response in MS patients seems to be largely independent of any other anti-viral immunity. The only coincidence was found with CMV IgG antibodies which might point towards some immunological cross-reactivity in anti-viral immune response or other mechanisms leading to combined viral infections such as shared transmission. J. Med. Virol. 89:3-9, 2017. © 2016 Wiley Periodicals, Inc.

Post-transfusion hepatitis in a London hospital: results of a two-year prospective study

Seven hundred and sixty-eight patients were seen and tested at frequent intervals after transfusion of whole blood. Eight patients were judged to have developed icteric or anicteric post-transfusion viral hepatitis, an incidence of 1%. Five were icteric and four of these were hepatitis B antigen (HB Ag) positive; two of these four died. One of the fatal cases and one non-fatal HB Ag positive case had received HB Ag positive blood. Two other antigen-positive patients had received blood or plasma or both which had not been tested for antigen.

Thirty-five patients showed conspicuous or sustained elevations of alanine transaminase without clinical features of hepatitis.

Four were positive for HB Ag but had not received antigen positive blood.

Two who had received antigen positive blood remained antigen negative, but one developed hepatitis B antibody (HB Ab).

Two other patients were also transfused with plasma.

Five had serological evidence of cytomegalovirus (CMV) infection accompanying the enzyme changes.

One patient who had received HB Ag positive blood remained antigen-negative and showed no abnormalities.

Five patients who became HB Ag positive, although they had been given antigen-negative blood, remained clinically and biochemically well.

Cytomegalovirus primary infection or reactivation occurred in another 32 patients; five had isolated, transient enzyme rises, one other was associated with a drug-induced focal liver necrosis and 26 showed no enzyme changes. Epstein–Barr virus infections, one of which was associated with a transient upset of enzyme activity, were detected in five patients. There were no cases of post-perfusion syndrome.

Severe proctitis, perforation, and fatal rectal bleeding secondary to cytomegalovirus in an immunocompetent patient: report of a case

Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. In immunocompetent individuals, the infection is usually subclinical but it can sometimes be life threatening. We describe a case of fatal CMV proctitis in a 71-year-old man following an Ivor-Lewis esophagectomy. After surgery he developed renal failure, methicillin-resistant Staphylococcus aureus pneumonia, and acute respiratory distress syndrome. He recovered but developed melena and massive fresh rectal bleeding. Sigmoidoscopy revealed severe proctitis and a biopsy was consistent with ischemia. Despite undergoing a proctectomy he continued to bleed and died despite every effort. The final histological examination of the rectum revealed a CMV infection.

Successful Treatment of Multiple Small-Bowel Perforations Caused by Cytomegalovirus in a Patient with Malignant Lymphoma: Report of a Case

We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/microl, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.

Prolonged hepatitis caused by cytomegalovirus and non-alcoholic steatohepatitis in 16-year-old obese boy

Recently, the prevalence of non-alcoholic steatohepatitis (NASH) has been increasingly reported in patients with type 2 diabetes and obesity. NASH exists not only in adults but also in children. We report on an 16-year-old boy with prolonged hepatitis associated with NASH after cytomegalovirus hepatitis. Increased transaminase levels recovered in parallel to his weight reduction.

CONCLUSION

Clinicians should be aware of the possibility that prolonged acute hepatitis might be associated with non-alcoholic steatohepatitis in adolescents.

Cytomegaloviral enterocolitis: clinical associations and outcome

PURPOSE

Cytomegaloviral enterocolitis is an uncommon disorder that can complicate inflammatory bowel disease. It is more common in patients with acquired immunodeficiency syndrome and can occur in patients on immunosuppressive therapy for autoimmune or inflammatory diseases and in allograft recipients. Mortality rates of up to 71 percent have been reported for cytomegaloviral enterocolitis. The aims of this study were 1) to identify the presentation, underlying medical conditions, treatment, and outcome of patients with cytomegaloviral enterocolitis and 2) to determine the prevalence of this infection in patients undergoing intestinal resection for inflammatory bowel disease.

METHODS

A retrospective chart review of patients with pathologic evidence of cytomegaloviral enterocolitis from 1985 through 1996 was performed. To determine the prevalence of this condition, the hospital discharge database was searched for the diagnoses of ulcerative colitis and Crohn's disease in patients who underwent bowel resection.

RESULTS

93 patients (mean age, 44 years; 66 percent males) had cytomegaloviral infection in the small intestine (n = 6), large intestine (n = 86), or appendix (n = 1). Patients with acquired immunodeficiency syndrome (n = 42), with ulcerative colitis (n = 11), with Crohn's disease (n = 11), receiving organ transplant (n = 12), receiving bone marrow transplant (n = 8), and in other immunosuppressed states (n = 11) comprised this study. Seventeen patients (18 percent) underwent intestinal resection, and the remaining 76 patients were treated medically. Abdominal pain (77 vs. 37 percent; P < 0.01) and gastrointestinal bleeding (65 vs. 34 percent; P < 0.05) were more common presenting symptoms in patients who required resection than patients in the medically managed group. Mortality was 17.6 percent in the surgically managed group and 14.5 percent in the patients who were managed medically. The median duration of ulcerative colitis in patients with coexisting cytomegaloviral infection was 12 months. The prevalence of cytomegaloviral enterocolitis was 4.6 percent in patients with ulcerative colitis and 0.8 percent in patients with Crohn's disease.

