Changes in Toxoplasma diagnosis.

The serological laboratory workload in detecting toxoplasma infection may be expected to change with changes in the clinical profile of patient populations. We have examined the clinical information and laboratory results for patients referred to the Scottish Toxoplasma Reference Laboratory in April-March 1999-2000 and 2009-2010. Numbers of patient sera submitted for testing were similar (1624 and 1552) but there was a change in the clinical profile, with a significant fall in patients with symptoms of current infection (612 versus 335; P<0.0001) and a significant rise in immunocompromised patients (275 versus 531; P<0.0001). Although the percentage of patient samples with toxoplasma antibody decreased (53.9% versus 37.5%; P<0.0001), the number of positives increased with age, demonstrating the continuing risk of toxoplasma infection. More cases of current infection were identified in 2009-2010 than in 1999-2000 (48 versus 35). This increase was significant both for all females with current infection (P=0.0253) and also for those in the childbearing 20-39 years age group (P=0.0388). Our literature search did not find any published information on toxoplasma workload in the last decade. In summary, we have shown that there have been significant changes in the laboratory diagnosis of toxoplasma infection but it is as important as ever that effective diagnostic strategies are maintained.

More specific bands in the IgG western blot in sera from Scottish patients with suspected Lyme borreliosis.

AIMS: To identify further Western blot bands that may be specific in the diagnosis of Lyme borreliosis. METHODS: The Borrelia burgdorferi antibody profiles of 270 western blot positive patients and 241 western blot negative patients from 2008 were examined. RESULTS: 27 different non-specific bands were detected in both groups. Six of 27 (22%) of the non-specific bands were detected significantly more in the western blot positive patients compared to the western blot negative patients (20 kDa, p<0.0001; 28 kDa, p<0.002; 36 kDa, p<0.002; 37 kDa, p<0.007; 48 kDa, p<0.023; 56 kDa, p<0.028; two-tailed F test). CONCLUSION: Results suggest that the 20, 28 and 48 kDa bands should be regarded as specific.

Toxoplasma tachyzoites from cell culture are more appropriate in some situations.

BACKGROUND: Laboratories traditionally culture toxoplasma tachyzoites in animals for testing and experimental use. This article considers why available cell culture methods are not used more often. AIM: To compare HeLa cell culture and animal culture for production of toxoplasma tachyzoites. METHODS: In 2000 HeLa culture replaced animal culture for continuous production of toxoplasma tachyzoites in the Scottish Toxoplasma Reference Laboratory. The performance of animal culture (1994-1998) was compared with HeLa culture (2004-2008). A PubMed search was carried out for 1998 and 2008 to assess the culture methods used in laboratories. RESULTS: Animal culture was able to produce higher yields of tachyzoites (10(9) from a cotton rat peritoneal harvest compared to 10(7) from a 75 cm(2) cell culture flask) but significantly more HeLa cultures were successful (93% versus 84%; p=0.025). There was no difference in the quality of tachyzoites from animal and HeLa cultures as demonstrated by the high levels of success in the dye test. HeLa culture offered significant advantages in flexibility and control. A review of the literature showed no significant change in the method of culture used in laboratories between 1998 and 2008 (p=0.36). CONCLUSION: The availability of cell culture methods and the increasingly stringent regulations on the use of animals have not resulted in a decline in the use of animal culture. Animals are necessary for certain experiments but many studies could use cell-culture-derived parasites.

Learning to cope with chronic illness. Efficacy of a multi-component treatment for people with chronic fatigue syndrome.

OBJECTIVE: The aim of this study was to determine the efficacy of an out-patient, multi-component programme developed for patients with chronic fatigue syndrome (CFS). METHODS: Twenty-two patients were assessed before and after six months of treatment. Findings were compared with 22 individuals on the waiting list. The programme offered medical care as well as information and counselling to help patients to understand, accept and cope with their illness. RESULTS: At six months, there were significant differences between the groups for fatigue, self-efficacy and anxiety. Overall, 82% of the treated patients reported feeling better and 23% had improved to such a degree that they were discharged from the clinic. The gains were maintained at twelve months. CONCLUSION: This programme was found to be both helpful and acceptable and may provide a useful first-line intervention for many patients with CFS. PRACTICE IMPLICATIONS: Short, pragmatic programmes may be as effective as cognitive-behaviour therapy.

Comparison of mumps-IgM ELISAs in acute infection.

BACKGROUND: In Scotland there has been an outbreak of mumps with over 4000 confirmed cases in the last 2 years. As laboratory diagnosis is usually requested on patients with symptoms, a prompt diagnosis early in the illness is required. OBJECTIVES: To assess the performance of the five different commercial IgM-ELISAs used in Scottish Virus laboratories. STUDY DESIGN: The Specialist Virology Laboratory (SVC) Edinburgh distributed a serum panel to all Scottish laboratories that diagnose mumps by IgM-ELISA. The panel consisted of 45 sera from patients with confirmed mumps (date of onset known for 44/45) and 11 sera from patients with alternative diagnoses. Each laboratory performed their own commercial IgM-ELISAs blindly and reported results to the SVC Edinburgh. RESULTS: Sensitivity ranged from 24% to 51%. Assays performed better on samples taken later than 10 days after onset of symptoms. Specificity was about 82% for most assays. CONCLUSION: The sensitivity of commercial mumps IgM-ELISAs varied greatly. The Microimmune mumps-IgM ELISA had the best overall sensitivity in acute serum specimens. Diagnostic laboratories should be developing the means to perform direct detection of mumps virus for acute presentation and requesting convalescent bloods, if acute blood samples have no detectable IgM.

Audit of the laboratory diagnosis of Lyme disease in Scotland.

An audit was performed on the laboratory diagnosis of lyme disease in Scotland. The problem of a significant number of patients with clinical symptoms of lyme disease being reported as seronegative or equivocal by the confirmatory Western blot test was identified. Comparisons of current practice were made with American and European standards, and the Western blot scoring system revised. When applied retrospectively (April 2003 to March 2004), 39 (33 %) of 116 serum samples previously negative or equivocal became weak positive or stronger. Thirty-one (80 %) of these 39 samples were from patients with clinical details suggestive of early lyme disease. The changes were implemented and assessed prospectively for 6 months. There was a significant increase in the proportion of equivocal results, with fewer negatives compared to the same time period 1 year previously. This audit has helped clinicians in the diagnosis of lyme disease and the management of these patients in Scotland.