Delay in B-lymphocyte recovery and function following rituximab for EBV-associated lymphoproliferative disease early post-allogeneic hematopoietic SCT.

Treatment with rituximab is highly effective for EBV-associated post transplant lymphoproliferative disease. However, little is known about its immunological sequelae in pediatric allogeneic hematopoietic SCT (HSCT). Time to normal CD19+ B-lymphocyte values in blood and intravenous immunoglobulin (IVIG) substitution needed to maintain an IgG>400 mg per 100 ml in six consecutive pediatric allogeneic HSCT patients treated with rituximab for symptomatic EBV reactivation were compared with a matched cohort of non-rituximab-treated patients. Follow-up of the six patients ranged from 149 to 1546 days; all but one survived. The mean (+/-s.d.) time to recovery of CD19+ B-lymphocytes was 353+/-142 days as compared with 139+/-42 in the controls (P<0.01). Similarly, substitution of IVIG as a measure of functional B-cell recovery was extended from a mean of 122+/-45 to a mean of 647+/-320 days, and the cumulative dose of IVIG increased from a mean of 1.86+/-0.51 to 4.4+/-0.97 g/kg, respectively (P<0.05). One patient had functional B-lymphocyte deficiency for >3 years and ultimately required two stem cell boosts. Rituximab is a live-saving treatment for pediatric HSCT patients but may lead to prolonged and even persistent B-cell deficiency.

Viral reactivation is not related to septic complications after major surgical resections.

Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t-tests and Chi2-tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications.

Evaluation of two enzyme immunoassays for detection of human rotaviruses in fecal specimens.

The two assays evaluated in this study (the Ridascreen rotavirus and the Pathfinder rotavirus) exhibited comparable sensitivities (100%) but highly divergent positive predictive values (93.74 and 57.7%, respectively) when compared on 393 specimens. This difference should be considered when using these tests on collectives with an unknown or low prevalence.

Replication-competent herpes simplex virus type 1 mutant expressing an autofluorescent glycoprotein H fusion protein.

The heterocomplex of glycoproteins H (gH) and L (gL) of herpes simplex virus type 1 (HSV-1) is essential for viral infectivity and is involved in viral penetration, cell-to-cell spread, and syncytium formation. We constructed an HSV-1 mutant expressing a gH-EGFP (enhanced green fluorescent protein) fusion protein under the control of the gH true late promoter. The EGFP coding sequence was cloned after the gH signal peptide into the HSV-1 genome. Superinfection of transfected, gH-nontranscomplementing cells with gH-negative HSV-1 resulted in a replication-competent recombinant virus. Cells infected with the recombinant virus exhibited strong and stable EGFP-specific fluorescence late in infection, and autofluorescence was detected in purified virions. The recombinant genotype of the mutant was confirmed by PCR. The 140-kD gH-EGFP fusion protein showed an N-linked glycosylation pattern similar to gH-1, was recognized by the conformation-dependent gH-specific monoclonal antibodies 52S and LP11 and formed a heterocomplex with gL which was transported to the cell surface and integrated into the viral envelope. Infectivity of the gH-EGFP mutant was neutralized by antibodies 52S and LP11. To our knowledge, this is the first replication-competent HSV-1 mutant expressing an autofluorescent essential glycoprotein which will be a versatile tool for studies of penetration, late gene expression, transport and tissue spread.

Detection of human serum antibodies against type-specifically reactive peptides from the N-terminus of glycoprotein B of herpes simplex virus type 1 and type 2 by surface plasmon resonance.

A single-step surface plasmon resonance protocol for the detection of antibodies against herpes simplex virus type 1 and type 2 (HSV-1, HSV-2) in human sera was established using the BIAcore system. Two peptides from corresponding segments of the N-terminus of HSV-1 and HSV-2 glycoprotein B (gB), i.e. peptide gB-1 (60-73) (GAAPTGDPKPKKNK) and peptide gB-2 (55-68) (SPATTKARKRKTKK), were identified as immunogenic. Employing both peptides as diagnostic antigens in the surface plasmon resonance assay, a sensitivity for the detection of HSV-1 and HSV-2 type-specific antibodies of 83 and 86%, respectively, was achieved as compared with immunoblotting as a reference method. Peptide gB-1 (60-73) allowed the discrimination between HSV-1 and HSV-2 type-specific antibodies with a specificity of 67%, whereas peptide gB-2 (55-68) reacted in a strictly HSV-2 type-specific manner. It is concluded that peptides from the N-terminus of gB-1 and gB-2 are recognized predominantly by human sera in an HSV-specific manner. Peptide gB-2 (55-68) can be employed successfully for the determination of type-specific antibodies against HSV-2.