CONCLUSIONS

These data suggest that cytomegaloviral infection more frequently complicates ulcerative colitis than Crohn's disease. Furthermore, a short and fulminant course of ulcerative colitis may indicate coexisting cytomegaloviral infection. The overall low mortality in this retrospective study suggests that aggressive medical and surgical treatment improves survival in patients with cytomegaloviral enterocolitis.

Rasmussen's encephalitis: an autoimmune disorder?

Rasmussen's encephalitis is a rare progressive pediatric epileptic syndrome. Recent evidence from experimental animals and patients with the disease suggests an important role for both humoral and cell-mediated immune mechanisms in the pathogenesis of this disease. The glutamate receptor subunit GluR3 may be an important autoantigen in the disease. (This review has been modified from a review published in Current Opinion in Neurology 1996, 9:141-145.)

Lymphocyte responses to human cytomegalovirus in different groups of patients in Britain and in adults from west Africa and the Middle East

Antibody prevalence and lymphocyte proliferation responses to cytomegalovirus (CMV) and herpes simplex virus (HSV) were compared in several different groups of patients: genitourinary medical (GUM) patients, hemophiliacs, men with clinical acquired immunodeficiency syndrome (AIDS) and cases of primary CMV mononucleosis, and also in adults in the general population (control subjects) comprising separate groups native to Britain, West Africa, and the Middle East. Among the British control subjects who were positive for CMV IgG, all were also positive against CMV antigen by the lymphocyte transformation test (LTT). However, among those who were CMV IgG-positive in the various groups of patients, 20-86.9% gave positive responses to CMV antigen by the LTT; moreover, 75.7% and 55.5% of the CMV IgG-positive healthy control subjects from West Africa and the Middle East, respectively, gave positive LTT responses to CMV antigen. When the same groups of patients were tested for responsiveness to HSV antigen by the LTT, there was good agreement between a positive result by this test and by serology in all except those with primary CMV mononucleosis (42.8%). Overall, lymphocyte responses to CMV were significantly impaired in healthy, CMV antibody-positive subjects from West Africa and the Middle East compared to similar subjects from Britain.

Viral infections in the immunocompetent patient

Human herpesviruses and human papillomaviruses are ubiquitous and may cause an array of oral disease. Herpesviruses are unique because recurrent localized disease occurs after the primary infection. Human papillomaviruses are known for their ability to produce benign epithelial proliferations and increasingly are implicated in the development of oral cancer. This article reviews the pathogenesis of common oral lesions induced by these viruses.

The etiologic patterns in microcephaly with mental retardation

Microcephaly with mental retardation forms a distinct subgroup among mentally retarded individuals. The paucity of studies on the etiology of this condition in India made the investigators to study this population. It HTO aimed to study the demographic and clinical characteristics, and the etiologic pattern in children with microcepltaly and mental retardation The sample consisted of 82 children who were examined by detailed clinical assessment and a battery of investigations. A definite etiology could be found in 56% of children which have been grouped into prenatal embryonic, prenatal maternal/environmental, and birth and neonatal causes. Non-genetic causes were the most common. The prenatal etiology constituted nearly twice that of birth and neonatal causes. Majority of the etiologic factors were preventable. The role of socio-environmental factors has been discussed As a group, the neurological disorders were found to be the most commonly associated medical condition. Malnutrition, specially of severe degree, was significantly associated with this group compared to the general population. The study findings indicate that there is a significant place for prevention.

A rat cytomegalovirus infection model as a tool for immunotoxicity testing

A rat cytomegalovirus infection model for use in immunotoxicity testing has been developed. In resistance against viruses, natural killer cells and cytotoxic T-cells play an important role. Therefore, this model complements other rat host resistance models for immunotoxicity testing, i.e. existing bacterial and parasitic infection models in which cytotoxic T-cells and natural killer cells play a minor role. Host resistance against cytomegalovirus infections in the rat was determined by titrating infectious virus levels in organs after cytomegalovirus infection in an in vitro infectivity test denoted as the Plaque Forming Unit (PFU) Test. In this test, homogenates of different organs were investigated for infectious virus titers on rat embryonic cell monolayers. We demonstrated that in the salivary gland, the major target organ for rat cytomegalovirus, virus was detectable from 8 days onward after intraperitoneal infection. To show that this model is suitable for the detection of immunotoxicity four different methods for immunosuppression were investigated: 1. gamma-irradiation, 2. congenitally athymic rats, 3. chemically induced immunosuppression, 4. ultraviolet-B (UVB) irradiation. Rat cytomegalovirus titers in the salivary glands of irradiated (500 rad 1 day prior to infection) or congenitally athymic rats were significantly increased as compared to non-irradiated rats and euthymic control rats respectively. In TOX-Wistar rats, given 20 or 80 mg bis(tri-n-butyltin)oxide (TBTO) per kg food beginning 6 weeks before cytomegalovirus infection, a regimen known to have immunotoxic effects, cytomegalovirus titers in the salivary glands were significantly increased as compared to non-TBTO-treated cytomegalovirus infected rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Seroprevalence of antibodies to human herpesviruses in England and Hong Kong

