The histology of nasopharyngeal masses: a comparison between HIV positive and HIV negative patients.

The aim of this study was to compare the histology of nasopharyngeal masses of HIV positive and HIV negative patients and to determine the prevalence of malignancy in nasopharyngeal masses in HIV positive patients. The records of all patients who had nasopharyngeal biopsies performed at the Department of Otorhinolaryngology, Universitas Academic Hospital between January 2006 and December 2011, were reviewed and 151 patients were identified. The HIV status of 110 of these patients was known: 78 (70.9 %) were HIV positive and 32 (29.1 %) were HIV negative. The CD4 count was known in 63 (80.8 %) of the HIV positive patients with the median CD4 count being 275 cells/µl (14-712 cells/µl). Most nasopharyngeal masses in HIV positive patients were benign. Malignancies were significantly more common in the HIV negative group than in the HIV positive group, with six (7.7 %) of the nasopharyngeal masses in the HIV positive group being malignant, while eight (25 %) of those in the HIV negative group were malignant. Most nasopharyngeal masses in HIV positive patients are due to lymphoid hyperplasia. The presence of large cervical lymphadenopathy should alert one to the possibility of a malignancy rather than a benign disease process.

Comparison of fast-track diagnostics respiratory pathogens multiplex real-time RT-PCR assay with in-house singleplex assays for comprehensive detection of human respiratory viruses.

Fast-track Diagnostics respiratory pathogens (FTDRP) multiplex real-time RT-PCR assay was compared with in-house singleplex real-time RT-PCR assays for detection of 16 common respiratory viruses. The FTDRP assay correctly identified 26 diverse respiratory virus strains, 35 of 41 (85%) external quality assessment samples spiked with cultured virus and 232 of 263 (88%) archived respiratory specimens that tested positive for respiratory viruses by in-house assays. Of 308 prospectively tested respiratory specimens selected from children hospitalized with acute respiratory illness, 270 (87.7%) and 265 (86%) were positive by FTDRP and in-house assays for one or more viruses, respectively, with combined test results showing good concordance (K=0.812, 95% CI=0.786-0.838). Individual FTDRP assays for adenovirus, respiratory syncytial virus and rhinovirus showed the lowest comparative sensitivities with in-house assays, with most discrepancies occurring with specimens containing low virus loads and failed to detect some rhinovirus strains, even when abundant. The FTDRP enterovirus and human bocavirus assays appeared to be more sensitive than the in-house assays with some specimens. With the exceptions noted above, most FTDRP assays performed comparably with in-house assays for most viruses while offering enhanced throughput and easy integration by laboratories using conventional real-time PCR instrumentation.

Otitis media: viruses, bacteria, biofilms and vaccines.

Otitis media typically presents as either acute otitis media (AOM), with symptoms including fever, otalgia, otorrhoea or irritability and short duration; or as otitis media with effusion (OME), which is often asymptomatic and characterised by accumulation of fluid in the middle ear. Diagnostic certainty of otitis media is challenging, given the young age of patients and variability of symptoms. Otitis media predominantly occurs as coincident to viral upper respiratory tract infections and/or bacterial infections. Common viruses that cause upper respiratory tract infection are frequently associated with AOM and new-onset OME. These include respiratory syncytial virus, rhinovirus, adenovirus, parainfluenza and coronavirus. Predominant bacteria that cause otitis media are Streptococcus pneumoniae, Moraxella catarrhalis, and non-typeable Haemophilus influenzae. Antibiotic therapy does not significantly benefit most patients with AOM, but long-term prophylactic antibiotic therapy can reduce the risk of otitis media recurrence among children at high risk. In Australia, 84% of AOM is treated with antibiotic therapy, which contributes to development of antibiotic resistance. Vaccine development is a key future direction for reducing the world burden of otitis media, but requires polymicrobial formulation and ongoing monitoring and modification to ensure sustained reduction in disease burden.

Rate of concurrent otitis media in upper respiratory tract infections with specific viruses.

