Clinical severity of respiratory syncytial virus group A and B infection in Sydney, Australia.

Respiratory syncytial virus (RSV) has two major antigenic groups, A and B. There is disagreement as to whether or not there is a difference in the clinical severity of disease caused by the two RSV groups. This 3-year prospective study of infants and children with RSV-positive bronchiolitis examines the relative virulence of RSV Groups A and B and assesses the role that breast-feeding may have in modifying the clinical severity of infection. Clinical severity was graded I (ventilated, severe), II (oxygen therapy, moderate), III (no ventilation or oxygen, mild). RSV serogrouping was performed. After exclusion of 60 subjects with known predisposing factors for severity, 444 infants and children were studied (Group A, 337; Group B, 107). The difference in proportion of subjects with severity grade I and II with Group A compared with Group B infection was 6% (95% confidence interval, 4.7 to 16.7). For infants 0 to 6 months of age this difference was 5.6% (95% CI, 7.3 to 18.4). Nineteen cases were nosocomially transmitted. There was a predominance of Group A RSV infection but no difference in severity between Group A and Group B infection.

A report of a spring-summer outbreak of echovirus II infection.

A spring-summer epidemic of echovirus II in New South Wales, Australia, is reported. The symptomatology was found to be age dependent. Neonates and young infants tended to have a severe 'septicaemic' illness. Older infants had a variety of clinical presentations: aseptic meningitis, febrile convulsions, upper respiratory tract infections, and acute enteritis. Children over the age of two in this study uniformly presented with symptoms suggestive of aseptic meningitis--confirmed by cerebrospinal (CSF) cytology in the majority of cases. The clinical presentation of an acute febrile illness in the young child may not allow for distinction between bacterial and viral infection. The importance of the recognition and confirmation of a viral aetiology relates to the subsequent management: i.e. antibiotics may be withheld, hospitalisation may be shortened, and a more favourable prognosis can be made. Certain epidemiological clues and laboratory studies are helpful in suggesting a viral aetiology, but a definitive diagnosis of enteroviral infection may only be readily achieved by virus isolation in tissue culture.

A family outbreak of toxoplasmosis: a serendipitous finding.

A family outbreak of toxoplasmosis involving five members of a Lebanese family is described. We believe it to be the first reported outbreak of toxoplasmosis in Australia. Kibbi , a traditional Lebanese dish which can occasionally incorporate raw meat, may have been the source of infection. The chance occurrence of an outbreak of hepatitis A in the same family subsequently led us to discover this outbreak.

Respiratory syncytial virus: a report of a 5-year study at a children's hospital.

A study over a 5-year period (1979-1983) of RSV infections in children in Sydney, Australia is reported. In common with findings made elsewhere in the world, annual epidemics of RSV infection commencing in autumn and lasting 4-6 months, with peak activity in mid-winter, were observed in 1979, 1980, and 1983. However, in 1981 and 1982 virus activity was first detected in midsummer, peaked in autumn, and was present throughout most months of the year. The alteration in virus activity in 1981 and 1982 was not associated with changes restricted to these 2 years in factors such as the age groups or sex ratio of patients affected or in the clinical categories predominantly affected. A study of climatic variables, however, indicated unusually low rainfall in 3 of 4 years encompassing this period. Study over a longer period is indicated to determine if these observed alterations in seasonal activity of RSV will be repeated in future years. Any possible relationship of such a change to rainfall could then also be better assessed.

Adenovirus type 7 infections in children in New South Wales, Australia.

This study describes our experience of adenovirus type 7 infection in children in New South Wales, Australia. Some aspects of the epidemiology of the infection are also recorded. A community outbreak, a hospital-ward outbreak, sporadic cases, and data from a centralised registry are described. Results of genome-type identification using restriction endonucleases are given. Adenovirus type 7b infection was associated with significant mortality and points to the need, previously expressed, for an adequate vaccine for high-risk infants. Continued surveillance of adenovirus type 7 infections worldwide is necessary to identify genome types so that appropriate vaccines can be developed.

Brief report: parainfluenza virus type 3 infections: findings in Sydney and some observations on variations in seasonality world-wide.

Parainfluenza virus type 3 (Para 3) is an important childhood pathogen causing a significant amount of bronchiolitis and pneumonia in infants. Virus data were analysed over a twelve-year period (1978-1989), and a peak incidence of infection was observed in spring as in Houston, USA, unlike in the United Kingdom where summer epidemics appear to be the norm. The temperature ranges were analysed in the different study areas during Para 3 epidemics and similar ranges in temperature were noted which might provide an explanation for the apparently discordant findings in seasonality reported from different parts of the world.

Renal failure due to BK virus infection in an immunodeficient child.

We report a child with cartilage-hair hypoplasia and Hodgkin's disease who developed progressive renal failure and died following infection with a polyomavirus, BK virus. Renal biopsy showed interstitial inflammation, tubular atrophy, and intranuclear inclusions in tubular epithelium, with large numbers of papovavirus particles within the cells. BK virus infection was confirmed by polymerase chain reaction on renal biopsy material and in urine and the demonstration of a high titre of haemagglutination inhibition (HI) and IgM antibody to the virus in the patient's serum. This case emphasises the need to study in depth any unusual clinical manifestation in immunocompromised patients to delineate better the full clinical impact of less well-established pathogens such as BK virus.

Giant parapox infection in a two year old child.