The age-related prevalence of antibodies to herpesviruses was compared in England and Hong Kong. Altogether 327 sera from England and 266 sera from Hong Kong were tested for antibodies to herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6). Herpesvirus infections were common in both countries but generally were acquired earlier and were more prevalent in Hong Kong. Over 90% of children in Hong Kong were infected with VZV, EBV, and HHV-6 by 8 years of age. HSV and CMV were the least prevalent childhood infections in both countries, although, 30-40% of babies in Hong Kong became infected during the first year of life. CMV infections were rare throughout childhood in the English cohort. Overcrowding and early attendance at kindergarten may aid more efficient and earlier transmission of herpesvirus in Hong Kong. The high prevalence of CMV in particular may have implications for the management of young pregnant women and organ transplant recipients in Hong Kong.

Cytomegalovirus: a virus of increasing relevance to oral medicine and pathology

Human cytomegalovirus (HCMV) is a ubiquitous herpesvirus, emerging as an opportunistic pathogen in immunocompromised persons, particularly those infected with human immunodeficiency viruses (HIV). Clinical syndromes caused by HCMV are usually not specifically identifiable without laboratory investigations. However, it is now apparent that HCMV may cause oral ulceration in immunocompromised persons and it may play a role in other diverse conditions in these and other patients.

Correlative studies of rheumatoid factors and anti-viral antibodies in patients with rheumatoid arthritis

An analysis of the relationship between the immune response to ubiquitous herpes family viruses, namely Epstein-Barr virus (EBV), cytomegalovirus (CMV), and varicella-zoster virus (VZV) and the presence of rheumatoid factors (RF), which are autoantibodies characteristic of patients with rheumatoid arthritis (RA), was conducted. Antibody profiles (RF, anti-viral antibodies) were monitored in the serum of the RA patients, and in normal individuals. No patient was found to have circulating RF in the absence of anti-viral antibodies. When the patients and normal controls were subdivided according to the presence of serum RF, it was found that when RF were present, the frequency of anti-CMV antibodies, but not anti-EBV or anti-VZV antibodies, was significantly higher (P = 0.02) when compared with RF-negative individuals. The titres of anti-CMV but not anti-VZV antibodies were found to increase in the RA patients with disease duration. To see if these viruses could stimulate RF production in vitro, peripheral blood mononuclear cells (PBMC) isolated from the patients and normal controls were stimulated with viral antigens. PBMC from normal controls, but not from RA patients, appeared to be responsive to viral antigen stimulation and produced RF. These data suggest that the immune response to CMV, to a greater extent than to EBV or VZV, correlates with the presence of RF.

Cytomegalovirus mononucleosis--associated gastric ulcers in normal host

A case of cytomegalovirus (CMV) mononucleosis associated with gastric ulcers is reported in a normal non-immunocompromised host. The demonstration of intranuclear inclusion bodies in a few gastric glandular epithelial cells contributed to the diagnosis of CMV gastritis. Extraction of DNA from the gastric biopsy specimens and the amplification of CMV-DNA by the polymerase chain reaction (PCR) showed the presence of CMV-DNA in the gastric mucosa. In situ hybridization with a probe derived from CMV genomic regions demonstrated the numerous glandular cells with CMV-DNA at the nuclear region. Treatment with a proton pump inhibitor to suppress gastric acid secretion was useful to mitigate the epigastralgia and to hasten the ulcer healing. The value of highly sensitive PCR and the in situ hybridization method to detect the CMV-DNA were emphasized for rapid and sensitive diagnosis of CMV gastritis.

Cytomegalovirus infection of the larynx in the acquired immunodeficiency syndrome

CMV is the most important viral opportunist in patients with AIDS. Nearly all patients with AIDS have been exposed to CMV and the virus can be isolated from many. When CMV-related disease occurs in AIDS, it has usually involved the eye or gastrointestinal tract. In lesions in which CMV is the suspected etiology, evidence of direct pathogenicity of the virus should be obtained, usually histologically. Accurate diagnosis is essential because long-term therapy with a relatively toxic drug (ganciclovir) is indicated. We have presented a case of CMV infection of the larynx that responded, albeit slowly, to ganciclovir. Additional cases may arise as the prevalence of AIDS increases. Because of the potential for airway compromise and the tendency toward chronicity, CMV infection of the larynx should be of a significant concern both for the patient and the otolaryngologist.

Polymerase chain reaction for detection of human cytomegalovirus infection in a blood donor population

We have used the polymerase chain reaction (PCR) to analyse 420 normal donor blood samples taken at a city centre donation site. Three sets of human cytomegalovirus (HCMV) primers specific to the HXLF6, immediate early and late antigen gp64 genes, of the alpha, beta and gamma antigen coding regions respectively, were used to allow for the possibility of sequence variation. There was perfect correlation between the three sets of primers. Latex agglutination and enzyme-linked immunosorbent assay (ELISA) were also employed to provide data for a comparative study. The complete data show that infection with human cytomegalovirus is not only age related but is also sex related. The female population examined using PCR reached a peak infection rate of 80% by the age of 40-50 years whereas the male population reached a 98% infection rate following an almost linear increase with age. Latex agglutination data shows a similar picture although the infection rate peaks around 20% lower than with PCR. The data shows an increase in sensitivity using the PCR rather than the serology although the clinical significance of this has yet to be determined. The work presented here also demonstrates the suitability of the polymerase chain reaction as a potential diagnostic and epidemiological tool.

