Epstein-Barr virus reactivation and multiple sclerosis.

Infection with Epstein-Barr virus (EBV) is considered one of the possible key environmental factors in the aetiology of multiple sclerosis (MS). Whether EBV plays an underlying role as an activator of MS remains, however, controversial. Sixty-one patients with definite relapsing-remitting multiple sclerosis (RRMS) according to the Poser criteria were followed for 1 year. Blood samples were drawn at baseline, months 3, 6 and 12, and in case of any clinical exacerbation. Twenty-three baseline-paired exacerbation samples in the same set were quantitatively analysed to examine whether exacerbations in MS were associated with a change in anti-diffuse component of the EBV-early antigen (EA-D) IgG ratio. All the 61 patients (100%) were anti-viral capsid antigen (VCA) IgG positive, one (2%) was anti-VCA IgM positive and 60 (98%) were anti-EBV nuclear antigen IgG positive. Mean anti-EA-D IgG at baseline was 0.57 (range 0.12-2.70) and at the time of exacerbations 0.61 (range 0.11-2.70). Wilcoxon signed rank test revealed no differences between the 23 baseline and paired exacerbation samples (P = 0.58). Our findings suggest that reactivation of latent EBV infection does not play a significant role for exacerbations in RRMS.

Changing trends in genital herpes simplex virus infection in Bergen, Norway.

AIM OF STUDY: To document the proportion of each herpes simplex virus (HSV) type in genital HSV infection and changes over time during a 10 year period. DESIGN: Retrospective comparative study in sexually transmitted disease (STD) patients with genital HSV infection at the outpatient clinic for STD, Haukeland Hospital, Bergen, Norway. RESULTS: HSV-2 was the major cause during the 80's, whereas HSV-1 constitutes a greater part of the cases during the 90's, especially in female patients and in the younger age groups with primary or initial disease, where HSV-1 is the causative viral type in up to 70-90% of the cases. CONCLUSION: The documented change from HSV-2 towards HSV-1 in cases of genital HSV infection may have implications as to prognosis, future usefulness of vaccines, present and future usefulness of new type-specific serological tests.

Clinical cowpox cases in Norway.

In 1994, a human and a feline case of cowpox virus infection appeared in the western part of Norway. Cowpox has not been diagnosed with certainty in Norway since the beginning of this century, when it was associated with the use of cowpox virus as a vaccine against smallpox. The human infection manifested as a spontaneously emerged, severe ulceration at the medial angle of the right eye in a 37-y-old woman, and developed into a relatively severe dermatitis. The ulcer healed slowly, leaving a scar. The feline infection was represented by a febrile, dehydrated and anorectic 6-months-old non-pedigree short-hair, with crater-like ulcers all over the body. After antibiotic and fluid therapy, revision of the skin lesions and amputation of a gangrenous toe, the cat recovered. Electron microscopy of the isolates and cultivation of virus on chorioallantoic membrane of chicken embryos confirmed the suspicion of cowpox virus infection.

Altered antibody pattern to Epstein-Barr virus but not to other herpesviruses in multiple sclerosis: a population based case-control study from western Norway.

OBJECTIVE: The prevalence of anti-EBV antibodies was studied in a group of 144 patients with multiple sclerosis and 170 age, sex, and area matched controls from the county of Hordaland, western Norway. The prevalence of three other herpesviruses, herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV), were also included. METHODS: Antibodies to various virus antigens were determined by enzyme linked immunosorbent assay (ELISA) and indirect immunfluorescence (IIF) in serum samples from 144 patients with multiple sclerosis and 170 controls. RESULTS: All of the 144 patients with multiple sclerosis had IgG antibodies to EBV compared with 162 of 170 controls (p=0.008). The frequency of IgG antibodies to EBV capsid antigen (VCA), nuclear antigen (EBNA), and early antigen (EA) was significantly higher in patients with multiple sclerosis compared with the controls (p<0.000001, p=0.01, and p<0.0001 respectively). The presence of antibodies was independent of the initial course of the disease and the disease activity at the time of blood sampling. The prevalence of IgG antibodies to HSV, CMV, and VZV did not differ between cases and controls. CONCLUSION: The results suggest a role for EBV in the aetiology of multiple sclerosis.

