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[Viral myocarditis and classical virology. Clinico-virologic and experimental data].

A viral etiology of myocarditis has been proven stringently only in a few cases and mostly enteroviruses have been shown to be involved. In fact, a virological diagnosis of viral myocarditis is still rarely possible today. Virus isolation from heart-tissue is hard to achieve and biopsies, if at all, are often performed too late. Successful virus isolation from other materials (e.g. faeces, throat swab) or a serological diagnosis of acute virus infection cannot easily be correlated etiologically with cardial symptoms, depending of course also on the kind of virus infection diagnosed. To prove an acute infection serologically a fourfold rise in antibody titer or for some viruses specific IgM has to be detected. A group specific diagnosis of "acute enterovirus infection" is not reliably possible at the moment. The neutralization test is the only relatively type specific test in enterovirus serology. Intraserotypic virus variants cannot be detected by normal serology. Even when determining neutralizing IgM-antibodies, interpretation of results raises problems due to long persistence and possible cross reactivity. In case of suspected viral myocarditis clinicians should institute early and broad virological diagnostic measures. Virologists have to establish methods for virus or antigen determinations by molecular biological means. Furthermore, a fast and easy serological method for the diagnosis of an "acute enterovirus infection' would be very helpful. For research on the pathogenesis established animal models have to be used.

Animals

A clinical virology database for a regional virology service.

We describe a laboratory information system employing a virus and chlamydia database developed over seven years which is used by a regional laboratory, performing virus and chlamydia testing. The information system is implemented on a University mainframe computer and accessed by computer terminals in the laboratory. The database is used to identify patients, store patient test results, minimize clerical work and improve accuracy of reported results. The database also serves as a patient registry for use in education and research.

Adolescent

Standardization of sensitive human immunodeficiency virus coculture procedures and establishment of a multicenter quality assurance program for the AIDS Clinical Trials Group. The NIH/NIAID/DAIDS/ACTG Virology Laboratories.

An independent quality assurance program has been established by the Division of AIDS, National Institute of Allergy and Infectious Diseases, for monitoring virologic assays performed by nearly 40 laboratories participating in multicenter clinical trials in the United States. Since virologic endpoints are important in evaluating the timing and efficacy of therapeutic interventions, it is imperative that virologic measurements be accurate and uniform. When the quality assurance program was initially created, fewer than 40% of the laboratories could consistently recover human immunodeficiency virus (HIV) from peripheral blood mononuclear cells (PBMCs) of HIV-infected patients. By comparing coculture procedures in the more competent laboratories with those in laboratories who were struggling to isolate virus, optimal conditions were established and nonessential reagents and practices were eliminated. Changes were rapidly introduced into a laboratory when experience dictated that such modifications would result in a favorable outcome. Isolation of HIV was enhanced by optimizing the numbers and ratios of patient and donor cells used in cultures, by standardizing PBMC separation procedures, by using fresh rather than frozen donor PBMCs, by processing whole blood within 24 h, and by using natural delectinated interleukin 2 instead of recombinant interleukin 2 products in existence at that time. Delays of more than 8 h in the addition of phytohemagglutinin-stimulated donor cells to freshly separated patient PBMCs reduced recovery. Phytohemagglutinin in cocultures and the addition of Polybrene and anti-human alpha interferon to media were not important in HIV isolation. The introduction of a consensus protocol based on this information brought most laboratories quickly into compliance. In addition, monthly monitoring has successfully maintained proficiency among the laboratories, a process that is critical for the scientific integrity of collaborative multicenter trials. Problems which might not be appreciated for months are now being resolved early, before data can be compromised unknowingly. This consensus protocol is recommended for any laboratory attempting to isolate HIV for the purpose of standardizing recovery and for accessing virologic endpoints in clinical trials.

Culture Media

Viruses in drinking-water. Reconsideration of evidence for postulated health hazard and proposals for virological standards of purity.

Stringent virological standards for drinking-water have been proposed by the World Health Organisation and by others, but there is no evidence of the spread of virus infection by drinking-water that has been adequately treated to conventional bacteriological standards. There is evidence for waterborne transmission of hepatitis and viral gastroenteritis but the case for the introduction of virological standards is critically examined. It is concluded that there is no evidence that drinking-water in the U.K. contributes to the spread of virus infection, and that the introduction of virological standards for drinking-water could not at present be justified. Moreover, in the absence of any information relating the degree of viral contamination to disease, there is no logical basis on which to set the level of a practical virological standard.

Disease Outbreaks

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease.