We report the case of a two year old boy who developed a large tumour on his face. The lesion resembled a pyogenic granuloma clinically and histologically. Viral studies indicated a parapox infection and a bovine source was supported on epidemiological grounds. The lesion was removed by shave excision and the area healed without significant scarring.

Chlamydia trachomatis and respiratory disease in infants.

Eleven infants under six months of age with respiratory symptoms and positive results of serological tests for Chlamydia trachomatis, including an infant from whom chlamydiae were isolate, are presented. The three distinct patterns of illness in these infants were a bronchitis with paroxysmal coughing, a bronchiolitis syndrome, and a diffuse afebrile pneumonia. We conclude that chlamydial respiratory disease should be considered in Australian infants with the described features. The diagnosis can be confirmed by immuno-fluorescence.

Coconut as a medium for the experimental production of aflatoxin.

Fresh, grated coconut has been found to be an excellent medium for aflatoxin production by Aspergillus flavus. Under optimal conditions, yields of 8 mg of total aflatoxin per g of substrate were obtained. Continuous agitation of the growth medium under moist conditions at 24 C produced highest yields. Aflatoxin was assayed both biologically and chromatographically. The aflatoxin content of cultures varied biphasically with the duration of incubation. It is suggested that this pattern could result from the sequential operation of factors promoting aflatoxin formation on the one hand and a detoxifying mechanism on the other.

Identification of pregnancies at risk from cytomegalovirus infection.

The fluorescent antibody technique was used for the identification of specific cytomegalovirus IgM in the sera of twenty-four of 1065 unmarried pregnant women. Seventeen of them were followed to term and five infected infants were identified. Two other infants had CMV IgM in neonatal serum samples but virus excretion was not demonstrated. The congenital infection rate in this study was 5.3 per 1000 births by virus excretion and 7.9 per 1000 if cases with specific IgM are included; from previous studies a rate of 8.8 per 1000 was expected. The reasons for the lack of relationship between specific IgM in the mothers' serum and infected babies is discussed.

A two-part study of the aetiological role of rotavirus in intussusception.

The aetiology of intussusception is ill-defined, with viruses being incriminated as one of many possible aetiological agents. A two-part study was performed by us to investigate the aetiological role of rotavirus in intussusception. Retrospective epidemiological data revealed a negative correlation between the incidence of rotaviral gastroenteritis and the incidence of intussusception. A prospective investigation employing electronmicroscopy, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence studies of faeces and fluorescent antibody studies of sera demonstrated evidence of rotavirus infection in only 2 of 24 children with intussusception. No evidence was forthcoming in this study of an aetiological role of rotavirus in intussusception.

The post-mortem diagnosis of influenzal infection by fluorescent IgG, IgA and IgM antibody studies on necropsy blood.

Necropsy blood from cases diagnosed as dying from influenza A was examined for specific antibody in the IgG, IgA and IgM fractions and a specific diagnosis of recent infection was made if either IgM or IgA antibody and low titres of IgG antibody were found. By these criteria a diagnostic rate of 77% was found in those cases from whom no virus was isolated. The use of infected cell monolayers grown on polytetrafluoroethylene-coated slides gave a simple method of carrying out these antibody assays, and the use of necropsy blood did not require any special methods of transport of specimens to the virus laboratory.

Japanese encephalitis after a two-week holiday in Bali.

Japanese encephalitis is described in a 10-year-old girl after a short holiday in Bali. Four days after returning to Australia the patient presented with a high fever, stupor and rapidly-developing focal neurological signs. Recovery occurred gradually over a period of three months and she has returned to school. Japanese encephalitis viral infection was confirmed by a marked rise in specific haemagglutination-inhibition antibodies and the presence of immunoglobulin M antibodies to the flavivirus group. It is important to be aware of the possibility of arboviral infection in patients with encephalitis. In view of the recent outbreaks of Japanese encephalitis in Asia, travellers to the region should be warned to protect themselves from mosquito-bites.

Coxsackie B, mumps, rubella, and cytomegalovirus specific IgM responses in patients with juvenile-onset insulin-dependent diabetes mellitus in Britain, Austria, and Australia.

Patients from England, Austria, and Australia with recently diagnosed juvenile-onset insulin-dependent diabetes (type 1) mellitus (IDDM) and matched controls were tested for specific IgM responses to Coxsackie B1-5 viruses. 37 of 122 (30%) patients aged less than 15, but only 15 of 204 (6%) controls, were positive (p less than 0.005). Differences in Coxsackie B virus specific IgM responses between patients and controls were statistically significant for patients in England and Austria (p less than 0.005). Coxsackie B virus specific IgM responses were detected in only 3 of 31 patients aged greater than 16. Virus-specific IgM responses were directed against a single serotype, usually Coxsackie B4 or 5, in 23 of 37 (62.5%) children aged less than 15; 10 of 13 (77%) of children aged less than 7 had monotypic responses. Among families of Austrian patients with IDDM, 8 of 79 (10%) siblings had Coxsackie B virus specific IgM responses, 1 of whom subsequently had IDDM, but none of the 80 parents was positive. In contrast, there was no evidence of recent infection by mumps, rubella, or cytomegalovirus (CMV), since mumps-virus specific IgM was present in only 2 of 100 children with IDDM and 5 of 139 controls; no rubella or CMV specific IgM responses were detected in 60 sera from patients with IDDM.