Long-term persistence of immunoglobulin A (IgA) and IgM antibodies against human cytomegalovirus in solid-organ transplant recipients.

The retrospective analysis of 494 solid-organ transplant recipients revealed that during the follow-up period (mean duration, 3.2 years) 184 (88%) of 209 anti-human cytomegalovirus (HCMV) immunoglobulin A (IgA)-positive patients remained IgA positive, as did 128 (74.85%) of 171 anti-HCMV IgM-positive patients. We conclude that anti-HCMV IgA and IgM testing for management of clinically relevant HCMV infections in solid-organ transplant recipients is dispensable.

Comparison of Roche Cobas Amplicor Mycobacterium tuberculosis assay with in-house PCR and culture for detection of M. tuberculosis.

The new Roche Cobas Amplicor Mycobacterium tuberculosis assay, which is a semiautomated version of the manually performed Roche Amplicor M. tuberculosis test, was compared to culture and an IS6110-based in-house PCR protocol. A total of 1,681 specimens from 833 patients, including specimen types other than sputum, were tested in parallel by both the in-house PCR and the Cobas Amplicor M. tuberculosis assay. After we resolved discrepant PCR results, the sensitivity, specificity, and positive and negative predictive values for the Cobas Amplicor M. tuberculosis assay were 66.33, 99.71, 94.36, and 97.66%, respectively. The corresponding values for the in-house PCR were 91.08, 99.85, 97.87, and 99.37%, respectively. For culture- and smear-positive specimens, the sensitivity of the Cobas Amplicor M. tuberculosis test was 96.42% (in-house PCR, 100%). If only smear-negative sputum specimens were considered, the Cobas Amplicor M. tuberculosis assay exhibited a sensitivity of 45.45% (in-house PCR, 63.63%) relative to that of culture. With a modified protocol for DNA extraction (washing of samples plus ultrasonication), both PCR methods performed better with gastric aspirates than with sputum samples (sensitivity of the Cobas Amplicor M. tuberculosis assay with smear-negative gastric aspirates, 70.00%; sensitivity of in-house PCR, 90.00%). With dithiothreitol being used for liquefaction of specimens in this study, the Cobas Amplicor M. tuberculosis assay exhibited an inhibition rate of 9.16%. In our view, the new Cobas Amplicor M. tuberculosis test (i) is well suited for typing of smear-positive specimens, (ii) may also be applied to gastric aspirates and other types of specimens if DNA extraction methods are modified appropriately, and (iii) exhibits a sensitivity with smear-negative sputum specimens which makes it recommendable that a minimum of three samples from the same patient be tested.

Detection of Cryptosporidium parvum in human feces by PCR.

C. parvum has a high pathologic potential also for man, especially for immununosuppressed patients. The microscopic detection of cysts in feces is neither easy nor always reliable. During the recent years, considerable progress has been achieved in establishing PCR-based approaches for i) sensitive detection of C. parvum in a variety of specimen types [3, 9-16, 18, 21, 24, 25, 27, 29-32, 34], ii) identification of individual genotypes of C. parvum [2, 4-7, 17, 19, 20, 22, 23, 26, 28, 33] and iii) viability testing of C. parvum organisms [8, 9, 13, 29, 30]. The protocols published so far include nested PCR [3, 8, 18, 34], RT-PCR [13, 29], and use of the UNG carryover prevention system [10]. The aim of this work was to establish a PCR system for the detection of C. parvum oocysts in stool samples, applying the same specimen preparation procedure as applied for immunofluorescence. In addition, we combined the UNG carryover prevention system with the use of long, PCR-generated digoxigenin-labelled probes, thus achieving a sensitivity comparable to nested PCR und circumventing the contamination risks associated with nested PCR protocols. We developed a simplified sucrose-cushion-based protocol for preparation of clinical specimens (adopted from [1]), satisfying both the needs of immunofluorescence and PCR. When tested with stool samples spiked with C. parvum oocysts, the analytical sensitivity of PCR was 3,500 oocysts/ml stool (immunofluorescence: 3,000 oocysts/ml stool), demonstrating that both methods were equivalent with respect to analytical sensitivity. However, when PCR and immnunofluorescence were applied to clinical samples (n=5) with known positivity for C. parvum, only the specimen with the shortest duration of storage (5 weeks) could be correctly identified by PCR (clinical sensitivity: 20%). Our results demonstrate, that the PCR approach presented in this work is not suited for highly sensitive detection of C. parvum in faeces. This was mainly due to the fact that sucrose-gradient purified material was used, which relies on the presence of morphologically intact oocysts in the specimens. Desintegration of oocysts by excystation and/or storage may lower the parasite yield of the protocol drastically. As a consequence, a protocol extracting the entire DNA from faeces should be used for PCR for detection of C. parvum [34].

