Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies.

Ten microbiological departments in Norway have participated in a multicenter evaluation of the following commercial tests for detection of Epstein-Barr virus (EBV)-specific and heterophile antibodies: CAPTIA Select viral capsid antigen (VCA)-M/G/EBNA (Centocor Inc.), Enzygnost anti-EBV/immunoglobulin M (IgM) and IgG (Dade Behring), Vironostika EBV VCA IgM/IgG/EBNA enzyme-linked immunosorbent assay (ELISA) (Organon Teknika), SEROFLUOR immunofluorescence assay and EBV Combi-Test (Institute Virion Ltd.), anti-EBV recombinant IgM- and IgG-early antigen/EBNA IgG ELISA (Biotest Diagnostics), EBV IgM/IgG/EBNA ELISA (Gull Laboratories), Paul-Bunnell-Davidsohn test (Sanofi Diagnostics Pasteur), Monosticon Dri-Dot (Organon Teknika), Avitex-IM (Omega Diagnostics Ltd.), Alexon Serascan infectious mononucleosis test (Alexon Biomedical Inc. ), Clearview IM (Unipath Ltd.), and Cards+/-OS Mono (Pacific Biotech, Inc.). The test panel included sera from patients with primary EBV infection, immunocompromised patients with recent cytomegalovirus infection, healthy persons (blood donors), and EBV-seronegative persons. Among the tests for EBV-specific antibodies the sensitivity was good, with only small differences between the different assays. However, there was a greater variation in specificity, which varied between 100% (Enzygnost) and 86% (Biotest). Tests for detection of heterophile antibodies based on purified or selected antigen (Avitex, Alexon, Clearview IM, and Cards+/-OS Mono) were more sensitive than the Paul-Bunnell-Davidsohn and Monosticon tests.

Early changes in peripheral blood T cell subsets induced by antiretroviral treatment of human immunodeficiency virus-1 positive individuals.

Human immunodeficiency virus (HIV)-1 infection causes a gradual decline in peripheral blood CD4+ T cells. Shortly after the primary infection, an expansion of the activated memory CD8+ T-cell pool is also observed paralleling increased levels of plasma viraemia. In the present study we investigated the immediate effects of zidovudine therapy on peripheral blood T-cell subsets during the first 3 weeks of therapy in a group of HIV-1 positive individuals receiving influenza vaccine. HIV-1 positive individuals who received vaccine, but no treatment, were included as controls. Both the number of CD4+ and CD8+ T cells increased during the first week of therapy in parallel with a decline in plasma viraemia. The majority of CD4+ T cells contributing to this expansion expressed CD28, CD45RO and Fas, whereas the expanded CD8+ T cells were predominantly CD28-, CD45RO+, CD38+, Fas+ and Fas+ (CD95). We propose that the increase in the number of activated memory T cells observed in peripheral blood immediately after the onset of antiretroviral treatment is most likely caused by the redistribution of cells from various lymphoid organs in response to decreased levels of viral load in these compartments. The degree of T-cell redistribution is probably dependent on the magnitude of virus suppression.

[HTLV examination of Norwegian blood donors]. / HTLV-undersøkelse av norske blodgivere.

Approximately one third of the Norwegian blood donor population has been tested for infection with human T-lymphotropic virus type I and II (HTLV-I/II). This study was initiated to provide an indication as to whether or not the Norwegian transfusion service should screen the entire donor population for HTLV I/II. No HTLV-I infections were found among the blood donors. One new donor was confirmed HTLV-II positive. This individual had previously used drugs intravenously. HTLV-I/II infection can be regarded as a marker for risk behaviour, and testing can be of significance in the quality assurance of the transfusion service. We recommend that the entire blood donor population be tested for HTLV-I/II infections, and thereafter only new donors. The benefit of this scheme should be evaluated in the future.

[An outbreak of hepatitis A among intravenous drug addicts in Oslo 1995-96]. / Hepatitt A-epidemi blant intravenøse stoffmisbrukere i Oslo 1995-96.

Intravenous drug abuse is a well-known risk factor for acquiring hepatitis A infection. Among drug abusers most cases are sporadic, but epidemic outbreaks may occur occasionally. In this article we describe an epidemic outbreak including 144 serologically proved cases of hepatitis A among intravenous heroin and amphetamine abusers in Oslo. The outbreak lasted for 11 months. 59 (41%) of the patients were admitted to hospital. One of them died and seven developed severe but reversible acute hepatitis. We also registered 26 cases of hepatitis A among close contacts, 14 of whom were associated with a nosocomial outbreak that affected nurses, fellow patients and relatives. We do not know how the hepatitis A virus was introduced into the abuser population, but the further spread was probably dominated by a combination of faecal-oral transmission and parenteral transmission secondary to sharing needles. Although we were unable to detect hepatitis A virus in confiscated drug samples by means of polymerase chain reaction we cannot exclude that some abusers were infected by injection of contaminated amphetamine.