[A case of cowpox]. / Et tilfelle av kukopper.

A 37-year-old woman was admitted to the dermatology department at a regional hospital with a severe ulceration at the medial angle of the right eye. Virus culture yielded orthopoxvirus-like particles, later identified as cowpox virus. The clinical picture and virological diagnosis of cowpox are discussed. Emphasis is placed on the need for awareness among health personnel that such infections may well be encountered in an increasingly unvaccinated population. Guidelines for clinicians and for virology laboratories are given. Cats as a zoonoic source is discussed.

[Quick diagnosis of respiratory syncytial virus infection]. / Hurtigdiagnostikk av respiratorisk syncytialt virus-infeksjon.

Respiratory syncytial virus (RSV) is a frequent cause of respiratory tract infections in children, and the infection spreads rapidly in hospitals. It is therefore important to diagnose the disease quickly. We have examined two quick tests for detecting RSV-antigen in nasopharyngeal aspirates: Directigen RSV (Becton Dickinson, MD, USA) and TestPack RSV (Abbott Laboratories, Chicago, IL, USA). Both tests are based on the enzyme immunoassay (EIA) principle. The results were compared with a method using direct immunofluorescence. When the immunofluorescence test was used as the standard, the sensitivities of Directigen and TestPack were 83 and 74%, and the specificities 84 and 100%, respectively. Both of the EIA-tests had a lower sensitivity than desired, and Directigen gave some uninterpretable results. The tests may be considered for use in small laboratories with limited facilities or as a supplement to other diagnostic methods.

[Introduction and evaluation of HIV tests in the North-East part of Tanzania]. / Innføring og evaluering av HIV-tester i den nordøstlige del av Tanzania.

The MUTAN (Tanzanian Norwegian AIDS Project) virology programme has comprised research, intervention, surveillance and education as part of the Tanzanian National AIDS Control Programme. HIV testing of blood donors was introduced in 1988 in the regions Arusha and Kilimanjaro. Simple and rapid HIV-tests have been evaluated continuously, as well as the possible use of alternative specimen samples for testing. The polymerase chain reaction for detection of HIV proviral DNA was established at the Northern Zone Reference Hospital, The Kilimanjaro Christian Medical Centre in Moshi, in 1993.

Raised levels of antibodies to human viruses at the clinical onset of autoimmune chronic active hepatitis.

Patients with autoimmune chronic active hepatitis (AICAH) often have very high titres of antibodies to rubella and/or measles virus. In the present study a young girl at the clinical onset of AICAH exhibited very high titres of antibodies against influenza viruses A and B, parainfluenza viruses, rubella virus and varicella-zoster virus. The titres normalized over 2 months except for rubella and varicella-zoster antibodies. Strong reactivities were seen against the rubella structural proteins E1, E2 and C in Western blot but IgM antibodies were not demonstrated. Total IgG was increased with normal ratios of subclasses. The IgG1 was the dominant antibody to E1 and E2, while IgG4 dominated the anti-C response. There was no significant shift in subclass reactivities over one year from onset. The polymerase chain reaction (PCR), using a nested primer set, was negative for rubella virus RNA in a liver biopsy obtained at the clinical onset and in peripheral blood mononuclear cells (PBMC) 1 year later. Co-cultivation experiments using PBMC and permissive cell lines were also negative for rubella virus. Hence, in the very early phase of AICAH there may be a transiently enhanced antibody response to various unrelated viruses.

[Varicella zoster infections and neurologic complications]. / Varicella zoster-infeksjoner og neurologiske komplikasjoner.

