Tick-borne encephalitis transmitted by unpasteurised cow milk in western Hungary, September to October 2011.

In October 2011, a cluster of four tick-borne encephalitis (TBE) cases was identified in Hungary. Initial investigations revealed a possible link with consumption of unpasteurised cow milk sold by a farmer without authorisation. We performed a cohort study including all regular customers of the farmer. Overall, eleven cases (seven confirmed and four suspected) were identified. Customers who had consumed the farmer's unpasteurised cow milk had more than a two-fold increased risk for being a TBE case, although not at statistically significant level.

Equine encephalomyelitis outbreak caused by a genetic lineage 2 West Nile virus in Hungary.

BACKGROUND: The spread of lineage 2 West Nile virus (WNV) from sub-Saharan regions to Europe and the unpredictable change in pathogenicity indicate a potential public and veterinary health threat and requires scientific awareness. OBJECTIVES: To describe the results of clinical and virological investigations of the 1st outbreak of a genetic lineage 2 WNV encephalomyelitis in horses. ANIMALS: Seventeen horses with neurologic signs. METHODS: Information regarding signalment, clinical signs, and outcome was obtained for each animal. Serology was performed in 15 cases, clinicopathological examination in 7 cases, and cerebrospinal fluid was collected from 2 horses. Histopathology was carried out in 4 horses, 2 of which were assessed for the presence of WNV in their nervous system. RESULTS: WNV neutralizing antibody titers were between 10 and 270 (median, 90) and the results of other serological assays were in agreement with those of the plaque reduction neutralization test. Common signs included ataxia, weakness, asymmetric gait, muscle tremors, hypersensitivity, cranial nerve deficits, and recumbency. Twelve animals survived. Amplicons derived from the infection-positive specimens allowed molecular characterization of the viral strain. CONCLUSIONS AND CLINICAL IMPORTANCE: From our results, we conclude that this outbreak was caused by a lineage 2 WNV strain, even though such strains often are considered nonpathogenic. Neurological signs and survival rates were similar to those reported for lineage 1 virus infections. The disease occurrence was not geographically limited as had been the typical case during European outbreaks; this report describes a substantial northwestern spread of the pathogen.

Barriers to targeted HIV testing on an acute admissions unit: evaluation of the UK guideline.

BACKGROUND: One-quarter of people living with human immunodeficiency virus (HIV) in the UK are unaware of their infection, leading to late presentation with consequent increased morbidity and mortality, as well as ongoing transmission of infection. Recent UK guidelines advise HIV testing of patients with 'indicator diseases' in secondary care. There are limited seroprevalence data to support this recommendation, and acute medical settings present operational difficulties that may limit its feasibility. METHODS: We conducted an audit of HIV testing rates over a 3-month period in an inner London acute admissions unit. RESULTS: Lower respiratory tract infection and fever were the most frequent indicator diseases. A total of 14% were known to be HIV positive on admission, indicating a high prevalence of HIV infection among patients presenting with indicator diseases. Of the remaining 56 patients, 29% were tested for HIV infection, with one new positive diagnosis. CONCLUSION: Longer hospital admission and infectious disease consult were associated with testing. Introduction of an HIV testing protocol based on the UK recommendations had no impact on testing rates. Given the high prevalence of HIV infection in these acute hospital settings, more intensive strategies are needed to facilitate testing.

Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure.

BACKGROUND: Although higher blood pressures are generally recognised to be an adverse prognostic marker in risk assessment of cardiology patients, its relationship to risk in chronic heart failure (CHF) may be different. OBJECTIVE: To examine systematically published reports on the relationship between blood pressure and mortality in CHF. METHODS: Medline and Embase were used to identify studies that gave a hazard or relative risk ratio for systolic blood pressure in a stable population with CHF. Included studies were analysed to obtain a unified hazard ratio and quantify the degree of confidence. RESULTS: 10 studies met the inclusion criteria, giving a total population of 8088, with 29 222 person-years of follow-up. All studies showed that a higher systolic blood pressure (SBP) was a favourable prognostic marker in CHF, in contrast to the general population where it is an indicator of poorer prognosis. The decrease in mortality rates associated with a 10 mm Hg higher SBP was 13.0% (95% CI 10.6% to 15.4%) in the heart failure population. This was not related to aetiology, ACE inhibitor or beta blocker use. CONCLUSION: SBP is an easily measured, continuous variable that has a remarkably consistent relationship with mortality within the CHF population. The potential of this simple variable in outpatient assessment of patients with CHF should not be neglected. One possible application of this information is in the optimisation of cardiac resynchronisation devices.

West Nile virus infections in Hungary, August-September 2008.

Between 2003 and 2007, a yearly average of six cases of West Nile virus neuroinvasive infection were diagnosed in Hungary. In 2008, 14 cases have been confirmed by the end of October. In contrast with previous years the infection has now appeared also in the north-western part of the country which is endemic for tick-borne encephalitis.

Myotonic dystrophy: practical issues relating to assessment of strength.

