Diagnóstico serológico de parotiditis epidémica: valor de la titulación de IgG específica / Serological diagnosis of mumps: Value of the titration of specific IgG

Introducción: El objetivo del estudio fue determinar un punto de corte de la titulación de IgG mediante ELISA en el diagnóstico de parotiditis. Métodos: Se estudiaron sueros de 85 casos de parotiditis (confirmados por PCR en saliva) y de 2.351 controles de la población de la Comunidad de Madrid. Resultados: La detección de IgM fue positiva en 21 casos (sensibilidad del 24,7). El mejor punto de corte de IgG correspondía a títulos ≥4.900 (sensibilidad del 64,7% y especificidad del 86,1%). De 42 pacientes vacunados con ≥1 dosis de triple vírica se detectó IgM en 4, mientras que la detección de IgG ≥4.900 fue positiva en 29 (sensibilidad del 69,0%). Conclusiones: Un resultado de IgG ≥4.900 fue casi 5 veces más probable en un paciente con parotiditis que en otro sujeto no infectado. La detección de títulos elevados de IgG frente a parotiditis puede mejorar el rendimiento diagnóstico de la IgM en vacunados (AU)

Introduction: The aim of this study was to evaluate a cut-off point of the titration of IgG by ELISA in the diagnosis of mumps. Methods: A study was made of serum samples from 85 mumps cases (confirmed by PCR in saliva) and 2,351 controls of the general population of the Region of Madrid. Results: The IgM detection was positive in 21 cases (sensitivity of 24.7%). The best cut-off point corresponded to IgG titres ≥4,900 (sensitivity of 64.7% and specificity of 86.1%). Among 42 patients immunised with at least one dose of measles mumps, rubella vaccine IgM was detected in 4 cases. However, the detection of IgG ≥4,900 was positive in 29 (sensitivity of 69.0%). Conclusions: An IgG result of ≥4.900 was almost 5 times more probable in a patient with mumps than in a non-infected patient. The detection of high titres of IgG against mumps could improve the IgM results in vaccinated people (AU)

[Specific features of the epidemic process of measles and epidemic parotitis in territories with ecologically unfavorable conditions]. / Osobennosti épidemicheskogo protsessa pri kori i épidemicheskom parotite na ékologocheski neblagopoluchnykh territoriiakh.

Differences in the epidemic process of measles and epidemic parotitis in cities situated at territories with ecologically unfavorable conditions have been established. The intensity of the epidemic process of measles and epidemic parotitis is higher in those cities where a higher total level of pollution has been established. A high level of morbidity in these infections is due to disturbances in the immunological resistance of children living in such cities and, as a consequence, having insufficient postvaccinal immunity. A higher percentage of seronegative children among those immunized against the corresponding infections and a higher morbidity level among this category of the population have been established. To decrease morbidity in measles and epidemic parotitis to the level, sporadic for such cities, a greater coverage of children with immunization (up to 99-99.5%) is necessary.

Isolation and characterization of mumps virus strains in a mumps outbreak with a high incidence of aseptic meningitis.

In 1993, mumps with a high incidence of aseptic meningitis became prevalent in Akita prefecture, Japan. Three mumps virus isolates obtained from the nonvaccine-associated cases lacked the BamHI restriction cleavage site of the P gene, like the Urabe strain (Yamada, A. et al, Vaccine 8: 553-557). However, four additional nucleotide substitutions were found in the determined region of 157 bp. Fourteen of 19 cases from which mumps virus showing the Urabe-like RFLP profile was detected were complicated with symptomatic meningitis, whereas there were only four cases of meningitis among 23 individuals infected with the wild type showing no Urabe-like RFLP profile (non-"Urabe-like" wild-type). The incidence of meningitis was over 70% among patients infected with the "Urabe-like" wild-type virus. The "Urabe-like" wild-type. disappeared after February 1994 in the epidemic area and was replaced by the non-"Urabe-like" wild-type. Patients infected with the "Urabe-like" wild-type lived in a closed colony, in which there were two instances of transmission between siblings. Thus this outbreak was transient and narrowly localized.

[Experimental hydrocephalus induced by intraplacental mumps virus inoculation].

