Transmission of HIV-1 infection after a fight.
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Biomedical subjects
Publications and source records attributed to P Morgan-Capner.
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Between two and seven sera from cases of persistent detection of rubella-specific IgM for periods in excess of 2.5 months, but in the absence of recent primary rubella or rubella reinfection, were examined for rheumatoid factor, heterophile antibody, and IgM reactivity against toxoplasma and a number of viruses. The relative avidity of the rubella-specific IgG1 has been assessed in all the sera by two methods. None of the sera contained rheumatoid factor or heterophile antibody, nor did any contain detectable concentrations of IgM specific for any of the panel of antigens apart from five sera which contained low concentrations of IgM specific for some coxsackieviruses B. No sera were positive for low avidity specific IgG1 although three did give equivocal results with one avidity test and one gave equivocal results with the second avidity test.
Persistence of specific IgM in sera following primary rubella infection was compared with the maturation of the specific IgG1 response. 206 sera, from 171 patients with primary rubella, taken 1 day to 2.5 years after onset of illness, were tested. Rubella-specific IgM was detected by M-antibody capture radioimmunoassay in 100% of sera taken 15-28 days after onset, but in only 9% taken 3-4 months after onset. However, using the diethylamine (DEA) shift value (DSV) method, low avidity specific IgG1 was detected in 91% sera taken at 3-4 months and at 5-7 months 21% of sera remained positive. Using an avidity index method, with urea in the wash buffer, none of the sera were positive for low avidity specific IgG1 beyond 3 months after onset. With DEA in the wash buffer, the number of sera positive rose to 38% at 3-4 months. Thus, the DSV method for detecting low avidity specific IgG1 is a useful additional test for confirming or refuting a diagnosis of primary rubella and is of particular value for assessing pregnant patients.
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We describe a case of arthropathy due to rubella reinfection. Clinical rubella reinfection with rash and lymphadenopathy has been reported but as far as we are aware this is the first report of a case with arthropathy as the sole presentation. Rubella IgG subclass and avidity tests confirmed the reinfection.
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Certain viral infections in pregnancy may present a hazard to the fetus or the newborn, but only rarely to the woman herself. A number of such viral infections have only been recognized in recent years and are presenting new difficulties in diagnosis, management and testing policies. Even those which are long-established causes of fetal infection still have unresolved problems.
An IgM capture enzyme-linked immunosorbent assay for rubella-specific IgM was used to assess the avidity of specific IgM by comparing the results obtained with and without a mild protein denaturant in the washing fluid used after incubation of IgM with rubella haemagglutinating antigen. An avidity index (AI) was calculated with AIs less than 50% considered to indicate low avidity. Sera from recent primary rubella, rubella reinfection and from patients persistently reactive for specific IgM were tested. Urea and diethylamine (DEA) were compared as the protein denaturants. Twenty-six of 28 sera from cases of primary rubella gave an AI less than 50% with DEA, compared with 25 of 28 with urea. Seventeen of 20 sera from cases of reinfection gave an AI greater than 50% with DEA whereas only 14 of 20 had a similarly high avidity with urea. Eight of 10 sera from 4 cases of persistent specific IgM reactivity gave AIs greater than 50% with DEA, although this was reduced to 5 when urea was used. Thus a difference has been demonstrated between the avidity of specific IgM in primary infection from that demonstrated after a secondary antigenic challenge (reinfection). This may help in serologically distinguishing primary infection from reinfection.
Serum samples from individuals of a wide age range, collected in northwest England in 1984 and 1986, provide the basis for an analysis of the epidemiology of mumps virus infection. A radial haemolysis test yielding quantitative antibody measurements was used to screen samples for mumps-specific IgG. Analyses of resultant age-seroprevalence profiles, using statistical models, revealed an age-related pattern in the rate of infection per susceptible similar to that observed for other childhood infections. This rate, or force of infection, was low in young children, high in older children, and low in adults. In addition, the serological surveys provide evidence for time-dependent changes (both epidemic and longer-term) in the rate of mumps virus transmission. The longer-term changes, reflected in the pattern of the age-acquisition of specific antibodies, are supported by evidence from case notification data. The implications of temporal changes in incidence to the interpretation and design of serological surveys are considered.
One hundred and seventy-nine ambulance personnel working in Lancashire were tested for markers of past or current hepatitis B. None was currently infected but two (1.1 per cent) had had hepatitis B in the past with full recovery. Thus, the prevalence of past hepatitis B was within the range observed for blood donors in the UK.