Predictive value of cytomegalovirus viraemia for the occurrence of CMV organ involvement in AIDS

In HIV-infected patients, the presence of cytomegalovirus (CMV) viraemia is predictive of the development of acquired immunodeficiency syndrome (AIDS), but it is not known whether it predicts further occurrence of CMV organ involvement. To assess the predictive value of CMV viraemia in the occurrence of CMV organ involvement, CMV blood cultures were performed at the onset of AIDS in 71 patients. They were prospectively followed up for at least 6 months, with a mean of 16.6 +/- 7 months (6-36 months). CMV viraemia was present in 28/71 patients (39.5%) at the onset of AIDS. CMV organ involvement occurred in 18/71 patients (25.4%) after 8.7 +/- 3.3 months. Fourteen of the 28 patients (50%) with early CMV viraemia developed CMV organ involvement after 7.7 +/- 6.3 months as compared with 4/43 patients (9.3%) who were not viraemic at the onset of AIDS with a mean follow-up of 11.8 +/- 3.8 months (P less than 0.001). At the time of CMV organ involvement, CMV viraemia, however, was present in 94.4% of the cases. No differences in survival was observed between initially viraemic and non-viraemic patients. No difference has found in mean CD4 cell count between viraemic and non-viraemic patients. This high predictive value of early CMV viraemia in AIDS for the occurrence of CMV organ involvement underlines the need for repeated search for CMV organ involvement when CMV viraemia is detected, and for less toxic antiviral drugs that might be used earlier.

T-lymphocyte effects on murine cytomegalovirus pulmonary infection

Cytomegalovirus (CMV) infections were induced in male BALB/c mice treated with rat monoclonal antibodies (MAb) to deplete selectively CD8 and CD4 cell populations in vivo. The animals were then inoculated intraperitoneally with murine CMV and the infection was monitored virologically and histologically. High concentrations of virus were found in the lungs of mice depleted of CD4 or both CD4 and CD8 cells. These animals developed pulmonary infections that persisted for at least 49 days after inoculation. In contrast, immunologically intact mice and those administered anti-CD8 MAb experienced only a transient infection of the lungs. Focal interstitial infiltrates of mononuclear cells were demonstrated in pulmonary tissues of CD4 MAb-treated animals, but not in normal mice and those receiving the CD8 MAb. Adoptive transfer of CD4 cells to animals (rendered immune-incompetent by thymectomy and irradiation) protected against pulmonary infection and the development of interstitial pneumonia. Mice treated with CD4 MAb failed to produce specific CMV antibody, whereas the depletion of CD8 cells had no effect on antibody elaboration. Administration of anti-CD4 and CD8 MAb did not affect virus replication in the salivary glands, the preferential site for CMV infection in the mouse. Induction of pulmonary infection and interstitial pneumonia by CMV in BALB/c mice is mediated by CD4 T cells.

Human cytomegalovirus labyrinthitis

The purpose of this report is to present a review of the clinical and histopathologic findings in human cytomegalovirus (HCMV) labyrinthitis. Human cytomegalovirus infection was first recognized in its congenital disseminated form and, subsequently, in a subclinical form. In 1968, the first temporal bone demonstration of endolabyrinthine infection was reported. To date, there have been reports made on only nine temporal bones in infants with HCMV infection. The light microscopic findings, in general, have been similar, with cytomegalovirus inclusion-bearing cells involving the nonneuroepithelial cells in both the cochlear and vestibular endolabyrinth. A few cases have been studied with fluorescent antibody methods, but have resulted in conflicting reports regarding the presence of virus in cells of the organ of Corti and spiral ganglia. Subclinical congenital HCMV infection, including labyrinthine infection, has also been studied. Only two groups have performed major prospective studies along with systematic and careful periodic audiologic evaluation in cytomegalovirus congenitally infected children. Their findings demonstrated significant hearing loss in 33% to 48% of symptomatic patients and in 6.9% to 13% of asymptomatic children. There also was evidence of progressive hearing loss in some of these children. Vestibular dysfunction is less well characterized. The long-term sequelae may include Meniere's syndrome. Acquired HCMV infection in children and adults has not been demonstrated histopathologically, although it has been associated with sudden deafness and acute labyrinthitis. This observation is based primarily on serologic data.