Experimental production of congenital hydrocephalus was undertaken by inoculating mumps virus into pregnant hamsters intravenously or intraplacentally. When the mumps virus was inoculated intravenously on the 8th, 10th, 12th, or 14th day of gestation, some fetuses were aborted and those which could come to term did not develop hydrocephalus after birth. Offsprings from the mothers, which had had intraplacental inoculation on the 14th day of gestation, showed ventricular dilatation in about 28%. Histological examination revealed inflammatory infiltration on the surface of ependymal layers, subependymal edema and microglial activation in the underlying ependyma of the aqueduct. These findings were thought to have resulted from ependymitis caused by mumps virus. The transplacental infection of mumps virus is considered to be extremely rare. However, in such conditions as the placental barrier is impaired, mumps virus will possibly pass through the placenta, and will cause hydrocephalus to the infant.

Molecular characterization of mumps virus strains circulating during an epidemic in eastern Switzerland 1992/93.

Ten mumps virus isolates recovered during an epidemic in Switzerland between Autumn 1992 and Spring 1993 were compared by nucleotide sequence analysis of the SH gene. The isolates were found to belong to two distinct yet closely related wild type strains in a newly identified European mumps virus lineage.

[Etiology of epidemic parotitis]. / A parotitis epidemica etiológiája.

Blood samples of 204 acute parotitis patients in a fifteen month period (1991-1992) were systematically examined for IgM, IgA, IgG antibodies of mumps and parainfluenza-virus 1, 2, 3 (PIV) by immunofluorescent test (IFT) and, in special cases several other virological examinations have been done. The etiological role of mumps-virus, parainfluenza-virus 1, 2, 3, one of the other viruses was confirmed in 76.0%, 1.5%, 6.3%, 1.5%, 4.9% of the cases, respectively. The etiology remained unknown in 9.8%. There were clinical symptoms of meningitis or orchitis in some and lymphadenopathy in several of the parainfluenza-virus caused parotitis patients. The authors conclude, that the parainfluenza-viruses are the second most frequent etiological agents of parotitis next to mumps-virus. They found that the Respiratory Syncytial Virus (RSV) also play etiological role in parotitis. This observation should be confirmed in the future by some other kind of virological tool too. The authors call attention to the difficulties and pitfalls of the virological serology in the infections caused by paramyxoviruses (PMV).

Serological diagnosis of parainfluenza virus infections: verification of the sensitivity and specificity of the haemagglutination-inhibition (HI), complement-fixation (CF), immunofluorescence (IFA) tests and enzyme immunoassay (ELISA).

Using four serological tests paired sera were examined of 117 patients with acute respiratory diseases, in whom parainfluenza viruses (PIV) infection was demonstrated by virus isolation, and of 41 patients with typical clinical mumps symptoms. Comparative analysis showed the high sensitivity of IFA and ELISA. A significant rise of antibodies in convalescent sera with homologous antigen of PIV was found in nearly 100 percent of cases. Only the sera of youngest children with high titres of persisting maternal antibodies remained without seroconversion. Cross heterologous antibody responses could be found by means of ELISA in 45% and by IFA in 10%, of patients who in the past experienced infection with one or more PIV or mumps virus--apart from homologous antibody reaction. HI and CF test proved to be less sensitive for detection of postinfections antibodies, especially in primoinfections with PIV types 1 and 2.

Nucleotide sequence analysis of Urabe mumps vaccine strain that caused meningitis in vaccine recipients.

Mumps virus was isolated from the cerebrospinal fluid of eight patients who acquired meningitis within 4 weeks of immunization with live Trivirix vaccine that contains mumps (Urabe Am 9), measles (Schwarz), and rubella (RA 27/3) viruses. Part of the haemagglutinin-neuraminidase (HN) gene from three postvaccination isolates of mumps virus, three wild strains and the Urabe and Jeryl Lynn vaccine strains was cloned following polymerase chain reaction (PCR) amplification, for the purpose of sequence analysis. A 200-nucleotide portion of the cloned HN genes was sequenced and compared to published sequences of two other strains (RW and SBL-1). The postvaccination mumps strains were identical in sequence to Urabe and were distinguishable from the wild and the Jeryl Lynn vaccine strains. Twenty-two out of 200 positions were seen to vary among the group of viruses. It was concluded that the Urabe vaccine strain was the cause of postvaccination meningitis. Therefore, with effect from 1990, Trivirix measles, mumps and rubella vaccine is no longer licensed for sale in Canada.

