Measles seroprevalence and vaccine response in HIV-infected adults.

Measles in HIV-infected patients can be a severe, even fatal, illness. The prevalence of measles seropositivity in HIV-infected adults and the durability of these antibody levels are uncertain. A prospective survey of 210 HIV-infected adults found that 95% of the adults had demonstrable antibodies using a standard ELISA technique. Seropositivity was no different in patients with CD4 counts over 400, from those with more advanced disease and CD4 counts under 200 (p = 0.8). Six seronegative patients were vaccinated and had serial antibody determinations: two of six (33%) patients had a durable positive antibody response at 1 year, and none had any observed toxicity. Vaccination of the identified measles-seronegative HIV-infected adults who are at high risk for measles is recommended, but a measurable antibody response may be expected in only a minority of cases.

Varicella immunity and clinical disease in HIV-infected adults.

Varicella is an infrequent but potentially severe infection in adult HIV-infected patients. We reviewed five cases of varicella in HIV-seropositive men; two were complicated by severe headache and meningismus, and one of these patients also had hepatitis and thrombocytopenia. All five patients responded well to acyclovir therapy, but one patient had dermatomal zoster 2 years later, and another failed to have detectable antibody after infection. We also performed a serosurvey on 181 consecutive HIV-infected patients presenting themselves for evaluation. A total of 95% of these patients had demonstrable antibody to varicella-zoster virus. Immune status to varicella did not correlate with the declining CD4 count, which was well preserved even in patients with fewer than 200 CD4 cells/mm3.

The Rhino-Probe nasal curette for detecting respiratory syncytial virus in children.

During two outbreaks of respiratory syncytial virus (RSV) infection, 68 children with acute respiratory illnesses were cultured for RSV using a Rhino-Probe (RP) nasal curette and either a nasopharyngeal (NP) swab or a nasal wash (NW). In the first outbreak isolations of RSV by the RP nasal curette and NP swab methods were compared. RSV was cultured from 25 of 42 (60%) subjects using the RP nasal curette and from 20 of 42 (48%) subjects using the NP swab. In the second outbreak the RP nasal curette and the NW collection techniques were compared. RSV was isolated from 15 of 26 (58%) children evaluated. RSV was cultured from 14 of 15 (93%) patients by RP and 13 of 15 (87%) when using NW. In the group of culture-positive subjects, the TESTPACK RSV rapid antigen test was positive in 10 of 15 (67%) using the RP and in 6 of 15 (40%) using the NW. Like the NP swab the RP nasal curette was simple, noninvasive and relatively inexpensive, yet it was as sensitive as the NW for detection of RSV.

Adenomatoid tumor of testicle.

A rare case of intratesticular adenomatoid tumor is described. Pathologically and clinically this tumor is associated with the seminiferous tubules and the rete testis. The patient underwent left inguinal exploration to confirm the testicular tumor. A radical orchiectomy was performed. We believe this is the first case of documented intratesticular adenomatoid tumor that did not arise from either tunica albuginea or epididymis. The cytologic origin of adenomatoid tumors and an unusual finding of decreased spermatogenesis with marked atrophy of the testes are also presented.

Review of testing for human immunodeficiency virus.

The performance of HIV testing requires meticulous attention to preanalytic, analytic, and postanalytic variables, especially matters of patient confidentiality. Laboratory directors must pay strict attention to quality control and quality assurance practices. Careful attention to these considerations can produce a screening program in low-prevalence populations that has an extremely low false-positive rate, with a positive predictive value of greater than 99%. Issuing a clear and concise laboratory report to the clinician is important. The Fifth Consensus Conference on Testing for Human Retroviruses of the Association of State and Territorial Public Health Laboratory Directors, March 1990, has recommended that ELISA be reported as reactive or nonreactive; IFA as reactive, nonreactive, or nonspecific, and WB as reactive, nonreactive, or indeterminate. It is recommended that the terms positive and negative be reserved for the summary interpretation given at the conclusion of the HIV-1 antibody testing algorithm. The testing algorithm used for HIV antibody screening at Scripps Clinic is shown in Figure 3. Other algorithms for complete testing on a single sample only or on two separate samples are reported. We agree with others that the patient should not be counseled for infection with HIV until a reactive confirmatory test(s) establishes a positive diagnosis. Certain special situations in diagnostic testing deserve comment. Establishing the diagnosis of HIV infection can be difficult in seronegative persons with acute infection. Polymerase chain reaction, viral culture or antigen detection may be useful tests in this situation. However, careful interpretation of test results and close correlation with patient risk factors are important to establish the proper diagnosis. Reports of seronegative persons, some remaining seronegative over a protracted time, have raised concerns over the transfusional risk of HIV infection. Blood donor screening programs are using careful donor qualification and recruitment practices that, combined with antibody testing, are highly effective in minimizing the risk of transfusion-transmitted HIV infection. A recent study reported the odds of contracting HIV infection from transfusion as 1:153,000 per unit transfused. Current screening strategies have been estimated to allow 20.5 infected units per million donated units to be transfused in high-prevalence areas and 4.7 infected units per million donated units in low-prevalence areas. As these studies indicate, there is a very small but identifiable risk of HIV infection in recipients of blood or blood products screened negative by current practices. The laboratory director must be versed in the comprehensive recommendations related to prevention of HIV transmission by blood and blood products.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of the standardized disk diffusion and agar dilution antibiotic susceptibility test methods by using strains of Neisseria gonorrhoeae from the United States and Southeast Asia.