Five cases of asymptomatic maternal reinfection with rubella are described that occurred in England and Wales during 1985-8 and resulted in intrauterine infection. The criteria for diagnosing reinfection are described. In four cases the rubella contact was with the woman's own children. Two women had therapeutic abortions, rubella virus being recovered from the products of conception, and three were delivered of infants with congenitally acquired disease. Though the risks associated with maternal reinfection with rubella are very small and being measured in a prospective study, it is hoped that the recently introduced augmented programme of rubella vaccination will reduce rubella in the community and therefore this small risk still further.
Virus-specific antibody responses were studied in 12 children with cancer in whom rubella was diagnosed by seroconversion or a rising titre (greater than or equal to fourfold) of haemagglutination inhibiting (HI) antibody. Our results confirmed the difficulties of making a diagnosis of rubella infection in immunocompromised children using criteria for interpreting antibody assays established in immunocompetent patients. Specific IgM antibody persisted for more than 2 months in 7 of 10 children with probable primary rubella, 3 of whom had high concentrations of such antibody 6, 7 and 11 months after the rash. Radial haemolysis and specific IgG1 and IgG3 antibody responses were low in 4, 2, and 4 patients, respectively. One child apparently had a rubella reinfection and, in another, rubella antibody passively acquired from blood transfusions was probably responsible for the HI seroconversion. Nonetheless, the benign clinical course of rubella in immunocompromised children was confirmed.
Tissue from the explanted hearts of 21 patients with idiopathic dilated cardiomyopathy or 19 patients with other specific heart muscle diseases were investigated for presence of enterovirus-specific RNA with an enterovirus group-specific cDNA probe. This was complementary to coxsackievirus B2 RNA sequences between nucleotide numbers 6,550 and 7,400, which are highly conserved between enteroviruses. Hearts from six patients with dilated cardiomyopathy and one patient with ischemic heart disease were found to contain virus RNA. Serology revealed that only one patient (dilated cardiomyopathy group) was positive for coxsackievirus B-specific IgM but negative for virus RNA in the myocardium. Quantitation of leukocytes and T-lymphocytes in the myocardium and expression of major histocompatibility locus antigens revealed no significant differences associated with persistence of virus RNA. These data demonstrate that enterovirus RNA persists in myocardium of a significant proportion of patients with end-stage dilated cardiomyopathy in the absence of a continuing cell-mediated or humoral immune response.
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Before the introduction of measles, mumps, and rubella vaccine a survey was carried out to measure antibody prevalence to the three viruses by age. A total of 8716 samples of serum collected by five public health laboratories in different parts of England during 1986-7 were tested. Despite the current measles vaccination programme 60% of children aged 1-2 years did not have measles antibody and over 80% did not have antibodies to mumps and rubella. In the 3-4 year age group 17% of the children were susceptible to measles, 55% to mumps, and 73% to rubella. The results suggest that vaccinating children early in the second year of life will be necessary to eliminate the three diseases. The survey provides baseline data for continuing surveillance of the immediate and long term effects of the new vaccination strategy.
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An antiglobulin enzyme-linked immunosorbent assay for rubella-specific IgG1 and IgG3 was adapted to measure antibody avidity by incorporating a mild protein denaturant, diethylamine (DEA), into the serum diluent. Sera were tested at varying dilutions, both with and without DEA, if they contained sufficient specific IgG1 or IgG3. The optical density (OD) was measured and curves were plotted. The highest OD (V) was noted and halved (V/2). The distance between the OD curves at V/2 was measured as the DEA shift value. Sera were examined from people whose sera contained rubella-specific antibodies as a consequence of infection or vaccination in the distant past (24 sera), recent primary rubella (66 sera), symptomatic reinfection (11 sera) or asymptomatic reinfection (64 sera). For specific IgG1 the DEA shift value was less than 0.6 for cases of rubella in the distant past, compared with greater than 0.8 for the first month after primary infection. The maximum DEA shift value for the sera from cases of reinfection was 0.65. No serum from cases of rubella in the distant past contained sufficient specific IgG3 to estimate avidity. The sera collected within 1 month of onset of primary rubella gave DEA shift values greater than 0.7 compared with sera from reinfections, which gave DEA shift values less than 0.6, except for two sera from a case of symptomatic reinfection. Thus the assessment of specific IgG subclass avidity is of value in differentiating serologically primary rubella from reinfection.