[Virological evaluation of mumps meningitis following vaccination against mumps].

1) We report 5 cases of aseptic meningitis following vaccination against mumps. Of the 5 cases, 4 cases were diagnosed as mumps meningitis. 2 cases received monovalent mumps vaccine and the other 2 MMR vaccine. They consisted of 2 boys and 2 girls, aged 2 years and 2 months to 4 years and 5 months. The period between vaccination and symptoms ranged from 15 days to 20 days (mean 18 days). Cerebrospinal fluid of the cases contained 507 to 2688 cells/mm3. Eruption was observed in the 2 cases who received MMR vaccine, while parotid swelling was not seen in any case. 2) In all 4 cases, IgM antibody to mumps virus in the cerebrospinal fluid was detected by the ELISA or EIA methods. Causative organism of the fifth case was obscure. 3) PCR (Polymerase Chain Reaction) tests revealed that mumps virus isolated from 2 cases were of vaccine strain origin. 4) To evaluate the frequency of mumps meningitis following vaccination, it seems important to investigate carefully the number of children who received the vaccine and to exclude the cases of aseptic meningitis caused by other agents. On the other hand, cases of young infants tend to be overlooked because of atypical signs.

Differentiation of vaccine and wild mumps viruses using the polymerase chain reaction and dideoxynucleotide sequencing.

Parts of the F gene from 16 mumps viruses derived from vaccines and clinical isolates were amplified using the polymerase chain reaction and their nucleotide sequences were determined. Over a region of 111 nucleotides, eight regions of variability were detected with a maximum of six (5.4%) changes occurring between any two virus strains. The Jeryl Lynn and Urabe vaccine strains were clearly different from each other and from wild virus isolated from cases of non-vaccine-associated mumps. In contrast, viruses isolated from the cerebrospinal fluid and throat in cases of meningitis and parotitis following vaccination with the Urabe strain were identical to this strain. We conclude that the vaccine was the source of these infections.

[Septic pneumonia caused by Bacillus cereus]. / Bacillus cereus okozta szeptikus pneumonia.

The authors describe the case of a 3-year old girl whose septic pneumonia was caused by B. cereus and developed following serial viral and bacterial infections, which produced assumably transient immunoppressed condition. Attention is drawn to the possibility of serious diseases caused by faculative bacteria in certain cases. The increasing pathological significance of bacteria existing in the soil is pointed out and the importance of hemoculture examination is stressed.

Isolation of mumps virus from vaginal secretions in association with oophoritis.

Mumps virus was isolated from the cervico-vaginal secretions of a 31-year-old woman presenting with mild signs of oophoritis accompanied by xantholeucorrhoea. The serological finding of mumps-specific IgM antibodies was further evidence confirming the casual link between mumps virus and ovarian pathology. Rarely, ovarian involvement may be the only manifestation of mumps infection. The importance of this diagnosis and its relationship to the possible development of secondary oligomenorrhoea and early menopause is discussed.

[Comparative clinico-morphological research on measles and mumps infections in an experiment on guinea pigs]. / Sravnitel'nye kliniko-morfologicheskie issledovaniia korevoi i parotitnoi infektsii v éksperimente na morskikh svinkakh.

The pathological process typical of measles and mumps infections was reproduced clinically and morphologically in 250 experimental guinea pigs infected into the anterior eye chamber with different strains of measles and mumps viruses. The intraocular inoculation of measles virus induced in guinea pigs the signs of iridocyclitis and follicular conjunctivitis, whereas inoculation of mumps virus induced dacryoadenitis as well as iridocyclitis and follicular conjunctivitis. The severity of the reproduced process and its dynamics correlated with the pathogenicity of measles and mumps virus strains used in the experiment. The specificity of pathological changes observed in the eye structures was verified virologically by the isolation of virus from the eye membranes and the presence of virus-neutralizing antibodies in the blood sera of the animals.