Archive for December, 2005

Comparison of Two Culture Media and Three Sampling Techniques for Sensitive and Rapid Screening of Vaginal Colonization by Group B Streptococcus in Pregnant Women

Source: Journal of Clinical Microbiology Sep 2004 p.3975-3977 Vol.42 N.9

Chakshu Gupta* and Laurence Edward Briski

Department of Pathology, St. John Hospital and Medical Center, Detroit, Michigan

The Centers for Disease Control and Prevention (CDC) recommend universal screening of all pregnant women between 35 and 37 weeks of gestation for group B streptococci (GBS) by use of a selective broth medium. Recent reports suggest that Granada medium can be used for rapid and direct visual identification of GBS colonies. However, studies comparing the Granada medium method to the selective broth method are few, and while some report comparable sensitivities, others have found significant differences in detection rates between the two methods. This prospective study compared a method using Granada agar to a Todd-Hewitt broth method with subculture to blood agar in order to determine which GBS detection method is more sensitive and less labor-intensive and has a more rapid turnaround time. Detection rates for three sampling techniques (rectovaginal, vaginal only, and cervical only) were also compared. Consecutive specimens for GBS screening received over a 6-month period from 1,635 pregnant women were included. Overall, GBS was detected in 390 (23.8%) women. The Granada medium gave positive results for 348 of these women, and the selective broth gave positive results for 385, indicating sensitivities of 89.2% for the Granada medium and 98.7% for the selective broth. These findings show that the Granada medium method is less sensitive than the selective broth method and should not replace it as the only method for screening pregnant women for GBS. However, the Granada medium method reduced detection time to 1 day and also reduced the use of ancillary tests in approximately 90% of positive cases. Additionally, no significant differences were noted in the detection rates with rectovaginal, vaginal, and cervical specimens.

* Corresponding author. Mailing address: Department of Pathology, St. John Hospital and Medical Center, 22101 Moross Rd., Detroit, MI 48236. Phone: (313) 343-3520. Fax: (313) 881-4727. E-mail: Chakgupta@yahoo.com.

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December 24, 2005 at 4:09 pm Leave a comment

Detection of Hepatitis A Virus RNA in Saliva

Source: Journal of Clinical Microbiology Sep 2004 p.4329-4331 Vol.42 N.9

Vincent Mackiewicz, Elisabeth Dussaix, Marie-France Le Petitcorps, and Anne Marie Roque-Afonso*

Centre National de Référence pour les Virus à Transmission Entérique (HAV), Laboratoire de Virologie, Hôpital Paul Brousse, Villejuif, France

Hepatitis A virus (HAV) is shed in feces but also in saliva. HAV RNA was detected in saliva in five out of six acutely infected patients with HAV viremia. Serum and saliva sequences were identical. The simplicity of obtaining material allows the recommendation of the use of saliva for investigation of outbreaks.

* Corresponding author. Mailing address: Centre National de Référence pour les Virus à Transmission Entérique (HAV), Laboratoire de Virologie, Hôpital Paul Brousse, 94804 Villejuif, France. Phone: 33 1 45596956. Fax: 33 1 45593724. E-mail: anne-marie.roque@pbr.ap-hop-paris.fr.

December 24, 2005 at 4:06 pm Leave a comment

Prevalence of Hepatitis C Virus Infection among Hemodialysis

Source: Journal of Clinical Microbiology Sep 2004 p.4321-4322 Vol.42 N.9

Patients at a Tertiary-Care Hospital in Mexico City, Mexico
Nahum Méndez-Sánchez,* Daniel Motola-Kuba, Norberto C. Chavez-Tapia, Jesús Bahena, Ricardo Correa-Rotter, and Misael Uribe Departments of Biomedical Research and Gastroenterology and Liver Unit and Hemodialysis Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico

We determined the prevalence of hepatitis C virus (HCV) in hemodialysis patients by antibody testing and HCV RNA determination by PCR. A total of 149 patients with kidney failure with replacement therapy were tested. The prevalence of anti-HCV was 6.7% (10 of 149 patients), and viremia was detectable in 8 of 149 (5%) patients. Three of 149 patients (2%) were anti-HCV negative with detectable HCV RNA.

* Corresponding author. Mailing address: Departments of Biomedical Research and Gastroenterology and Liver Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico. Phone: (525) 606-6222, ext. 4215. Fax: (525) 666-4031. E-mail: nmendez@medicasur.org.mx.