Presently, most Neisseria gonorrhoeae testing is based on beta-lactamase tests and agar dilution with common therapeutic agents. The National Committee for Clinical Laboratory Standards (NCCLS) recently described a disk diffusion test that produced results similar to the reference agar dilution method for the antibiotic susceptibility of N. gonorrhoeae. We obtained 71 gonococcal isolates from active-duty males aboard a United States Navy vessel while deployed in the Western Pacific during 1989. In addition, 47 isolates of N. gonorrhoeae were obtained from sexually transmitted disease clinics within the branch clinic operations of the Naval Hospital, San Diego (SD), and tested. Antibiotic susceptibility tests by using the NCCLS agar dilution and disk diffusion techniques were compared. Among the Southeast Asia (SEA) isolates, 47% were beta-lactamase producers compared with 10.5% of the SD isolates. The mean MICs (SEA/SD) in micrograms per milliliter for both groups were as follows: penicillin, 88/15; tetracycline, 2.2/0.95; erythromycin, 1.2/0.49; ceftriaxone, 0.016/0.012; cefotaxime, 0.034/0.03; cefuroxime, 0.44/0.17; cefoxitin, 1.3/0.97; spectinomycin, 150/131; ciprofloxacin, 0.07/0.034; norfloxacin, 0.77/0.29; lomefloxacin, 0.15/0.0.056; and ofloxacin, 0.07/0.036. The established NCCLS interpretive criteria for both susceptibility methods appear applicable to domestic gonococcal strains. However, modifications may be necessary for the more antimicrobial agent-resistant SEA isolates on the basis of the clinical success and cure rates following the indicated single-dose regimens for the geographic region.

Cat scratch disease associated with neuroretinitis in a 6-year-old girl.

Cat scratch disease is a subacute regional lymphadenitis usually preceded by a history of being scratched by a cat or young kitten. The spectrum of illness ranges from mild self-limited adenopathy to severe systemic disease, including hepatosplenomegaly, encephalopathy, osteolytic lesions, splenic abscesses, mediastinal masses, and neuroretinitis. Vision loss is a rare complication of the disease. The authors report a patient with cat scratch disease associated with acute febrile illness, lymphocytic meningitis, and acute vision loss secondary to neuroretinitis. To their knowledge, this is the first ophthalmic case reported in which the diagnosis is supported by both a positive skin test and positive histopathology.

Malignant schwannoma of the clitoris in a 1-year-old child.

A 1-year-old infant with von Recklinghausen's neurofibromatosis was seen because of increasing clitoral enlargement over a 7-month period. The mother, who also had neurofibromatosis, was treated 2 years beforehand for an acoustic neuroma. The child was treated by radical clitorectomy. Pathologic examination revealed malignant schwannoma, a tumor not previously described in this site. Vincristine, dactinomycin, and cyclophosphamide chemotherapy was given for 2 years to prevent local recurrence and metastatic spread. The child remains tumor free 2.5 years after diagnosis.

Changes of resistance of enteric bacteria in mice given tetracycline in drinking water.

Tetracycline given to mice via their drinking water for long periods changed the gram-negative enteric flora and increased the minimal inhibitory concentration of tetracycline for Proteus and Escherichia coli in the feces.

Effect of resistance possessed by certain enteric microorganisms upon orally inoculated Salmonella.

Mice shedding aerobic gram-negative microorganisms with high levels of resistance to tetracycline were orally inoculated with Salmonella typhimurium. Levels of resistance of salmonella isolated from tissue were shown not to be increased and, in most instances, were lower than preinoculation levels.