Comparison of the sensitivity of four rapid assays for the detection of antibodies to HIV-1/HIV-2 during seroconversion.

OBJECTIVES: To compare the sensitivity of four rapid assays for the detection of antibodies against HIV-1 during early seroconversion. METHODS: Four rapid assays for the detection of antibodies to HIV-1/HIV-2 (SUDS HIV 1 + 2, TestPack HIV-1/HIV-2, HIV-SPOT and CAPILLUS HIV-1/HIV-2) were evaluated on 38 sera derived from 14 HIV-1 seroconverters, formerly tested with Abbott second- and third-generation HIV-1/HIV-2 enzyme immunoassay (EIA) and Diagnostic Biotechnology HIV blot 2.2. EIA-negative sera had also been investigated by HIV-1 antigen testing and polymerase chain reaction (PCR) analysis detecting HIV-1 proviral DNA. RESULTS: On 16 sera which were Abbott second-generation EIA negative, the SUDS assay rated highest with six positive results. Four sera were TestPack positive. No specimens in this group were HIV-SPOT positive or CAPILLUS positive. Of the remaining 22 sera (Abbott second- and third-generation EIA positive), all but two were positive in all tests. CONCLUSIONS: The study revealed differences in the sensitivities of the rapid assays in the early phase of seroconversion. The most sensitive assay, SUDS, was even more sensitive than the Abbott third-generation EIA, while TestPack and the EIA were equally sensitive. Based on these findings, we suggest the inclusion of these assays in the supplemental testing for detection of antibodies to HIV.

Quantification of lipopolysaccharides in human bile with or without gram-negative bacteria.

Lipopolysaccharide (LPS) was assayed in 78 samples of human common-duct bile, obtained at endoscopic retrograde cholangiography. The LPS was assayed by a chromogenic limulus amebocyte lysate (LAL) test, after dilution of bile samples in heparinized plasma and inactivation of inhibitors. The assay was not influenced by other biliary constituents, as demonstrated by the recovery of standards. Bile pigments did not influence the results. The LAL test was positive in 60 of the samples, 59 of which had a positive culture for gram-negative bacteria or Candida sp. The levels of LPS were significantly correlated to the total number of bacteria (n = 16, R = 0.55, p less than 0.05). The median LPS level was 35,250 ng/l and showed a very large variation (140 ng/l to 27.8 mg/l). In four of the samples gram-negative bacteria were present, but no LPS could be detected. The study demonstrates the presence of LPS in great quantities in human bile and supports the feasibility of using the LAL test on bile samples. The presence of LPS (within the detection limit) appears to be associated with local microbial colonization.

Antibodies against BK virus in renal transplant recipient sera: results with five different methods indicate frequent reactivations.

Sera from 10 renal transplant recipients were investigated longitudinally for antibodies to human polyomavirus BK (BKV) using specific IgG-, IgA- and IgM-ELISA, hemagglutination inhibition (HAI) and neutralization tests (NT). Nine patients had anti-BKV serum antibodies before transplantation. The serological findings in 5 patients were compatible with reactivation of BKV infections. The results obtained with different tests were generally in good agreement. However, according to the definition of significant titer increase. 1-3 patients would have been undetected by employing HAI alone. High levels of antibodies detected by the other tests generally corresponded well with NT titers, i.e. the ability to neutralize infectivity. All the 5 patients with reactivation also showed an increase in specific IgA antibodies.

The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula.

Small-intestinal bacterial overgrowth may be one etiologic factor in pigment gallstone disease, previously shown to be prevalent in patients with juxtapapillary duodenal diverticula. In this study the bacterial microflora in the duodenum was examined in 52 patients admitted for endoscopic retrograde cholangiography, 27 with and 25 without duodenal diverticula. Endoscopic sampling was done with a microbiology specimen brush. The reproducibility of the method was good. Presence of gas in the anaerobic cultivation media corresponded closely to growth of Enterobacteriaceae, with a sensitivity of 90% and a specificity of 98%. Gas production in thioglycollate medium with 1% glucose is proposed as a simple criterion of bacterial overgrowth. Patients with diverticula had significantly higher total numbers of bacteria in the duodenum than patients without diverticula (p less than 0.01). Enterobacteriaceae and fecal streptococci dominated the flora in patients with diverticula, and gram-positive cocci were most frequently isolated from patients without diverticula.

Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula.

Patients with juxtapapillary duodenal diverticula have an increased occurrence of calcium bilirubinate gallstones. One possible hypothesis to explain this observation is enzymatic deconjugation of bilirubin conjugates in the bile. Beta-glucuronidase of human or bacterial origin may lead to deconjugation of the bilirubin glucuronides in bile. This, in turn, may increase the amounts of unconjugated, water-insoluble bilirubin which can precipitate as calcium bilirubinate, the main component of brown pigment stones. In this study we compared gallstone patients with and without duodenal diverticula treated with endoscopic papillotomy. Increased occurrence of bacteria producing beta-glucuronidase (p less than 0.01) and increased activity of bacterial beta-glucuronidase (pH 7.0) in the bile itself (p less than 0.01) were found in patients with duodenal diverticula. When the activity of the enzyme at pH 4.5, the optimum of the human enzyme, was measured, no such difference was found. The results support the hypothesis of bacterial glucuronidase as an etiologic factor in pigment gallstone disease in patients with duodenal diverticula. The high activity of bacterial enzyme found in the bile in some patients without diverticula suggests bacteria as an etiologic factor, independent of the presence of diverticula.

Rapid diagnosis of genital herpes simplex infection by an indirect ELISA method.

Herpes simplex virus (HSV) detection was performed by a rapid ELISA antigen detection method in a small field trial, and the results were compared to the results of ordinary cell culture isolation. Swabs from 54 patients, suffering from clinically suspected genital HSV infection, were examined by both methods. In 49 samples the results were identical. Three samples were negative by ELISA, but HSV was isolated by culture, while two samples were positive by ELISA, but negative by culture. Compared to the culture results, the ELISA method had 87.5% sensitivity and 93.3% specificity. Most culture positive samples were identified within two (54%) or three (75%) days, and all within six days after inoculation. The ELISA method turned out as a good and easy method for rapid detection of genital HSV infections.

Beta-glucuronidase activity related to bacterial growth in common bile duct bile in gallstone patients.

Beta-glucuronidase activity in the bile may be of importance in the etiology of pigment gallstones. This enzyme is of hepatic or bacterial origin. We have described a method to measure the activity of bacterial beta-glucuronidase in human bile, using 4-nitrophenyl-beta-D-glucopyranosiduronic acid as substrate. The method was used to measure the beta-glucuronidase activity in the bile from 51 patients with gallstone disease. This activity was related to the presence of beta-glucuronidase-producing bacteria in the bile. Escherichia coli, Bacteroides species, and Clostridium perfringens were the only species found to produce beta-glucuronidase. Patients with beta-glucuronidase-producing bacteria had on an average significantly higher enzyme activity in the bile than patients without such bacteria (p less than 0.01). The limitations of using artificial substrates in this type of studies are discussed.

Beta-glucuronidase-producing bacteria in bile from the common bile duct in patients treated with endoscopic papillotomy for gallstone disease.

This paper reports the occurrence of beta-glucuronidase-producing bacteria in the bile in gallstone patients treated with endoscopic papillotomy (EPT). The study included 36 patients--18 women and 18 men, aged 43-87 years, with a median of 72.5 years. Bile sampling was done with an endoscopic technique. All bacterial strains were tested for beta-glucuronidase activity with a rapid chromogenic tablet test, using 4-nitrophenyl-beta-D-glucuronic acid as substrate. Bacterial growth was found in the bile in 35 patients. Of 103 strains isolated, 30 produced beta-glucuronidase. Twenty-five of the patients had at least one beta-glucuronidase-producing strain in the bile. All 26 strains of Escherichia coli were producing the enzyme. Both strains in the Bacteroides fragilis group and one out of two strains of Clostridium perfringens were producing beta-glucuronidase. The activity of the bacterial beta-glucuronidase was found within the pH range of the bile in these patients. A relationship between the presence of beta-glucuronidase-producing bacteria in the bile and pigment gallstone is suggested.

Bacterial growth in the duodenum and in the bile of patients with gallstone disease treated with endoscopic papillotomy (EPT).

