Molluscum contagiosum, another sexually transmitted disease: its impact on the clinical virology laboratory

Specimens from a vesicular lesion caused by molluscum contagiosum virus produced a cytopathic effect in cell culture that mimicked that produced by herpes simplex virus

Infection with molluscum contagiosum virus, a poxvirus, normally has a typical clinical presentation; therefore, laboratory confirmation is infrequently sought and the virus is rarely isolated in culture. As reported herein, viral culture of specimens from atypical lesions may produce an abortive infection in limited cell lines and a cytopathic effect suggestive of herpes simplex virus.

Vaccinia keratouveitis manifesting as a masquerade syndrome

A patient who used contact lenses and had a history of blunt trauma developed vaccinia keratouveitis after accidental ocular autoinoculation from a recent vaccination site. Corneal and conjunctival cultures were taken for bacteria, fungi, Acanthamoeba, and viruses. Viral-like cytopathic effects became evident in tissue culture within three days. Immunofluorescence studies were negative for varicella-zoster virus, herpes simplex virus, adenovirus, measles, mumps, parainfluenza, and influenza. Pox viral particles were identified in the infected tissue cultures by electron microscopy. The Hind III restriction endonuclease profile of the viral DNA isolate was similar to the Lister strain of vaccinia virus. Ocular vaccinia may manifest as a masquerade syndrome and may mimic signs of herpes simplex virus, varicella-zoster virus, and Acanthamoeba infection. Although vaccination with vaccinia is currently limited to a few populations throughout the world, vaccinia must still be considered in the differential diagnosis of infectious keratouveitis.

Clinical and molecular aspects of molluscum contagiosum infection in HIV-1 positive patients

Molluscum contagiosum virus (MCV) lesions from 31 human immunodeficiency type 1 (HIV-1) positive patients and 54 HIV-1 negative adult control patients were examined for the presence and type of MCV DNA by high stringency Southern hybridization using 32P-labelled or digoxigenin-labelled MCV DNA probes. Of the 83 patients whose lesions contained detectable MCV DNA, 77 were infected with a single type of MCV (16 with MCV 1; 29 with MCV 1v; 30 with MCV 2; and 2 with MCV 2v). Five patients had apparent double infections, with hybridization results indicating the presence of various combinations of MCV 1 or 1v and MCV 2 or 2v. When these results were analysed in the light of clinical data no correlations were found between the MCV type(s) detected and the clinical stage of HIV-1 infection; nor between the MCV types and the anatomical site of the lesions or persistence of infection. However, the HIV-1 positive patients were significantly more likely to be infected with MCV types 2 or 2v than were the controls (17/29, 59% versus 15/48, 31%; P less than 0.05). Since a concurrent study of MCV lesions in children aged 15 years or less has shown that the percentage of infections attributable to MCV 2 or 2v is extremely small (3%), this finding suggests that MCV lesions in HIV-1 positive patients are attributable to adult-acquired MCV infection rather than to reactivation of a childhood infection.

Direct detection of Molluscum contagiosum virus in clinical specimens by in situ hybridization using biotinylated probe

Molluscum contagiosum virus (MCV) is an unclassified poxvirus which has recently become recognized as causing a major sexually transmitted disease. At present no assay is available for specific detection of MCV because the virus cannot be serially propagated in cell culture. Since MCV produces an abortive, limited growth with some cytopathic effect in certain cell lines, we were able to develop an in situ hybridization assay for detection of MCV genome in clinical specimens. Human fetal diploid lung cell monolayers were infected with clinical specimens, and after proper incubation and fixation in paraformaldehyde, hybridization was performed under full stringency conditions with a molecularly cloned biotinylated probe. Only MCV infected cells showed homology to the MCV probe with a purple-brown cytoplasmic staining. Additionally, we have described an in situ hybridization assay for direct detection of MCV genome in formalin-fixed, paraffin-embedded biopsies. Characteristic intracytoplasmic Molluscum bodies (Henderson-Paterson bodies) were detected in stratum spinosum cells of the epidermis. Striking staining similarities have been observed between in situ hybridization and haematoxylin-eosin cytostaining. These procedures are the first successful identification of MCV genome in clinical samples by molecular hybridization, with sensitivity and specificity equal to or greater than electron microscopy.