We describe three patients who suffered from neurological complications to varicella-zoster virus infections. One had polyradiculoneuritis, another myelitis, and a third suffered from focal encephalitis. These patients were all treated with acyclovir, and showed good recovery within a few days. The diagnosis must be based on clinical characteristics, together with virological and immunological tests. The indications for antiviral treatment are discussed.

Prevalence of antibodies to hepatitis C virus and association with intravenous drug abuse and tattooing in a national prison in Norway.

A study was performed in order to determine the prevalence of anti-hepatitis C virus (HCV) antibodies, the risk factors for HCV infection and the markers of hepatic disease in a population of prisoners. Of 101 new prisoners admitted to a Norwegian national prison over a three month period, 70 were included in the study, of whom 32 (46%) were anti-HCV positive. Intravenous drug abuse was the predominant risk factor for HCV infection, although a history of tattooing was found by logistic regression analysis to be a significant risk factor independent of intravenous drug abuse. Most anti-HCV positive prisoners had a history of previous incarcerations. Among the anti-HCV positive subjects, increased alanine aminotransferase (> 50 U/l) was found in 23 (72%). HCV infection was the major cause of hepatic abnormalities in the study population. Only 15 (47%) of the anti-HCV positive prisoners reported knowledge of previous hepatic disease.

Ganciclovir therapy of congenital cytomegalovirus disease.

A newborn with cytomegalovirus disease with cerebral involvement was treated with ganciclovir for 21 days. The treatment resulted in only temporary cessation of virus shedding in the urine and probably had no ameliorating effect on the long-term clinical outcome.

Chlamydia pneumoniae infections in Norway 1981-87 earlier diagnosed as ornithosis.

Ornithosis has been a notifiable disease in Norway since 1957. During an outbreak of respiratory disease in 1981-82, described as ornithosis, contact with birds was stated in only 50% of the cases, suggesting that the infection was spread by interhuman transmission. A similar outbreak occurred in the western part of Norway in 1987. Serum specimens from altogether 260 patients, collected during the outbreaks in 1981-82 and in 1987, were investigated for antibodies against Chlamydia pneumoniae (strain TWAR). Evidence of recent infection with C. pneumoniae was found in 67.7% of the cases. The results indicate that the increased incidence of ornithosis in 1981-82 and in 1987 was due mainly to C. pneumoniae infections.

Evaluation of rapid tests for HIV antibody screening of blood donors

The enzyme-linked immunosorbent assay (ELISA) is currently the most accepted method used to screen for antibodies to HIV Conventional ELISA assays require from 1.5 to 3.5 hours to complete and an optical density (OD) reader to record results. We have therefore considered the applicability of using rapid tests for the screening of blood donors. The Testpack method is quick to perform; easy to interpret and sensitive. Results indicate that the Testpack method is suitable for the screening of blood donors and in emergency situations

Evaluation of rapid tests for HIV antibody screening of blood donors

The enzyme-linked immunosorbent assay (ELISA) is currently the most accepted method used to screen for antibodies to HIV. Conventional ELISA assays require from 1.5 to 3.5 hours to complete and an optical density (OD) reader to record results. We have therefore considered the applicability of using rapid tests for the screening of blood donors. The Testpack method is quick to perform; easy to interpret and sensitive. Results indicate that the Testpack method is suitable for the screening of blood donors and in emergency situations

Evaluation of a rapid test for detection of antibodies against human immunodeficiency virus (HIV).

A new test for rapid detection of HIV antibodies (HIVCHEK) was evaluated. A total of 107 sera were examined. Of these, 60 were from healthy blood donors and the rest from a serum panel containing HIV positives and samples with false positive reactions in ELISA and unspecific bands in the western blot (WB). There was close agreement (100%) between the methods. The specificity of the HIVCHEK was 100% in this study. The sensitivity was acceptably high based on testing of consecutive serum samples from two seroconversion patients. The test was rapid and easy to perform, and no extra equipment was needed.