On the structure of the epidemic spread of AIDS: the influence of an infectious coagent

The reported AIDS cases in the USA and the Federal Republic of Germany are growing almost exponentially. Considering the epidemiological curves for different risk groups (homosexual men, i.v. drug abusers, heterosexual partners etc.) it is extremely surprising, that nearly exactly the same development occurs in all risk groups. One only has to consider a certain time shift for each group. The conformity of the development for all groups is evident by the fact, that the curves representing the reported AIDS cases for different risk groups are straight lines (in a logarithmic scale) running nearly exactly in parallel. This remarkable parallelism can be understood only if the spread of AIDS is independent of the sexual or drug risk in a certain sense. On the other hand, the drastic overrepresentation of the sexually highly active groups and drug abusers in the number of AIDS cases obviously requires that the transmission of AIDS unequivocally depends on the sexual and drug risk. We present a mathematical model that is suitable to reconcile this apparent contradiction in the interpretation of the epidemiological data: the observed parallel time series for the spread of AIDS in groups with different risk of infection can be realized by computer simulation, if one assumes that the outbreak of full-blown AIDS only occurs if HIV and a certain infectious coagent (cofactor) CO are present. Such a situation is not uncommon, see, e.g. the influenza virus--Staphylococcus aureus system. According to the mathematical model this cofactor would spread independently of the sexual and drug risk--in contrast to HIV. However, due to its analytical properties the simulated cofactor cannot be identified so far with any known infectious agent.

Prevalence of cytomegalovirus antibodies in Brazilian and Japanese populations in the north-east of Brazil

The serological status to cytomegalovirus (CMV) was examined for 616 Brazilians and 399 Japanese immigrants living in the North-East of Brazil. The sera were screened for IgG antibodies to CMV by enzyme-linked immunosorbent assay (ELISA). The overall prevalence of CMV antibodies was higher in the Japanese population (83.7%) than in the Brazilian population (69.8%). The seropositivity was analyzed by factors of age, sex, ethnic background, and socioeconomic status. Mother-baby contact seems to be a factor of significance in the seroepidemiology of CMV infection.

Cervical carcinoma and human cytomegalovirus

Human cytomegalovirus (HCMV) is a sexually transmitted virus which has been implicated in both cervical cancer and its precancerous state, cervical intraepithelial neoplasia (CIN). The evidence for this and the current possible mechanisms by which HCMV could be involved are discussed at the molecular level.

Cytomegalovirus-specific antibody responses in renal transplant patients with primary and recurrent CMV infections

Cytomegalovirus (CMV) specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody responses were measured before and after renal transplantation in 20 patients with primary CMV infection and in 16 patients with recurrent CMV infection. In primary CMV infection IgG antibody titres to late antigen (IgG-LA) measured by indirect fluorescence (IFA) were approximately seven times higher than those obtained by the complement fixation test (CFT). In contrast, in recurrent CMV infection this difference was found to be about twofold. Virus-specific IgM antibody to late antigen (IgM-LA) was detected in 100 percent of patients with primary CMV infection and in only 50 percent of patients with recurrent CMV infection. The IgM-LA titres were highest in primary CMV infection and reached peak levels at approximately 10 weeks post transplantation, whereas in recurrent CMV infection the IgM-LA titres were lower and reached peak levels at three months post transplantation. Moreover, IgM-LA was found to persist in patients from both groups at nine months post transplantation. IgM antibody to early antigen (IgM-EA) was not detected in any patient in this study. However, significant fourfold titre rises in IgG antibody to EA (IgG-EA) were detected in 100 percent of patients with recurrent CMV infection and in 50 percent of patients with primary CMV infection. These results clearly show the difference in antibody responses to the various antigens of CMV in patients with primary and recurrent CMV infection.

Review of the herpesviruses and hepatitis A: the potential hazards in dental care

There is now an increased awareness of the risk of transmission of viral infections via blood and saliva after the publicity given to the human immunodeficiency viruses responsible for the acquired immunodeficiency syndrome. The herpesviruses have been found in blood, in blood products, and in saliva, and information with respect to these routes of transmission is convincing. Although hepatitis A virus is spread predominantly by water contaminated with feces (fecal-oral route), the virus is also found in saliva. On these grounds alone, these viruses must be considered a potential hazard in dentistry. Information in regard to the actual risks of their transmission in the context of dental practice is not yet available, primarily because a high proportion of infections are asymptomatic. Serologic studies of their prevalence suggest that all are widespread in the population. They are particularly common in many of the groups known to be at high risk for hepatitis B virus and human immunodeficiency virus, including promiscuous homosexuals, bisexuals, and intravenous drug abusers. In addition, pregnant women and their babies are particularly at risk from the herpesviruses. It is important to identify members of these high-risk groups as a potential source of transmission of infection through dental practice and in addition, it is important to identify them because they are prone to chronic sequelae.

Lymphocyte transformation test responses to cytomegalovirus in healthy adults from Britain and Iraq

Lymphocyte transformation tests to CMV were carried out on young healthy adults from Britain and Iraq. Positive results were obtained in all of 28 seropositive British subjects as compared to 17 of 33 (51.5%) seropositive Iraqis; moreover, stimulation index values in the British group (mean 11.58) were significantly higher than in the Iraqi group (mean 2.84). Attempts to relate these differences to demographic characteristics, antibody response to CMV, including the response to early antigens, lymphoproliferative response to herpes simplex virus, and to phytohaemagglutinin and the presence of blocking factors were unrewarding.