Direct detection of molluscum contagiosum virus in clinical specimens by dot blot hybridization

A dot blot hybridization protocol was developed for the direct detection of molluscum contagiosum virus (MCV) DNA in clinical specimens submitted for virus isolation. Samples were concentrated by high-speed centrifugation and treated with proteinase K; this was followed by a single phenol-chloroform extraction step. The DNA was denatured, and the entire volume was spotted onto a nitrocellulose membrane. A biotinylated DNA probe specific for the BamHI-C region of MCV type 1 was used for hybridization. Evidence of MCV DNA was visualized by using streptavidin alkaline phosphatase conjugate and 5-bromo-4-chloro-3-indolyl phosphate-nitroblue tetrazolium as the substrate. Results showed that nonspecific hybridization does not occur with herpes simplex virus- or orf virus-infected clinical specimens and that dot blotting is more sensitive and reproducible than electron microscopy.

Detection of molluscum contagiosum virus DNA by in situ hybridization

Three in situ hybridization protocols have been modified and used to comparatively examine formalin-fixed, paraffin-embedded tissue for the presence of molluscum contagiosum virus (MCV) DNA. Two cloned MCV 1 DNA fragments, MCV-1-B-D1 and MCV-1-B-F, were labelled with 32P-dCTP or digoxigenin-11-dUTP and used under conditions of high stringency to detect MCV DNA in sections of molluscum lesions. All methods were sensitive and were capable of detecting MCV after a minimum of 18 hours autoradiography (radiolabelled probes) or 3 to 18 hours (digoxigenin-labelled probes). However, one of the isotopic protocols produced less acceptable results in terms of non-specific background signals. A comparison of the DNA hybridization pattern with the underlying histopathological features of the molluscum sections revealed that there was not always a consistent association between the presence of detectable MCV DNA and cells containing the characteristic cytoplasmic inclusion bodies ("molluscum bodies") which are known to contain large numbers of virus particles. Although there is likely to be only limited scope for the application of this technique to diagnosis, it may prove useful for both retrospective and prospective epidemiological surveys. The in situ detection of MCV DNA may also be valuable for investigations into the cell biology of this imperfectly characterized virus.

Molecular epidemiology of Australian isolates of molluscum contagiosum

Molluscum contagiosum lesions obtained from 75 Australian patients, 22 (29%) of whom were HIV positive, were examined by restriction endonuclease analysis and Southern blot hybridisation using radiolabelled and digoxigenin-labelled MCV DNA probes. The isolates were classified (MCV 1, 1v, 2, and 2v) on the basis of these results, which were in turn correlated with the clinical features of each lesion. A total of 44 (59%) of the lesions contained MCV 1 or 1v, 24 (32%) contained MCV 2 or 2v, three (4%) contained multiple MCV types, whereas four (5%) of lesions submitted contained no detectable MCV DNA. The ratio of MCV 1/1v to MCV 2/2v was determined to be approximately 1.75:1. There were substantial differences between the distribution of MCV types 1 and 2 among patients of different age groups, but no significant relationship between MCV type and the sex of the patient was found. MCV 2 was more frequently detected in lesions from anogenital areas and in immunosuppressed (HIV-positive) patients, and MCV 1 was more commonly isolated from skin rather than genital lesions, but neither association was statistically significant. Fragment F (10 kbp) obtained from the genome of MCV 1 was capable of differentiating MCV 1 from MCV 2 when used as a probe in hybridisation experiments with BamHI cut samples and may be useful when small amounts of lesion prevents differentiation by direct visualisation of restriction endonuclease fragments.

Amplification techniques for detection of herpes simplex virus in neonatal and maternal genital specimens obtained at delivery

Viral culture amplification methods, including centrifugation, use of a cell pretreatment medium containing dimethyl sulfoxide and dexamethasone (DEX medium), and three commercial enzyme immunoassays (EIAs), were evaluated for use with low-titer, asymptomatic neonatal and obstetric samples obtained at delivery. The 4.5-h Ortho EIA was 59.7% sensitive at 16 h compared with 86.4% at 36 h in a spin-amplified format (SAT-EIA). After 36 h with DEX medium, the SAT-EIA was 97.3% sensitive using the 2.5-h modified Ortho EIA and 69.9% sensitive using the Fairleigh Dickinson EIA. Herpes simplex virus (HSV) cytopathic effect was reported in tube culture 1 to 2 days earlier in 8.1 to 35.9% of cells with DEX medium. Overall, the SAT-EIA using the modified Ortho EIA and cells with DEX medium detected 147 of 153 (96.1%) HSV isolates from samples obtained predelivery and 93.1% of 29 HSV positives from samples obtained at labor and delivery, with specificities of 100 and 99.9%, respectively, at 36 h.