OBJECTIVE: To estimate the coincidence of new otitis media (OM) for first nasopharyngeal detections of the more common viruses by polymerase chain reaction (PCR). New OM episodes are usually coincident with a viral upper respiratory tract infection (vURTI), but there are conflicting data regarding the association between specific viruses and OM. DESIGN: Longitudinal (October-March), prospective follow-up of children for coldlike illness (CLI) by diary, middle ear status by pneumatic otoscopy, and vURTI by PCR. SETTING: Academic medical centers. PARTICIPANTS: A total of 102 families with at least 2 children aged between 1 and 5 years (213 children; mean [SD] age, 3.7 [1.5] years; 110 male; and 176 white) were recruited from the local communities at 2 study sites by advertisement. MAIN OUTCOME MEASURES: New OM and CLI episodes and nasopharyngeal virus detections. RESULTS: A total of 176 children (81%) had isolated PCR detection of at least 1 virus. The OM coincidence rates were 62 of 144 (44%) for rhinovirus, 15 of 27 (56%) for respiratory syncytial virus, 8 of 11 (73%) and 1 of 5 (20%) for influenza A and B, respectively, 6 of 12 (50%) for adenovirus, 7 of 18 (39%) for coronavirus, and 4 of 11 (36%) for parainfluenza virus detections (P = .37). For rhinovirus, new OM occurred in 50% of children with and 32% without a concurrent CLI (P = .15), and OM risk was predicted by OM and breastfeeding histories and by daily environment outside the home. CONCLUSIONS: New OM was associated with nasopharyngeal detection of all assayed viruses irrespective of the presence or absence of a concurrent CLI. Differences among viruses were noted, but statistical significance was not achieved, possibly because of the low power associated with the small number of nonrhinovirus detections.

Detection of rhinoviruses by tissue culture and two independent amplification techniques, nucleic acid sequence-based amplification and reverse transcription-PCR, in children with acute respiratory infections during a winter season.

Five hundred seventeen consecutive nasopharyngeal aspirates were collected between October 1998 and May 1999 for episodes of acute respiratory tract infections in children presenting at the University Hospital of Antwerp. Culture and nucleic acid amplification techniques--nucleic acid sequence-based amplification (NASBA) and reverse transcription-PCR (RT-PCR)--were applied to detect rhinoviruses (RVs). Other respiratory viruses were detected by immunofluorescence (IF) analysis of the specimens and IF analysis of shell vial cultures. Among the 517 specimens, 219 viral agents were identified. They were, in decreasing order, rhinoviruses (93 [18.0%]), respiratory syncytial virus (76 [14.7%]), adenoviruses (16 [3.1%]), influenza viruses (15 [2.9%]), enteroviruses (15 [2.9%]), and herpes simplex virus (4 [0.8%]). For the evaluation of rhinovirus detection, culture positivity and/or a positive reaction in the two independent amplification methods was used as an expanded "gold standard." Based on this standard, the sensitivity, specificity, positive predictive value, and negative predictive value of culture were 44.7, 100, 100, and 99.8%, and those of NASBA and RT-PCR were 85.1, 98.3, 83.3, and 98.5% and 82.9, 93.4, 55.7, and 98.2%, respectively. NASBA and RT-PCR produced comparable results and were significantly more sensitive than virus culture. RVs showed the highest incidence in acute respiratory tract infections in children.

Sensitivity and specificity of Epstein-Barr virus IGA titer in the diagnosis of nasopharyngeal carcinoma: a three-year institutional review.

BACKGROUND: IgA antibody titers to the Epstein-Barr virus (EBV) viral capsid antigen (EBV IgA-VCA) and to the EBV early antigen (EBV IgA-EA) are used to screen for nasopharyngeal carcinoma (NPC). This study evaluates the sensitivity and specificity of EBV IgA-VCA and EBV IgA-EA titers in screening patients for NPC and in those diagnosed with NPC at our institution. METHODS: The NPC status was determined for all patients who had their EBV IgA-VCA and EBV-IgA EA titers measured over a 3-year period, and the sensitivity and specificity were calculated. RESULTS: Five thousand one hundred ninety-six samples were analyzed. NPC was diagnosed in 215 patients. The sensitivity and specificity of a raised EBV IgA-VCA titer (> or =1:5) for diagnosing NPC were 89% and 80%, respectively, with a raised EbV IgA-EA titer (> or =1:5) having a sensitivity and specificity of 63% and 97%, respectively. CONCLUSIONS: Although the EBV IgA-VCA titer is sensitive for the diagnosis of NPC, it should not be used as the sole means of screening for NPC in a population in which NPC is endemic.