BACKGROUND: Myotonic dystrophy type 1 is a slowly progressive multisystem disease in which skeletal muscle involvement is prominent. As novel physical and pharmacological treatments become available, it is crucial to be able to measure their efficacy accurately. METHODS: 158 consecutive patients with myotonic dystrophy were assessed annually in a specialist muscle clinic. Strength was measured using both the Medical Research Council (MRC) scale and a hand-held dynamometer. Dynamometer readings were obtained from 108 normal subjects (controls). RESULTS: The movements showing the greatest rate of change in strength were ankle dorsiflexion and pinch grip. Both of these showed a decline of only 0.06 points/year on the MRC scale. Using a hand-held dynamometer, a change in strength of 1.18 kgN/year for women and 1.61 kgN/year for men was detected. CONCLUSIONS: The MRC scale is unsuitable for detecting the small changes in strength seen in a slowly progressive disease such as myotonic dystrophy. Dynamometry provides a simple alternative that can give meaningful data over the duration of a typical clinical trial.

Serologically verified hantavirus infections in Hungary.

Between 1987 and 1993 the etiological diagnosis of haemorrhagic fever with renal syndrome (HFRS) of 55 patients was confirmed using hantavirus-specific serology. The geographical distribution of cases indicated that at least two different territories of Hungary are endemic for hantaviruses. These possible natural foci are different from, but overlapping with the region endemic for tick-borne encephalitis virus. Patients sera were shown to react differently with reagents prepared from different hantaviruses, indicating that different types are present simultaneously in both natural foci.

Detection of transfusion-associated hepatitis caused by non-A, non-B, non-C flavivirus.

Sera of patients suffering from acute hepatitis, and different forms of chronic hepatitis were found to be reactive to reagents prepared from the yellow fever virus (YF) vaccine strain. Serum samples of 1974 patients were tested, and 133 of them were positive. Hepatitis C virus specific antibodies were absent from the majority of them. The frequency of antibodies to other flaviviruses (tick-borne encephalitis, West Nile) and hepatitis B virus markers was similar to that measured among the population in Hungary positive for any of the surrogate markers of hepatitis infections. Results of both immunofluorescence tests, and Western blots suggest that there is a non-A, non-B, non-C hepatitis virus circulating among the Hungarian population, which possesses antigenic cross-reactivity with the yellow fever virus, but the identity to any of the known flaviviruses could not be verified yet. No history of yellow fever vaccination could be revealed in any of the patients included into this study. The anamnestic data on previous transfusions or surgical operations can be verified only in the case of the half of YFV-positive patients, nevertheless, the sexual transmission seems to be very infrequent. Attempts are continued in order to detect the viral RNA using polymerase chain reaction, and clone cDNA sequences for sequence analysis.

[Transfusion-associated non-A, non-B, non-C hepatitis caused by flaviviruses]. / A non-A, non-B, non-C flavivírus által okozott inokulációs hepatitis.

Hepatitis C virus was shown to be a member of the flavivirus family. Tick-borne encephalitis virus and West Nile virus, members of the same family occur in Hungary, too. Serum samples from patients suffering from transfusion associated hepatitis were tested with yellow fever virus antigens for specific IgG, and IgM using immunofluorescence test. Eight hundred serum samples were tested. Yellow fever virus related IgG antibodies were found in 232 sera. In the case of 72 patients specific IgM antibodies could also be detected. The majority of the IgM positive patients underwent surgical operation and/or blood transfusion 1 to 2 months before the onset of the disease. Fifty-four sera positive for yellow fever virus-related antibodies were tested with HCV reagents, but only 13 were found to be positive, or cross-reacting. The 20 patients with yellow fever related antibodies were controlled with tick-borne encephalitis antigens, too. Nevertheless, no measurable cross-reaction could be detected. No measurable cross-reaction could be detected with the West Nile virus. The hepatitis B markers also were tested in 44 sera positive for yellow fever antibodies. There was only one, which contained HBsAg, and 10 of them proved to be positive for anti-HBcAg. The results indicate, that a non-A, non-B, non-C flavivirus is also present in the Hungarian population, which can be detected on the basis of the antigenic cross-reactivity with the attenuated yellow fever virus. This virus seems to be responsible for every 11th transfusion associated hepatitis examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular epidemiology of tick-borne encephalitis virus: cross-protection between European and Far Eastern subtypes.

Tick-borne encephalitis virus isolates from widely separated geographic regions of the USSR, six isolates from Hungary and one from France were compared with the European and Far Eastern prototype viruses. Peptide mapping by limited proteolysis yielded similar patterns for five selected isolates from the USSR. All isolates from Hungary and France exhibited the same reactivity pattern with a panel of 16 protein E-specific monoclonal antibodies, whereas 10 out of 12 isolates from the Soviet Union showed minor differences at certain epitopes. However, no correlation between geographic origin of the isolates and their antigenic structure was observed. No statistically significant difference in the degree of protection was detected when mice were immunized with the European prototype vaccine and challenged with three selected Asian isolates and one from the European part of the USSR.