Cytomegalovirus pneumonitis in patients with AIDS. Findings in an autopsy series

Cytomegalovirus (CMV) pneumonitis is a common complication of AIDS. With the development of potentially effective drug therapy, the indications for treatment and best means of diagnosis have become issues of practical importance. We reviewed the clinical records and autopsy material from 54 patients dying with AIDS, 39 (72 percent) of whom had CMV infection documented postmortem by culture and the presence of inclusion bodies. Of the patients with CMV infection, disseminated disease was documented in 23 (59 percent) and pneumonitis in 31 (80 percent). Although the majority of patients with CMV pneumonitis had additional forms of pulmonary pathology, CMV was the only causative agent identified in two patients with severe pulmonary disease. Since CMV can cause severe lung damage and disseminated infection in patients with AIDS, specific treatment may be beneficial. Improved diagnostic technology is needed in this area.

Viral diseases involving the liver

Even though HAV, HBV and HNANB viruses are responsible for most of the viral hepatitis cases, many other viruses have been reported to cause hepatic injury. These viruses may involve the liver, either as part of a systemic illness (e.g. EBV, CMV, HSV) or as the primary target organ (e.g. yellow fever virus, Lassa fever virus, Ebola virus). Clinically overt hepatocellular dysfunction is rare in such viral infections. Biochemical disturbance of hepatic functions shown, for example, by rises in AST and ALT, is a frequent event and indicates hepatic damage. Morphological changes of the liver include varying degrees of hepatic necrosis with a paucity of inflammatory activities. Intranuclear or cytoplasmic inclusion bodies may be characteristic findings in these diseases. Laboratory diagnosis depends upon serology and liver histology. Treatment is still largely supportive in most of these diseases, although recent trials of antiviral agents show promise against some viruses. Chronic sequelae, such as cirrhosis or hepatocellular cancer, are not encountered. More work is needed to elucidate the pathogenesis of hepatic injury in these illnesses.

The importance of primary cytomegalovirus infection in childhood cancer

Sixty-eight paediatric patients with malignant tumours or leukaemia were followed for signs of infection with human cytomegalovirus (HCMV) over 1 year. HCMV was isolated from 24 out of 68 patients at some point during the observation period; from urine in 14, from both urine and throat in 9 patients, and from throat alone in 1 patient. Previous antibody analysis indicated the presence of HCMV antibodies in 10 of the 24 virus-shedding patients, while 7 patients were seronegative and 7 undefined. Thus the incidence of reactivation appears to be higher than that of primary infection in these immunocompromised patients. The mean duration of virus shedding was 4.2 months in the primary infection group, 1.7 months in the reactivation group and 1.1 months in the undefined group. No difference in the incidence of HCMV-associated illness was observed between patients with leukaemia and those with malignant tumours. Clinical symptoms associated with HCMV infection (pneumonia (2), fever (6) and hepatitis (1)) were observed in all patients with primary infections and in only five patients with reactivated infection.

The selection and characterization of human monoclonal antibodies to human cytomegalovirus

This communication describes the application of Epstein-Barr virus lymphocyte transformation technology to the production of human monoclonal antibodies specific for human cytomegalovirus. A group of such IgG antibodies have been characterized in terms of subclass, light-chain composition, specificity for particular viral proteins and neutralizing capacity. These results have shown that the production of antibodies by transformed lymphocytes is representative of the in vivo human immune response; the antibodies produced may therefore be of therapeutic value. This approach should prove to be useful for the identification of specific virion proteins which are antigenic in humans and for the in vitro evaluation of the immune responses to synthetic peptide vaccines.

Immunological cross-reactivities among three herpesviruses

Sixty adults were tested for humoral and cell-mediated immunity to varicella zoster virus (VZV), type 1 herpes simplex virus (HSV-1) and the human cytomegalovirus (CMV). Since herpesviruses share common antigens, we compared results in these individuals to assess whether our tests gave false positives due to cross-reactions. Of the 60, IgG antibody to VZV, HSV-1, CMV tested by ELISA was detected in 51 (85%), 34 (57%) and 20 (33%) respectively. All possible permutations of results were obtained and there was no evidence of cross-reactivity among the viruses. Lymphocyte transformation performed in 20 was found to be positive in 16 (80%), 13 (65%) and 8 (40%) for VZV, HSV-1 and CMV respectively. Similarly, all possible permutations of results were obtained. In addition, 8 subjects were found to have positive lymphocyte transformation responses for one or other of the viral antigens but no specific antibody was found in their sera. Thus, the antibody and lymphocyte transformation test were not influenced by possible cross-reacting antigens among the 3 herpesviruses we studied. Both tests are necessary to firmly establish whether a subject has had a prior infection.

Prevalence of cytomegalovirus antibody in nursing personnel

To evaluate the risk to nurses of childbearing age of acquiring cytomegalovirus (CMV) infection during the care of patients at high risk of the infection, 374 female hospital employees (288 nursing personnel) were interviewed and screened for antibody to CMV. Fifty-six percent of the population surveyed had antibody to CMV as measured by an immunofluorescent assay. Among nursing personnel, analysis of antibody prevalence by job title, work area, and duration of work showed no association between seropositivity and either current or past exposure to "high-risk" patients, such as infants and immunosuppressed individuals. Age, race (non-white), and the number of pregnancies reported by participants were significantly associated with the presence of antibody. Among 73 employees of a children's hospital, the prevalence of CMV antibody was 41%. This survey suggests that hospital nursing is not a major risk factor for acquiring CMV infection. However, this finding needs further evaluation in a prospective study of seroconversion rates among seronegative nurses.