December 24, 2005 at 4:04 pm Leave a comment

Evaluation of the Core Antigen Assay as a Second-Line Supplemental Test for Diagnosis of Active Hepatitis C Virus Infection

Source: Journal of Clinical Microbiology Sep 2004 p.4054-4059 Vol.42 N.9

Mel Krajden,1* Rishma Shivji,1 Kingsley Gunadasa,1 Annie Mak,1 Gail McNabb,1 Michel Friesenhahn,2 David Hendricks,2 and Lorraine Comanor3

British Columbia Center for Disease Control, Vancouver, British Columbia, Canada,1 Bayer Healthcare LLC, Berkeley, California,2 Independent Research Consultant, Palo Alto, California3

The British Columbia Center for Disease Control laboratory performs approximately 95% of all hepatitis C virus (HCV) antibody tests for the province’s 4 million inhabitants. In 2002, the laboratory tested 96,000 specimens for anti-HCV antibodies, of which 4,800 (5%) were seroreactive and required confirmation of active infection. Although HCV RNA assays with a sensitivity of 50 IU/ml or less are recommended for the confirmation of active HCV infection, given the large number of seroreactive specimens tested annually, we evaluated the Ortho trak-C assay (OTCA) as a second-line confirmatory test and determined its limit of detection (LoD). Of 502 specimens from treatment-naïve anti-HCV-positive individuals, 478 had sufficient volumes for evaluation by the OTCA and HCV RNA tests. Core antigen was not detected in 147 of 478 (30.8%) of these specimens, of which 37 of 147 (25.2%) were shown to be viremic by the VERSANT HCV (version 3.0) (branched-DNA) assay and/or the VERSANT HCV qualitative assay. Testing of 144 replicates of a World Health Organization standard dilution series indicated that the LoD of OTCA was 27,000 IU/ml. This LoD is consistent with the inability of OTCA to detect core antigen in clinical specimens with low viral loads.

We conclude that OTCA has limited value as a confirmatory test for the diagnosis of active HCV infection because 37 of 367 (10%) of viremic specimens had undetectable core antigen. Qualitative HCV RNA testing remains the present standard for the confirmation of active HCV infection in the diagnostic setting.

* Corresponding author. Mailing address: British Columbia Center for Disease Control, 655 W. 12th Ave., Vancouver, BC V5Z4R4, Canada. Phone: (604) 660-6044. Fax: (604) 660-6073. E-mail: mel.krajden@bccdc.ca.

December 24, 2005 at 4:01 pm Leave a comment

Long-Term Follow-Up Study of Chinese Patients with YMDD Mutations: Significance of Hepatitis B Virus Genotypes and Characteristics of Biochemical Flares

Source: Journal of Clinical Microbiology Sep 2004 p.3932-3936 Vol.42 N.9

Man-Fung Yuen,1* He-Jun Yuan,1 Erwin Sablon,2 Danny Ka-Ho Wong,1 Annie On-On Chan,1 Benjamin Chun-Yu Wong,1 and Ching-Lung Lai1*

Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, and Queen Mary Hospital, Hong Kong,1 Innogenetics N.V., Ghent, Belgium2

We sought to examine the role of hepatitis B virus (HBV) genotypes in virological breakthroughs and biochemical flares in patients with YMDD mutations during lamivudine therapy. Virologic breakthroughs (i.e., the reappearance of HBV DNA as determined by bDNA assay) and biochemical flares (mild flares = alanine aminotransferase [ALT] between 2 and 10 times the upper limit of normal [ULN]; severe flares = ALT >10 times ULN) were monitored in 154 hepatitis B e antigen-positive patients receiving long-term lamivudine. The HBV genotypes and YMDD mutations were determined. Forty-three patients had virological breakthroughs with YMDD mutations (median follow-up of 29.6 months [range, 22.3 to 61.4]). Twenty patients (47%) patients had mild biochemical flares; seven (16%) had severe flares.