A number of viruses cause acute central nervous system disease. The two major clinical presentations are aseptic meningitis and the less common meningoencephalitis. Clinical virology laboratories are now more widely available than a decade ago; they can be operated on a modest scale and can be tailored to the needs of the patients they serve. Most laboratories can provide diagnostic information on diseases caused by enteroviruses, herpesviruses, and human immunodeficiency virus. Antiviral therapy for herpes simplex virus is now available. By providing a rapid diagnostic test or isolation of the virus or both, the virology laboratory plays a direct role in guiding antiviral therapy for patients with herpes simplex encephalitis. Although there is no specific drug available for enteroviruses, attention needs to be paid to these viruses since they are the most common cause of nonbacterial meningitis and the most common pathogens causing hospitalization for suspected sepsis in young infants in the United States during the warm months of the year. When the virology laboratory maximizes the speed of viral detection or isolation, it can make a significant impact on management of these patients. Early viral diagnosis benefits patients with enteroviral meningitis, most of whom are hospitalized and treated for bacterial sepsis or meningitis or both; these patients have the advantage of early withdrawal of antibiotics and intravenous therapy, early hospital discharge, and avoidance of the risks and costs of unnecessary tests and treatment. Enteroviral infection in young infants also is a risk factor for possible long-term sequelae. For compromised patients, the diagnostic information helps in selecting specific immunoglobulin therapy. Good communication between the physician and the laboratory will result in the most benefit to patients with central nervous system viral infection.

Clinical Laboratory Techniques

Investigation of some problems of virology and creation of means of specific prophylaxis of virus infections in the institute of poliomyelitis and virus encephalitis, academy of medical sciences of the USSR.

Several great problems are clearly distinguished in the development of the Soviet medical virology. The team of the Institute of Polliomyelitis and Virus Encephalitis of the AMS of the USSR actively participates in the study of these problems. They include the investigation of theoretical questions of general virology, creation and improvement of means of specific prophylaxis of virus infections, virological examination of diseases endemic for single districts of the USSR as well as the search for, discovery and exploration of new viruses, causative agents of disease. The achievements of the team of the Institute of Poliomyelitis and Virus Encephalitis in the field of liquidation of poliomyelits, creation of new effective preparations against tick-borne encephalitis, rabies and other neurovirus infections are a clear consequence of the prophylactic trend of the Soviet health care, thoughtful planning of scientific work and broad, complex conception of scientific investigations, close connection with other scientific institutions, involvement of specialists of contiguous disciplines in scientific problems, international cooperation inthe elaboration of the mentioned problems within the framework of the CMEA, the use of the most modern and most perfect methods of scientific work and the accomplishment of all socio-economic and medical measures.

Academies and Institutes

[Epidemiology of HTLV-I carriers in Hirado Island and virological and immunological investigation of HTLV-I associated pulmonary disease].

Adult T-cell leukemia (ATL) is endemic in Kyushu. Our study at Hirado island in Nagasaki prefecture revealed a higher incidence (35.9%) of HTLV-I carriers in villages with fishing than in those without (16.5%). HTLV-I carriers showed a higher incidence of abnormal findings on chest roentgenogram (21.7%) than non-carriers (16.5%), but most were lesions of old pulmonary tuberculosis and pleural thickening. Virological and immunological investigations were performed for 10 HTLV-I carriers, 3 patients with HTLV-I associated myelopathy (HAM), and 3 patients with ATL to determine the presence of HTLV-I associated pulmonary disease. In HAM patients, there were high titers of anti HTLV-I antibody, positive IgA reaction to HTLV-I, and an increase in interleukin-2 receptor (IL-2)-positive T-cells in the peripheral blood; and lymphocytosis and an increase in IL-2-positive T-cells in the bronchoalveolar lavage fluid (BALF). Virological examination showed the presence of pX gene and tax1/rex1 mRNA in the peripheral blood and BALF. Similar immunological and virological findings in 2 of 10 carriers suggested the presence of HTLV-I associated pulmonary disease.

Aged

[The importance of virological studies in uveitis].

The paper describes results of the analysis of 853 case histories of patients with uveitis and those of virologic examinations (viruses of respiratory group) in 47 patients with severe uveitis predisposed to chronic recurrent course and resistant to used therapy. As a result of virologic studies, adenovirus from the conjunctiva of one patient was obtained; immunofluorescent studies were positive in 11 patients (virus of grip B in 2, of paragrippe in 1, adenovirus in 4, RS virus in 3, mixed virus infection in 1 patient). Positive serologic reactions were observed in 22 patients (virus of grip A in 7, of grip B in 2, of paragrippe in 1, RS virus in 1, mixed virus infection in 11 persons). The results obtained speak about necessity of virological studies in patients with severe uveitis. It is advisable to combine immunofluorescence and serologic examinations of patients.

Adolescent

Diagnosis of rhinovirus-infections by virological and immunofluorescent methods.