Cytomegalovirus infection of the nasopharynx.

This report describes a case of cytomegalovirus (CMV) infection of the nasopharynx. A 47 year old man presented with a nasopharyngeal mass of one month's duration. The patient had a history of pneumonia one month previously. Sinus computed tomography incidentally picked up a nasopharyngeal mass. The initial biopsy showed lymphoid hyperplasia. Repeated nasopharyngoscopy showed a prominent central nasopharyngeal mass without ulceration. Histology of the nasopharyngeal biopsy revealed several enlarged epithelial cells with characteristic CMV cytopathic changes. An immunohistochemical study, using a monoclonal IgG antibody against a CMV antigen, confirmed CMV infection. The patient's nasopharyngeal mass decreased in size gradually on follow up. To the best of our knowledge, this is the first reported case of CMV infection of the nasopharynx in the English literature. This disease entity should be considered in those patients presenting with nasopharyngeal mass, biopsy negative for malignancy, and no underlying immunosuppression or immunodeficiency.

Persistence of viruses in upper respiratory tract of children with asthma.

OBJECTIVES: Nasopharyngeal swabs of 50 asthmatic children in the symptom-free period were examined for the presence of adenoviruses, rhinoviruses and coronaviruses. A control group of 20 healthy individuals was included in this study. METHODS: A polymerase chain reaction was used to detect adenovirus DNA and rhinovirus and coronavirus complementary DNA. The fragments of amplified genetic material were visualized with the use of agarose gel electrophoresis. RESULTS: Adenovirus DNA was found in 78.4% of asthmatic children, rhinovirus RNA in 32.4% and coronavirus RNA in 2.7%. Adenovirus DNA was detected in one of the 20 nasopharyngeal swabs of healthy controls; the rest of the control samples were negative. CONCLUSIONS: The persistent presence of viruses in the upper respiratory tract of asthmatic children shows a possible connection between viral infections and asthma.

Epstein-Barr virus infection in nasopharyngeal lymphoid hyperplasia.

OBJECTIVE: To detect whether Epstein-Barr virus (EBV) harbors in nasopharyngeal lymphoid hyperplasia (NPLH) which is frequently to be seen in Guangzhou, a high-incidence area of nasopharyngeal carcinoma (NPC), and to explore the relation between NPLH and development of NPC. METHODS: Twenty-four 10% formalin-fixed, paraffin-embedded biopsies oef patients with NPLH and elevated serum IgA antibody titer (> or = 1:20) against viral capsid antigen of EB virus (IgA/VCA) were collected from the archives of the Department of Pathology, Sun Yat-sen University of Medical Sciences during the period of January to June, 1993. PCR plus Southern blotting hybridization for detection of EBV DNA W-fragment and in situ hybridization for detection of EB virus encoded small RNAs (EBERs) were performed. All the patients were followed up more than 5 years. RESULTS: Twenty-two of 24 (91.7%) NPLH tissues contained EBV DNA. A few definitely EBERs positive B-lymphocytes could be found in 17 out of 24 specimens (70.8%). Neither NPC nor any EBV-associated malignancies were developed in all of these 24 patients up to date. CONCLUSION: Most of the NPLH tissues taken from the patients with an elevated serum IgA/VCA titer carry EBV, which is harbouring in the nuclei of a few infiltrating and hyperplastic B-lymphocytes. The NPLH without epithelial dysplasia can not be recognized as a precancerous lesion, and EBV infection in these lesions is not an important event, having no substantial significance in development of NPC.

Disseminated mucosal papilloma/condyloma secondary to human papillomavirus.

This report details the histopathologic findings in a woman who acquired the human papillomavirus 6/11 in her late teens and developed papilloma/condyloma of the nasopharynx, oropharynx, anogenital region, urethra, and urinary bladder. General evaluations of immune function reveal no defect, and there was no evidence of HIV infection. The morphologic expression of HPV 6/11 infection appears to be completely dependent on the mucosal epithelium affected. The complete spectrum of benign and premalignant epithelial changes induced by the human papillomavirus family-papilloma, verrucae, condyloma acuminatum, epithelial hyperplasia, and dysplasia-were present in this patient with a single papillomavirus infection. We postulate that this patient has a specific immune deficiency that limits her ability to control local infection and spread of the papillomavirus.