Bacterial growth in the duodenum and in the bile was studied in 30 patients treated by endoscopic papillotomy (EPT) for stones in the common bile duct. Duodenal sampling was done endoscopically with a microbiology specimen brush, and bile was collected from the common bile duct using a catheter designed to avoid contamination from other sources. The same type of fecal flora was found in the duodenum and in the bile. The majority of patients had more than one strain in the duodenum as well as in the bile. Strains belonging to the Enterobacteriaceae and fecal streptococci dominated. Anaerobes were found in the duodenum in 27.7% of the patients, and in the bile in 16.7%. The heavy bacterial infestation of the common bile duct in our patients did not give rise to clinical symptoms.

Acquired immunodeficiency syndrome (AIDS). Clinical, immunological, pathological, and microbiological studies of the first case diagnosed in Norway.

The first case of acquired immunodeficiency syndrome (AIDS) in Norway, diagnosed in January 1983, is presented, with results of clinical, immunological, and microbiological studies and the results of autopsy. Immunological studies showed several immunological abnormalities, including a profound deficiency of the T-cell system of the type usually associated with AIDS. During the 11 months of symptomatic disease the patient had a series of opportunistic infections, including recurrent candida esophagitis, probable Pneumocystis carinii pneumonia, and severe and recurrent perioral Herpes simplex virus infection. During the last months he had increasing signs and symptoms of disseminated cytomegalovirus infection, which was probably the major cause of death, as revealed by autopsy. Autopsy also showed the presence of disseminated infection with a slowly growing, so far unclassified Mycobacterium species, and signs of a focal aspergillus pneumonia.

Comparison of the in vitro activity of azlocillin and carbenicillin against 856 clinical bacterial isolates.

Eight hundred and fifty-six strains of more than ten species: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Escherichia coli, Klebsiella spp, Proteus mirabilis, Proteus vulgaris, Enterobacter spp, Pseudomonas spp and Acinetobacter spp, were tested by the disc diffusion method against azlocillin and carbenicillin. Azlocillin was found to be superior to carbenicillin against Pseudomonas spp, and more than 90% of the tested strains had minimal inhibitory concentration (MIC) values well below the serum levels attainable after recommended doses of azlocillin. Against Enterobacteriaceae and Gram-positive cocci, however, azlocillin seemed to have little to offer.

Prevalence of cytomegalovirus antibodies in Norwegian kidney-transplant recipients and their living donors. A comparative study of two different methods.

376 sera from Norwegian kidney-transplant recipients and their living, related donors, were tested for the presence of cytomegalovirus antibodies (CMV-ab) by the complement fixation test (CF), and for IgG CMV-ab by the enzyme-linked immuno-sorbent assay (ELISA). Whenever the results of the two methods differed, the sera were also tested by the indirect fluorescence antibody test (FAT). 325 of 376 sera showed corresponding results, giving a concordance of 86 per cent between CF and ELISA, ELISA being the more sensitive of the two, with a sensitivity in the same range as FAT, and high specificity with only 0.3 per cent false positive results. The prevalence of CMV-ab in Norwegian kidney-transplant recipients and their living, related donors, differed very little. The overall CMV-ab seropositivity was 76 per cent. The prevalence increased from 50 per cent at the age of 20 years, to 80 per cent at 30 years and 90 to 100 per cent from 60 years of age.

A comparison of the in vitro activity of a new cephalosporin, cefuroxime, and cephalothin against 810 clinical isolates.

810 strains of eight species: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Escherichia coli, Klebsiella sp, Enterobacter sp, Proteus mirabilis and Proteus vulgaris, were tested by the disc diffusion method against cephalothin and cefuroxime. The activity of the two drugs was comparable to S aureus and S epidermidis, and a little in favour of cefuroxime regarding S faecalis. Cefuroxime turned out to be superior to cephalothin against the gram negative rods investigated. This pattern was most pronounced when Enterobacter was investigated.

Effects of cloxacillin, doxycycline, fusidic acid and lincomycin on the mechanical properties of bone and skin in young rats.

The influence of cloxacillin, doxycycline, fuside acid and lincomycin on the mechanical properties of bone and skin in young rats was examined. The concentrations of the antibiotics in plasma corresponded to therapeutic levels in man. After 14 days of medication the weights of the rats receiving cloxacillin or doxycycline were significantly less when compared with the controls. The doxycycline, the fusidic acid and the lincomycin treated rats had reduced longitudinal growth of femur and reduced tensile strength of intact skin. No differences between any of the antibiotic groups and the control group were found in the tensile strength of incisional skin wounds or in the mechanical properties of the femur and tibia.