Serum beta 2-microglobulin and human immunodeficiency virus infection.

Serum beta 2-microglobulin (beta 2-M) was measured in two prospectively evaluated groups of homosexual men in 1983 and 1985. Serum beta 2-M was raised in 64% of patients with HIV infection, but in only 6.7% of uninfected homosexuals. Depression of the total lymphocyte count was only clinically useful when it reached less than 1.0 X 10(9)/l. In further studies all patients with AIDS and AIDS-related complex (ARC) had raised levels of serum beta 2-M. Mean levels of beta 2-M did not differ between patients with persistent generalized lymphadenopathy (PGL) and asymptomatic HIV-infected patients. Raised serum levels of beta 2-M accompanied major immune dysfunction in HIV infection. Serum beta 2-M levels of greater than 3.0 mg/l in HIV-infected homosexual men were associated with progression to AIDS.

Hepatitis B virus reactivation or reinfection associated with HIV-1 infection.

Following acute hepatitis B virus (HBV) infection, most individuals develop antibodies to HBV surface (anti-HBs) and core antigen (anti-HBc). Prevalence studies have shown that 10-18% develop anti-HBc in the absence of detectable anti-HBs. We report four such cases, all with persistence of serum anti-HBc, who had evidence of a second period of active HBV replication as demonstrated by the reappearance of serum hepatitis B surface antigen (HBsAg). In one patient, an HBsAg subtype difference indicated that the second period of HBsAg-positivity was due to a reinfection. In the other cases, reactivation may also explain the findings. All cases were anti-HIV-1 seropositive at the time of reappearance of HBsAg. There is experimental evidence that anti-HBc has a protective effect against HBV infection; however, this may require intact cell-mediated immunity to be effective. HIV-1 infection may render such patients susceptible to reinfection. Alternatively, some patients with anti-HBc, but without detectable anti-HBs may have latent HBV infection. Immunosuppression associated with HIV-1 infection may allow reactivation.

Routine use of counter-immunoelectrophoresis test for detecting antibody to hepatitis B virus core antigen.

Tests by counter-immunoelectrophoresis for antibody to hepatitis B core antigen (anti-HBc) were introduced into a routine testing programme for evidence of hepatitis B virus infection. Samples tested for anti-HBc were selected on the basis of the results of tests for HBsAg and clinical details. The sensitivity and specificity of the test were assessed and correlations made with the presence of HBsAg. The presence of anti-HBc was very useful in the interpretation of a doubtful positive result for HBsAg in the haemagglutination test. With very few exceptions the serum samples positive for HBsAg by routine tests also contained anti-HBc. It is concluded that the test is valuable and merits introduction into routine testing programmes.

Serological studies on 40 cases of mumps virus infection.

The results of serological study of 40 cases of mumps virus infection are presented. Mumps virus was isolated from 20 of the patients studied and antibodies to the V antigen, the S antigen, and the haemagglutination antigen were performed in all cases. Analysis of these results shows that estimation of all three types of antibody is necessary to confirm the diagnosis in the maximum number of instances and that the long-accepted view that a characteristic pattern of antibody response is typical of the acute illness (namely, anti-S appearing earlier and in greater titre than anti-V) is questionable.

Serum beta 2-microglobulin and C reactive protein concentrations in viral infections.

Serum beta 2-microglobulin concentrations were assayed in a number of virus diseases. Infectious mononucleosis, cytomegalovirus, and influenza A were associated with pronounced increases in serum beta 2-microglobulin concentration. Smaller increases, with values generally less than 4 mg/l, were noted in other viral infections. Apart from in acute influenza A, the C reactive protein and beta 2-microglobulin responses were not associated.

Isolation of chlamydiae in untreated and Cytochalasin B treated McCoy cells.

A comparison was made between untreated McCoy cells and McCoy cells treated with Cytochalasin B for the isolation of chlamydiae of subgroup A. Chlamydiae were isolated in both cell systems from 125 specimens, whereas six agents were isolated only in untreated cultures and seven agents were isolated only in Cytochalasin B treated cultures.

Enzyme-linked immunosorbent assay for the detection of human rotavirus in stools.

A simple method for the detection of human rotavirus in stools is described, using a double antibody sandwich enzyme-linked immunosorbent assay. Polysterene microtitre plates were used as solid phase. Four capture antibodies were tried, bovine, egg-derived, guinea pig and monoclonal antibody to rotavirus. Both bovine and egg-derived antirotavirus labelled with horseradish peroxidase were used as the detecting antibodies. The results obtained were compared with a commercially available ELISA, Rotazyme (Abbott Laboratories), and also with the direct detection of rotavirus by electron microscopy. Bovine antibody was found to be an unsuitable capture antibody due to non-specific false positive reactions.

Prevalence of hepatitis B markers in patients and staff in a hospital for the mentally handicapped.

