Development, evaluation and application of an isocratic high-performance liquid chromatography (HPLC) assay for the simultaneous determination of aciclovir and its metabolite 9-carboxymethoxymethylguanine in human serum and cerebrospinal fluid.

9-Carboxymethoxymethylguanine (CMMG), the main metabolite of aciclovir (ACV), is a putative neurotoxin. Measurement of CMMG in body fluids may aid patient management. We describe the development, validation and application of a high-performance liquid chromatography (HPLC) method for the simultaneous determination of ACV and CMMG in human serum and cerebrospinal fluid (CSF). Recovery was between 94% and 100% at all concentrations both from serum (range 0-20 mg/L) and CSF (0-5 mg/L). The intra-assay precision (coefficient of variation (CV)) was <2% and the inter-assay precision (CV) was <5%. The limits of detection and quantification were 0.1 and 0.25 mg/L, respectively, in both body fluids. Significant interference from endogenous material or from drugs in clinical samples was not seen. CMMG was detected in most of the 55 clinical samples containing ACV, but little correlation was found between the levels of the drug and its metabolite.

Vancomycin therapeutic drug monitoring: is there a consensus view? The results of a UK National External Quality Assessment Scheme (UK NEQAS) for Antibiotic Assays questionnaire.

This study investigated vancomycin therapeutic drug monitoring (TDM) and issues related to patient management. Questionnaires were distributed to 310 participants in the UK National External Quality Assessment Scheme (NEQAS) for Antibiotic Assays. The response rate was 57.4%. The majority (76%) had an 'in-house' assay service based, almost exclusively, in the microbiology department, and a fluorescence polarization immunoassay (FPIA) was used by 97%. Almost half (48.7%) had an assay service available for 24 h/day, 7 days/week and 92.7% expected same-day results. The majority (80%) had issued guidelines for vancomycin use. A 12 hourly initial dosing regimen was used by 89%. Trough assay samples were taken <10 min before the dose by 91.5%. For post-dose assay samples, 44% took a sample at 1 h, 28% at 2 h and the remainder at 'other' times. For trough target ranges, 93% quoted <10 mg/L or 5-10 mg/L. There was no consensus with regard to post-dose assay sample times and 23 ranges were quoted. The majority (74.4%) regarded a trough level of >or=10 mg/L as 'toxic' but 13 concentrations were quoted as toxic post-dose measurements. In conclusion, there was a wide variability and poor consensus with regard to post-dose vancomycin assay sampling times, target ranges and what constituted a toxic level.

Absence of human astrovirus RNA in sewage and environmental samples.

Over a period of several weeks during the summer of 1996, samples of sewage, sea water, river water, sand and silt were collected from a sewage works at Weston-super-Mare, England and from coastal areas nearby. A sensitive reverse-transcriptase polymerase chain reaction (RT-PCR) was used to search for human astrovirus (HAstV) RNA in concentrates of the samples. No evidence of astrovirus was found in any sample, which suggests that contamination with these viruses is not a problem in this area during the summer holiday season. Furthermore, the single case of astrovirus diarrhoea diagnosed in this laboratory in the summer occurred at the end of the sampling period, and not in the survey area. The primers used sometimes yielded a product two-thirds the expected size but bearing no sequence homology with HAstV. The confirmation that poliovirus adsorbs to sand and silt shows that these materials might be able to concentrate other enteric viruses in water to a level which could be a threat to the health of people coming into contact with it.

Acyclovir-resistant herpes simplex virus infections in a bone marrow transplant population.

Over a 3-month period, four patients who had received unrelated donor (UD) bone marrow transplants (BMT) presented with severe mucocutaneous herpes simplex virus (HSV) infection while receiving acyclovir (ACV) prophylaxis. Sensitivity testing of the isolates revealed three to be acyclovir-resistant and in one patient the infection was also characterised by a marked failure to respond to foscarnet (phosphonoformic acid). The emergence of ACV-resistant HSV infections in themselves is a new and challenging problem, and yet a far greater problem will become evident if these infections develop resistance to non thymidine kinase dependent therapy.

Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group.

AIMS: To study the association between cytomegalovirus (CMV) excretion and interstitial pneumonitis in allogeneic bone marrow transplant (BMT) recipients, with reference to donor and recipient CMV antibody response. METHODS: The incidence of CMV excretion was prospectively studied in 62 allogeneic bone marrow transplantations performed on adults and children. All recipients received CMV seronegative blood products. Prophylaxis with high dose acyclovir and CMV immune globulin was given to high risk patients (donor or recipient, or both, CMV seropositive). RESULTS: CMV excretion was detected in eight of 26 (31%) high risk patients but in only one of 36 low risk patients (donor and recipient both CMV seronegative). Five of the eight (63%) excretors in the high risk category developed CMV, of whom four (80%) belonged to the seropositive recipient/seronegative donor group, and included the three CMV seropositive recipients whose CMV complement fixation antibody titres were 64 or greater before transplantation. CONCLUSIONS: These findings suggest that there is a subgroup of patients at especially high risk of developing CMV.

Possible latent infection with herpes simplex virus in the mouse eye.

Herpes simplex virus (HSV) was isolated from organ cultures of anterior segments of the eyes of mice inoculated with virus on the snout or directly onto the cornea at least 5 weeks previously. The frequency of isolation of the virus was not decreased by treatment of the animals with acyclovir, suggesting that the virus is latent by the criteria usually applied. Peroxidase-antiperoxidase staining of organ cultures that had shed virus showed that viral antigens were predominantly present in the anterior uvea. Inoculation of mouse eye anterior segments in vitro showed that this tissue was the most susceptible to productive infection. These results suggest the possibility that HSV can establish a latent infection in tissues of the anterior segment of the mouse eye.

Antiviral drug sensitivity in ocular herpes simplex virus infection.

Thirty-nine herpes simplex virus (HSV) isolates were assayed for their sensitivity to 10 different antiviral agents. Of these 39 HSV isolates 10 were cultured from recipient buttons obtained at penetrating keratoplasty in patients with inactive stromal scarring due to recurrent herpetic keratitis, 25 were cultured from patients with conjunctival and ulcerative ocular infections, and the remaining four were laboratory strains with known drug sensitivity patterns, thus providing controls for the experiment. All but one of the 35 clinical isolates of HSV were type 1 and all were sensitive to the 10 antiviral agents. A single type 2 isolate from a young man with recurrent conjunctivitis proved to be resistant to a number of the antiviral agents. Since many of the clinical isolates had been exposed to multiple and protracted antiviral drug treatment, it is suggested that antiviral drug resistance in type 1 HSV ocular infection is not a significant problem.

Group C rotavirus associated with fatal enteritis in a family outbreak.

A family outbreak of gastroenteritis involving three adults and three children is described in which diarrhoea and vomiting were the main clinical features. One infant died in whom no pathogens could be detected in either small or large intestinal postmortem samples. Stool samples from two symptomatic siblings contained rotaviruses as demonstrated by electron microscopy. Both of these faecal samples were negative when assayed in a group A specific rotavirus enzyme-linked immunosorbent assay (ELISA) and subsequent genomic analysis of these rotaviruses was suggestive of group C rotavirus. Serological evidence showed that these atypical rotaviruses were members of serogroup C. Other atypical rotaviruses in faecal samples from sporadic cases in symptomatic children were detected over a similar time period and location. These had electrophoretic RNA profiles similar to those in the family outbreak. Furthermore, seroepidemiological studies detected group C rotavirus antibody in blood donors resident in the location of the family outbreak.

Transmission of virus particles by cryotherapy and multi-use caustic pencils: a problem to dermatologists?