In January--May, 1971, detection of rhinoviurs infections among ambulatory patients with respiratory diseases in Moscow was carried out in parallel by virological and immunofluorescent methods. Rhinovirus infections were virologically confirmed in 13% out of 238 patients. By the indirect immunofluorescence technique, rhinovirus antigens of serotype 17 were detected in 2.2% out of 220 patients, of type 1B in 4.3% out of 183 patients, of type 48 in 5.6% out of 123 patients and of type 7 in 4.6% out of 86 patients. The use of immunofluorescence supplemented the results of virological examinations and increase the effectiveness of aetiological diagnosis of rhinovirus infections.

Adenoviridae

Virological surveillance for dengue haemorrhagic fever in Indonesia using the mosquito inoculation technique.

A dengue haemorrhagic fever surveillance system in Indonesia, based on virological and clinical observations, is described. The system uses the mosquito inoculation technique for virus isolation and is simple, economical, and well suited for endemic areas where support and facilities are limited. The data suggest that with good cooperation between the hospital and the virology laboratory, new serotypes and possibly even new strains of virus can be identified before the onset of epidemic activity. This type of virological surveillance may make it possible to prevent major epidemics in the future.

Culicidae

The management of Japanese quail and their use in virological research: a review.

Since the domestication of Japanese quail during the last few decades, they are extensively used as table birds and pet birds. These birds, because of their physiological resemblance to chickens, inexpensive maintenance and rapid generation turnover are increasingly used in biomedical research including virology. In the present review the life cycle of birds, care and incubation of eggs, rearing, nutrition and naturally occurring diseases are described. The use of Japanese quail, their embryos and cell cultures derived from them in virological research are also discussed.

Animal Feed

Quality control in diagnostic virology.

Quality control in diagnostic virology is in its infancy and some preliminary investigations are reported. Simulated specimens containing viruses have been prepared and distributed so that they could be included in the routine work of virus isolation in participating laboratories. Sera containing antibodies to rubella and influenza virus have also been sent to laboratories for testing. Laboratories were able to check their results immediately after the closing date, and could compare their performance with that of other laboratories when the analysis of each distribution was circulated. The results so far show considerable variation in performance and indicate that there is room for improvement in some laboratories. There is no evidence to show whether the exercise has had any effect on the practice of virology in participating laboratories but some baselines have been produced for comparison with the results of investigations in the future.

Antibodies, Viral

[Virologic diagnosis of interstitial pneumonia].

Viral pneumonia is not very frequent in healthy adults; it is mostly observed in elderly subjects infected with an influenza virus, a respiratory syncytial virus (RSV) or an adenovirus (AdV). In immunocompromised subjects, cytomegalovirus (CMV) is the most common of causal agents. From the point of view of clinicians, virological diagnostic methods must be rapid and specific, and for this reason direct examination techniques for respiratory specimens and immunological detection of virus are currently being developed in virology laboratories. These techniques make it possible, for example, to identify in less than two hours influenza viruses, RSV or AdV in bronchial secretions and CMV in bronchoalveolar lavage fluid after celle centrifugation. Virus isolation in cell cultures is the reference method, but the result is often delayed and the search for seroconversion may take several weeks.

Adult

[Virologic diagnosis of cutaneomucous herpes].

The virological diagnosis of herpes simplex infection rests on the demonstration of the virus or its constituents in lesions of the skin and/or mucous membranes. The reference method is isolation of the virus in cell cultures, but the recent development of enzyme immunoassays has led to a rapid and highly specific diagnosis. The present possibility of a selective and affective treatment enhances the value of an accurate virological diagnosis.

Herpes Simplex

[Evaluation of 30-year-activity of the Virology Laboratory of the Pasteur Institute in Madagascar (1958-1987)].

The authors studied the different activities of Pasteur Institute virology laboratory since it was created. In general virology laboratory, 1.685 viral strains were isolated from 9.533 studied samples (17.6% of positivity). Enterovirus represented 90% of the viral strains. From 2.417 taking of rhino-pharynx, 133 myxovirus were isolated: A/H3N2 represented 76% of them. 10.776 patients, from 36.169 antirabic department consultants, were vaccinated and 600 had an antirabic serotherapy. 2.828 suspect samples were analysed for the rabies diagnostic: 1.438 were positive (51%). The Institute produced 3.410 liters of Fermi human vaccine type.

Enterovirus

Development of scientific tools: an innovative activity of the "Stefan S. Nicolau" Institute of Virology.

The innovative activity of the research team of the "Stefan S. Nicolau" Institute of Virology in the field of scientific tool design is presented, in a brief description of the devices, apparatuses and systems claimed in 32 patents registered not only in Romania, but also in the United States of America, United Kingdom, West Germany, France and Belgium, applied in usual virology diagnosis, research and production, for analytical purposes of computer assisted absorption and fluorescence spectrophotometry and for bichromatic ultramicroanalysis.

Academies and Institutes