Patients and staff at a hospital for the mentally handicapped were screened for markers of infection with hepatitis B virus. Of 436 patients, 14 (3.2%) were carriers of hepatitis B surface antigen (HBsAg), of whom four were carriers of hepatitis B e antigen (HBeAg) and were considered to be 'infectious'. One-quarter of the patients had markers of hepatitis B infection. Males were four times more likely to have markers than females; and 13 of the 14 carriers of HBsAg were male. Patients with Down's Syndrome (DS) were six times more likely to be HBsAg positive, but were not more likely to have markers of infection than other patients. Phenytoin therapy did not predispose to carriage of HBsAg. Of 439 staff members, 26 (5.9%) had markers of hepatitis B infection. It was not considered that staff were at increased risk of infection with hepatitis B virus at the hospital, and that post-exposure prophylaxis for hepatitis B should continue. It is suggested that patients with DS who are not immune to hepatitis B should be offered immunization.

Effect of a vaccination programme on the distribution of rubella antibodies in women of childbearing age.

Results of routine rubella hemagglutination-inhibiting antibody tests on 39,005 serum samples showed that 9-5% of women of childbearing age in the Leeds region were seronegative, and a further 9-2% had low antibody titres of 1/8 or 1/16. Since routine rubella vaccination of schoolgirls began in 1970 the frequency of seronegative women in the fifteen to nineteen year age group has fallen by 5-7%. Clinical rubella was confirmed serologically in 140 women, 58 of whom were pregnant. 30 of these pregnancies were terminated, 2 resulted in spontaneous abortions, and 26 proceeded to term. One infant had congenital rubella.

Hazardous incidents and immunity to hepatitis B.

In the period March 1989 to October 1990, Leeds Public Health Laboratory received reports of 2975 needlestick and similar incidents involving National Health Service staff where there was a risk of transmission of hepatitis B virus. Despite an active immunisation programme in the hospitals where staff worked, 50% of those involved showed no evidence of immunity. In reviewing their immunisation programmes, health authorities should take account of those groups of staff who are at risk of exposure and ensure that all those included in the programme are encouraged to take up the offer of immunisation.

Cytomegalovirus infection and Alzheimer's disease.

Serum antibody titres to cytomegalovirus (CMV) were measured in 113 patients with Alzheimer's disease (AD), and 39 non-demented controls suffering from chronic functional psychoses. AD patients and controls had similar CMV antibody titres, and conventional CMV activity was not detected in post-mortem samples from eight AD patients. It is therefore unlikely that the CMV play any causal role in most cases of AD. The possession of the histocompatibility antigen HLA-B15 was significantly correlated with raised levels of CMV antibody in the AD patients, which suggests that HLA-B15 may be associated with an enhanced immune response to CMV.

Rubella vaccination and anti-D immunoglobulin administration in the puerperium.

The serum conversion rates and post-vaccination rubella haemagglutination inhibiting antibody titres of a group of women given both anti-D immunoglobulin and rubella vaccine in the puerperium have been compared with those of a similar group of patients who were given vaccine but no immunoglobulin. The serological response to rubella vaccination in susceptible women was satisfactory even when anti-D immunoglobulin was given shortly before vaccination.

A sero-epidemiological study of conventional infectious agents in Alzheimer's disease.

Serum antibody titres to Adenovirus, Chlamydia Group B, Coxiella burnettii, Cytomegalovirus, Herpes simplex virus, Influenza A, Influenza B, Measles and Mycoplasma pneumoniae were measured in 33 patients with a clinical diagnosis of Alzheimer's disease, and in 28 non-demented controls suffering from functional psychiatric disorders. No statistically significant differences were found between the patients and controls, and it is concluded that these agents play no role in the aetiology of Alzheimer's disease.

Viral antibodies and chronic liver disease.

Serum rubella, measles and cytomegalovirus antibodies were measured in patients with various forms of chronic liver disease and compared with those in age-matched controls. In CAH all three antibodies were found in significantly greater titre than in controls,and in cryptogenic cirrhosis titres to rubella were significantly increased. In alcoholic cirrhosis none was increased. There was no correlation between antibody titres and either the presence of portal-systemic shunts or the use of steroids. In patients with CAH measles titres were significantly related to the presence of ANF and SMA.

Rubella-neutralizing and haemagglutinin-inhibiting antibodies in children of different ages.

Rubella neutralization and haemagglutinin-inhibition tests were used to determine the incidence of rubella antibodies in the sera of 235 children and adolescents aged 1 month to 20 years. The tests showed good agreement in the detection of rubella antibodies resulting from acute infection. Maternal antibodies became undetectable within six months after birth. The proportion of children possessing rubella antibodies was found to be about 23% by the age of 5 years, rising sharply to 80% in the 6-12 years age group and 83% in the 13-20 years age group. Results indicate that the incidence of rubella infection may be higher in females than in males. The correlation between statements concerning a past history of rubella and immune status was poor, particularly in the older age groups. Any policy for vaccination against rubella must take into account the difficulties of identifying nonimmune persons in a large population.