The effect of the dosage of steroids on the incidence of cytomegalovirus infections in renal transplant recipients

In a retrospective survey of 92 cadaver renal transplant recipients, cytomegalovirus (CMV) infections were detected in 23 of 34 (68 per cent) patients treated with high doses of steroids but in only 27 of 58 (47 per cent) patients given low doses. Pretransplant blood transfusions were associated with both an improvement in one-year allograft survival-rates (P less than 0.05) and an increase in the incidence of CMV infections. When standardised for any transfusion effect, the incidence of CMV infections was significantly higher in those patients given high doses of steroids (P less than 0.05). In the same group of patients, moreover, CMV infections were associated with a statistically significant increase in the renal allograft survival-rate (P = 0.03).

Generalized neonatal herpes virus infection (cytomegalovirus or herpes virus type 1). Comparative examination of loci attacked by two viruses

Two autopsy cases, a 5-minute-old male infant with congenital cytomegalovirus (CMV) infection and a 10-day-old female infant with herpes simplex virus type 1 (HSV-1) infection, were presented. CMV antibody titer detectable by immunofluorescence (IF) technique was significantly high in the sera of both infant and mother in the CMV case. In another HSV-1 case, we have succeeded in HSV-1 isolation from autopsy liver and subsequent serological identification of the isolated virus, including a detection of high HSV-1 antibody titer in the mother's serum by IF. On light and electron microscopes, these two cases respectively showed typical findings as the severest form of each viral infection. As one of the marked differences between the two cases, the thymus in the HSV-1 case showed remarkable involution with a complete disappearance of thymic cortical lymphocytes. However, the CMV case exhibited an existence of intact thymus without viral injuries. Similar distinguishable differences between the two cases were observed also in the bone marrow. It additionally seems to be unique that cytomegalic inclusion bodies were disclosed fairly well in the submaxillary glands and rarely in the renal tubules even in the case with HSV-1.

Antibodies to cytomegalovirus in homosexual and heterosexual men attending an STD clinic

We studied the prevalence of antibody to cytomegalovirus (CMV) in 262 men (132 homosexual, 20 bisexual, and 108 heterosexual) attending the sexually transmitted diseases (STD) clinic at this hospital. Antibody to CMV at a titre of 1/4 or more was found in 92% of the homosexuals, 80% of the bisexuals, and 56% of the heterosexuals (p less than 0.0001). Among heterosexuals, but not homosexuals, nationality and social class showed a significant association with antibody to CMV. In both heterosexuals and homosexuals a history of gonorrhoea was more common in patients with antibody to CMV than in those without it. A similar finding was seen in heterosexual men with a history of non-specific urethritis (NSU). Using a series of log linear models, sexual orientation was shown to be the most important determinant of antibody to CMV in this population.

Prevalence of cytomegalovirus antibodies in Norwegian kidney-transplant recipients and their living donors. A comparative study of two different methods

376 sera from Norwegian kidney-transplant recipients and their living, related donors, were tested for the presence of cytomegalovirus antibodies (CMV-ab) by the complement fixation test (CF), and for IgG CMV-ab by the enzyme-linked immuno-sorbent assay (ELISA). Whenever the results of the two methods differed, the sera were also tested by the indirect fluorescence antibody test (FAT). 325 of 376 sera showed corresponding results, giving a concordance of 86 per cent between CF and ELISA, ELISA being the more sensitive of the two, with a sensitivity in the same range as FAT, and high specificity with only 0.3 per cent false positive results. The prevalence of CMV-ab in Norwegian kidney-transplant recipients and their living, related donors, differed very little. The overall CMV-ab seropositivity was 76 per cent. The prevalence increased from 50 per cent at the age of 20 years, to 80 per cent at 30 years and 90 to 100 per cent from 60 years of age.

Age-specific prevalence of complement-fixing antibodies to sixteen viral antigens: a computer analysis of 58,500 patients covering a period of eight years

The age-specific prevalence of CF antibodies against 16 viral antigens was determined by using the computerized data registry of the routine diagnostic laboratory of the authors' department. The material consisted of data based on serum specimens from about 58,500 patients. All ages from newborn infants to 90-year-olds were represented. The sera had been collected and tested with a CF screening test over a period of 8 years (1971-1978). Several different antibody prevalence patterns were distinguished in regard to the rapidity and timing of the initial increase of the prevalence, as well as to the mode of later changes in prevalence. For most respiratory viruses a rapid increase of the prevalence was seen through the childhood continuing, for some of them, up to the 30s (influenza A and coronavirus), while rather variable patterns were found in the older age groups. Herpes simplex and cytomegaloviruses showed, interestingly, another type of pattern: a slow increase of prevalence continuing through the whole age range. The frequency of herpes simplex antibodies reached 90% by the age of 80 years. Antibody levels against any antigen in infants less than one-month-old were equal to those in 20- to 40-year-old adults, and the expected rapid decrease of antibodies took place within the first 6 months of life. Possible influences of epidemics and repeated exposures to different viruses (external boosting), and of latent or chronic infections (internal boosting), as well as of technical variations, on the observed prevalence patterns are discussed.