Quantitation of human cytomegalovirus genomes in the brain of AIDS patients.

Human cytomegalovirus (HCMV) is one of the major pathogens causing neurologic disease in the immunocompromised host. A competitive nested polymerase chain reaction (PCR) was used to determine DNA load, distribution, and sequence variability of HCMV genomes in the brain of AIDS patients with and without HCMV encephalitis confirmed by histology and immunocytochemistry. By quantitative PCR, HCMV genomes were found to be distributed diffusely in the central nervous system (CNS) of all five patients with histologically proven HCMV encephalitis, but also in the brain of five of eight AIDS patients without neuropathological evidence of HCMV encephalitis. The viral DNA load in cases with HCMV encephalitis was increased 10- to 1,000-fold as compared to patients without evidence of encephalitis. A viral load above 6,000 copies HCMV/10(6) copies beta-globin was found to be highly suggestive for HCMV encephalitis. Characterization of PCR products by temperature gradient gel electrophoresis (TGGE) and direct sequencing allowed us to detect a sequence variability of the amplified fragment of HCMV glycoprotein B (gB) among different patients, but also among different HCMV foci within the same patient. Furthermore, two of five AIDS patients with HCMV encephalitis most likely experienced double infections with different HCMV strains. The experimental procedure described in this study should also be applicable to the detection of significant HCMV DNA levels in biopsy samples.

Neutralizing activity of antibodies against the major herpes simplex virus type 1 glycoproteins.

The specificity and neutralizing activity of antibodies against the major herpes simplex virus type 1 (HSV-1) glycoproteins were tested in serum samples of patients with a history of HSV-1 infection. By preabsorption of sera to preparations of native and denatured HSV-1 proteins, followed by immunoblotting and microneutralization, it was shown that the majority of neutralizing antibodies are directed against denaturation-sensitive epitopes. Furthermore, preabsorption of sera to proteins of viral ts and deletion mutants revealed that antibodies specific for gB, gC, and gE had a low neutralizing activity. These results suggest a major role of anti-gD in neutralization of viral infectivity. In addition, it was shown that antibodies directed against the gB monomer were distinct from antibodies against the gB homodimers. The latter, however, did not reveal any measurable neutralizing activity.

Removal of N-linked carbohydrates decreases the infectivity of herpes simplex virus type 1.

Purified preparations of herpes simplex virus type 1 Angelotti were digested with the exoglycosidases sialidase, beta-galactosidase, N-acetyl-beta-D-glucosaminidase and alpha-mannosidase, and with the endoglycosidases Endo-H and Endo-F. It was found that treatment of virions with Endo-F specifically decreased viral infectivity by a factor of 10. This reduction in titre was not associated with any measurable differences in virus adsorption, suggesting a role of N-linked complex type oligosaccharide chains in penetration. In contrast, a reduction in titre observed upon digestion of virions with exoglycosidases could be attributed to a proteolytic contamination in these enzyme preparations. Treatment of virions with Endo-H, demonstrated to be free of proteolytic contamination, did not reduce viral infectivity. Analysis of endoglycosidase-digested virions by monospecific antibodies and immunoblotting revealed a susceptibility of all four major glycoproteins (gC, gB, gE and gD) to Endo-F, but only gB was susceptible to Endo-H treatment. In contrast, of all the exoglycosidases used only sialidase was found to be active towards native viral glycoproteins. Upon analysis of endoglycosidase-digested virions we could not find any evidence for proteolysis, degradation or altered protein composition of viral envelopes. In contrast, vigorous inhibition of glycoprotein glycosylation by tunicamycin led to the formation of physically intact virions almost completely lacking all major glycoproteins. These data show that digestion of intact virions with glycosidases allows an analysis of the functional relevance of carbohydrate residues without any obvious alterations in the virion glycoprotein composition.