Two patients showed an elevation of bilirubin level that is >2 times the ULN. All patients recovered spontaneously. The cumulative risks for biochemical flares were 28, 47, and 58% for the first 3 years, respectively. Patients with biochemical flares compared to those without flares had a significantly higher median pretreatment ALT level (61 U/liter versus 34.5 U/liter [P = 0.012]). There were no differences in the cumulative risk of virological breakthroughs, risk, and severity of biochemical flares between patients with genotypes B (n = 11) and C (n = 32). There was an increase in the percentage of patients with single YMDD mutant at last follow-up compared to that at the time of virological breakthroughs (74% [n = 32] versus 47% [n = 20], respectively; P = 0.015). The chances of YMDD mutations with virological breakthroughs and biochemical flares were similar in patients with genotypes B and C. Biochemical flares were common, with 16% being severe in nature. High pretreatment ALT levels were associated with a higher chance of biochemical flares.

* Corresponding author. Mailing address: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Rd., Hong Kong, Peoples Republic of China. Phone: (852) 28553111. Fax: (852) 28162863. E-mail for M.-F. Yuen: yuenmf@netvigator.com. E-mail for C.-L. Lai: hrmelcl@hkucc.hku.hk.

December 24, 2005 at 3:57 pm Leave a comment

Detection of Intrahepatic Hepatitis B Virus DNA and Correlation with Hepatic Necroinflammation and Fibrosis

Source: Journal of Clinical Microbiology Sep 2004 p.3920-3924 Vol.42 N.9

Danny Ka-Ho Wong,1, Man-Fung Yuen,1, Eric Tse,2 HeJun Yuan,1,3 Simon

Siu-Man Sum,1 Chee-Kin Hui,1 and Ching-Lung Lai1*
Division of Gastroenterology and Hepatology,1 Division of Hematology and Oncology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong,2 Department of Medicine, Fudan University, Zhongshan Hospital, Shanghai, People's Republic of China3

Assessment of intrahepatic hepatitis B virus (HBV) DNA levels in patients with chronic hepatitis B is important in understanding the natural history of the disease and designing antiviral therapy regimens. However, there is no standardized method for the measurement of intrahepatic HBV DNA levels. We describe a convenient novel method for the measurement of intrahepatic HBV DNA levels based on a modified COBAS Amplicor HBV Monitor test for HBV DNA measurement and real-time PCR ß-actin gene detection for human genomic DNA (hgDNA) quantitation. Fifteen hepatitis B e antigen (HBeAg)-positive patients, 26 patients positive for antibody to HBeAg (anti-HBe), and 8 control patients were recruited. The mean between-run coefficient of variation for the ß-actin real-time PCR assay was 15.4%. All eight control patients had undetectable intrahepatic and serum HBV DNA levels. All chronic hepatitis B patients had detectable intrahepatic HBV DNA levels, and all but one anti-HBe-positive patient had detectable serum HBV DNA levels.

HBeAg-positive patients had higher median intrahepatic and serum HBV DNA levels than anti-HBe-positive patients (6,950 versus 676 HBV DNA copies/ng of hgDNA, respectively [P * Corresponding author. Mailing address: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Rd., Hong Kong, China. Phone: (852) 28554252. Fax: (852) 28162863. E-mail: hrmelcl@hkucc.hku.hk.

D.K.-H.W. and M.-F.Y. contributed equally to the study.

December 24, 2005 at 3:54 pm Leave a comment

Original article – Macrolide Resistance in Treponema pallidum in the United States and Ireland

Source: N Engl J Med Vol.351 N.2 p.154-158 Jul 8, 2004 Brief report Sheila A. Lukehart, Ph.D., Charmie Godornes, B.S., Barbara J. Molini, M.S., Patricia Sonnett, B.S., Susan Hopkins, M.D., Fiona Mulcahy, M.D., Joseph Engelman, M.D., Samuel J. Mitchell, M.D., Ph.D., Anne M. Rompalo, M.D., Christina M. Marra, M.D., and Jeffrey D. Klausner, M.D., M.P.H. For decades, syphilis infection has been treated with penicillin, and Treponema pallidum has not developed resistance to penicillin. In many countries, the recommended treatment for early syphilis is a single dose of penicillin G benzathine, which maintains bactericidal levels for weeks, killing the slowly metabolizing treponemes. Azithromycin, which has a long tissue half-life and can be administered orally, was found to be effective in the treatment of syphilis in a rabbit model1 and in small studies in humans.2,3,4,5,6 Because of its convenience and efficacy, azithromycin is increasingly being used for . . . FREE ACCESS Full Text of this Article   www.nejm.org

December 24, 2005 at 11:52 am Leave a comment

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