Occupational risk for primary cytomegalovirus infection among pediatric health-care workers

The risk of acquiring cytomegalovirus (CMV) from infected infants concerns pediatric health-care workers, particularly those who may be pregnant. We determined the prevalence of CMV antibody, and thus of past infection, in groups of medical students and house staff, nurses, and physicians, and in groups of pregnant and nonpregnant young women in the community. Although age, sex, and race influenced the results, occupation did not. We then estimated the exposure of the health-care workers by determining the prevalence of CMV infection in three groups of asymptomatic infants for whom they provided care; CMV was shed in urine or saliva of 1.6 per cent of newborns, 13 per cent of premature infants hospitalized for over a month, and 5 per cent of older infants seen in outpatient settings. When we determined the incidence of primary infection in the adult groups by retesting the seronegative members about two years later, we found that the annual attack rates in the medical students (0.6 per cent), house staff (2.7 per cent), and nurses (3.3 per cent) were not higher than in young women in the community (2.5 per cent during pregnancy and 5.5 per cent between pregnancies). We conclude that although pediatric health-care workers frequently and unknowingly care for infants shedding CMV, this occupational contact confers no greater risk than that faced by young women in the community at large.

Autopsy pathology in the acquired immune deficiency syndrome

The acquired immune deficiency syndrome (AIDS) is a devastating new illness which appears to be sexually and parenterally transmissible. AIDS was first described in the male homosexual community; however, the disease has more recently been described among intravenous drug abusers, Haitians, hemophiliacs, and others. The etiologic agent is unknown. AIDS may represent an infection by a previously undescribed organism, a mutant of a known microorganism, or a multifactorial combination of environmental, immunologic, and genetic factors. As a consequence of the disease's seemingly irreversible ablation of the cell-mediated immune system, AIDS victims succumb to a variety of infections and/or unusual neoplasms. In its fully developed form, mortality approaches 100%. At autopsy the gross and microscopic pathology of the syndrome can be divided into three general categories: 1) morphologic manifestations of profound lymphoid depletion; 2) infections, usually with mixed opportunistic pathogens; and 3) unusual neoplasms, most frequently Kaposi's sarcoma or high-grade lymphomas.

Cytomegalovirus infection in pregnancy: preliminary findings from a prospective study

8278 (56%) of 14 789 pregnant women who were screened for cytomegalovirus (CMV) antibodies at their first antenatal visit were seropositive. 42 (3 per 1000) infants screened were congenitally infected. 3 (7%) have serious handicaps, 14 (33%) have minor or transient problems, and 25 (60%) have so far had no problems. In 26 of the 42 mothers with infected infants CMV antibodies were present in the first antenatal blood sample. 28 (67%) of the infected infants were born to mothers who had experienced a primary infection in pregnancy and 7 (17%) to mothers who had experienced recurrent infection. In the remaining 7 (17%) it was not possible to determine the type of maternal infection. One handicapped infant was born after a probable recurrent CMV infection during pregnancy. These preliminary findings suggest that routine screening of pregnant women to detect evidence of primary CMV infection is not helpful.

The detection of antibodies to cytomegalovirus in the sera of renal transplant patients by an IgM antibody capture assay

An IgM antibody capture assay for detection of cytomegalovirus (CMV) IgM antibody (MACRIA) was developed. It was shown to be of similar sensitivity to the indirect immunofluorescence test but has the advantage that rheumatoid factor does not react in it and pretest fractionation of serum is not required. It does, however, give false results with some Paul Bunnell-positive sera. The assay was used to measure the IgM response in 28 renal transplant patients followed prospectively. Seven patients (100%) with primary infections and six of 13 (46%) patients with secondary infections developed IgM by MACRIA. Nine of 13 (69%) patients with CMV IgM-positive sera had symptoms other than pyrexia associated with CMV infections, while only one of seven (14%) IgM-negative infections were symptomatic. Four of seven irreversible rejection episodes were associated with CMV IgM. The possible significance of CMV IgM production is discussed.

Antibody to cytomegalovirus in Malta

Antibody to cytomegalovirus (CMV) was sought in sera from Malta using immunofluorescence. Seven per cent of the infants, 36% of the school children, increasing to 100% of the adults aged over 40 years were found to have antibody. Most infection occurred in pre-school children and adults over 25 years of age. This pattern of antibody acquisition appears different from that described for other countries.

A comparison of cervical cytomegalovirus (CMV) excretion in gynaecological patients and post-partum women

CMV was isolated from the cervix of 4.2 per cent of 191 gynaecological patients and from 9.8 per cent of 51 women post-partum; all patients were attending the same general practice clinic. The CMV excretion rate was particularly high in the early post-partum period decreasing to nearly normal levels as menstruation returned. Three of 14 (21.4 per cent) post-partum patients excreted CMV before menses had restarted whereas virus was isolated from only two of 36 (5.6 per cent) women who had returned to a normal menstrual cycle. Although this difference was not statistically significant, the excretion rate early post-partum was significantly higher than in the gynaecological group (p less than 0.05). Five of seven excretors in the gynaecological group were in the first half of a menstrual cycle at the time of virus isolation thus suggesting that hormonal changes may lead to CMV reactivation in the genital tract. Other factors which may influence the presence of CMV in the genital tract of non-pregnant women are discussed. Three of four infant born to women excreting virus on the cervix post-partum became infected with CMV.