The possibility of transmission of virus particles from patient to patient by multi-use silver nitrate sticks and styptic pencils and by cotton wool swabs that have been dipped repeatedly into Dewar flasks of liquid nitrogen was studied. The results showed that transmission by the sticks and pencils is unlikely but that virus particles can be transferred into and out of a Dewar flask on cotton wool swabs. We suggest that swabs should not be dipped repeatedly into the flask of liquid nitrogen but that, instead, a small aliquot of nitrogen should be decanted into a smaller 'clean' vessel and a new cotton swab used for each patient.

Restriction endonuclease analysis of herpes simplex virus from recrudescent lesions, from latent infection and during passage in the skin and nervous system of mice.

The stability of the restriction endonuclease profile of herpes simplex virus type 1 strain SC16 in mice was studied. Virus isolated from skin during acute infection was compared with that from latently infected ganglia and with that from recrudescent lesions induced by trauma. In another experiment virus serially passaged only in skin was compared with virus that had also replicated in the nervous system. The loss or gain of specific restriction sites was not observed but in some cases the mobility of certain fragments decreased.

A correlation between the weather and the incidence of ocular adenovirus infections.

Cyclical changes in the frequency of adenovirus isolation from patients with non-epidemic conjunctivitis were shown to correlate with monthly total hours of sunshine. Sunlight may predispose to clinical infection eyes already contaminated with adenovirus.

Comparison of ELISA with virus isolation for the diagnosis of genital herpes.

An enzyme linked immunosorbent assay (ELISA) system which detects and simultaneously types herpes simplex virus antigens in clinical specimens from patients with genital herpes has been compared with standard tissue culture isolation. Although more sensitive than a similar method previously described and also more sensitive than electron microscopy and immunofluorescence, ELISA did not detect all the viruses isolated in tissue culture. Costs were comparable. The speed of obtaining the result together with knowledge of the type causing infection are useful when antiviral chemotherapy is envisaged and when considering the likelihood of recurrences.

Simplified restriction endonuclease method for typing and subtyping adenoviruses.

Restriction endonuclease digestion of viral DNA labelled in vivo with phosphorus-32 has been used to type and to subtype both conventional and enteric adenoviruses. The method is a modification of that already described for typing and subtyping herpes simplex virus and, like the latter, needs far less material than methods previously described.

Isolation of herpes simplex virus from corneal discs of patients with chronic stromal keratitis.

Herpes simplex virus (HSV) was isolated from the corneal discs of six patients with herpes simplex keratitis, which were removed during penetrating keratoplasty and then cultured in vitro. The demonstration of persistent infection in stromal keratitis, even when the condition is quiescent, emphasizes the need for antiviral agents in treatment. The findings support the possibility that latent infection may become established at a peripheral site.

Comparison of a commercial ELISA system with restriction endonuclease analysis for typing herpes simplex virus.

Isolates of herpes simplex virus which had previously been typed by restriction enzyme analysis were typed again with a commercial ELISA system using polyclonal antibodies. There was complete correlation between the two techniques. Although restriction is more precise and definitive, when typing only is required the simplicity of ELISA makes it the preferred technique.

Comparison of the continuous cell line 293 with human embryo kidney cells and human embryo fibroblast cells for the cultivation of ocular viruses.

The continuous cell line 293 was evaluated as a replacement for primary human embryo kidney (HEK) cells in the cultivation of ocular viruses. The 293 cells were found to be as sensitive as HEK cells and human embryo fibroblast (HEF) cells for the cultivation of adenoviruses and herpes simplex virus (HSV) respectively. As a continuous cell line, 293 cells are preferable to HEK and HEF cells for the routine isolation of ophthalmic viruses.

A miniaturised and simplified technique for typing and subtyping herpes simplex virus.

A miniaturised, simplified and rapid method for typing and subtyping herpes simplex virus by restriction enzyme analysis of radioactively labelled DNA is described. This method requires far less label than those described previously, giving advantages in both cost and safety and therefore in its suitability for use in a routine laboratory. It produces results indistinguishable from those obtained by the parent method.