- Email: [email protected]
Diagnosis of shingles in general practice
A20
FIS 99 Abstracts
P34
P35 QUANTITATIVE CMV PCR: LIGHTENTING THE LOAD. A. J. Turner, A. M. Keams, P. R. Seiders, R. Freeman, J. Wheeler and M. Steward, Public Health Laboratory, General Hospital, Newcastle upon Tyne, NE4 6BE, UK CMV infection can lead to a number of clinical manifestations in the immunocompromised. The detection of CMV by PCR provides the potential for rapid diagnosis, and quantitation may identify those patients needing therapy and monitor its efficacy. The LightCyclerTM performs real-time PCR, such that the viral load in a specimen can be determined by the use of quantitative standards. In addition, sequence specific detection of PCR products can be achieved by the use of fluorescently labelled probes. Using primers directed against the glycoprotein B gene, a quantitative PCR (QPCR) assay for CMV on the LightCycler has been developed, which has an overall sensitivity of c. 10 copies, and a dynamic range of 2x103 - 5x10* copies/ml. Its performance is comparable to that of our ‘in-house’ qualitative assay, with the added advantages of speed (results are available in 40min), specificity (enhanced by use of a hybridisation probe), and results which are quantitative. Data will be presented on the testing of blindcoded collections of clinical material from other centres to evaluate the assay more extensively, and assessment of the robustness of the assay following its use in other laboratories.
P36 CHIKUNGUNYA FEVER AS A RISK FACTOR FOR ENDEMIC BURKITT’S LYMPHOMA IN MALAWI C van den Bosch’,G.Lloyd2,P.Kazembe3,Depts. of Virology’, Royal Postgraduate Medical School,Faculty of Medicine, University of London, Dept.of Paediatrics,‘.‘. Kamuzu Central Hospital, Malawi and ‘PHLS, C.A.M.R., Porton Down. Objective: To carry out a case control study to assess the possible role of Chikungunya Virus as a risk factor for endemic Burkitt’s Lymphoma (eBL). Method: Prospective case-control study of eBL patients with 2 sets of age and sex-matched controls was carried out in Malawi. Sera from 108 eBL patienls.1 11 hospital, and 97 local controls were screened for antibodies to Chikungunya Virus using 1gG and 1gM Elisas. Mantel-Haenszcl odds ratios were calculated. Results: Antibodies to Chikungunya were found in JJ (40.7%) of eBL patients on admission, another 25 seroconverted during their first admission and 5 with missing values seroconverted during their 1”’ or 2”d admission. A total of 74 (68.5%) of patients were seropositive by their 3’d admission. 52 (46.8%) hospital and 49 (50.5%) local controls also had Chikungunya virus antibodies. Conclusion: eBL patients were significantly more likely to bc seropositive from Chikungunya virus antibodies than either hospital (OR=2.36. 95% C.I. = 1.28-4.56. p=O.O02) or local controls (OR=2.28, 95% C.I. = 1.1-i-5.07. pO.009).
DIAGNOSIS OF SHINGLES IN GENERAL PRACTICE. PR.Smith, J. McGie, K. Hawrami, S. Argent, H. Mistry, J. Breuer, Dept of Virology, Barts & the London NHS Trust. Objectives: Shingles is a significant cause of morbidity in \ the community and antiviral therapy is shown to he effective in alleviating symptoms when given early after onset. Sensitivity of clinical diagnosis and laboratory tests is being investigated. Methods: A prospective study of Shingles in patients presenting to GPs in East London was carried out. Patients diagnosed with Shingles were referred for confirmation using electron microscopy/ immunofluorescence (EM/IF), culture and PCR of vesicle fluid. Results: A diagnosis of Shingles was confirmed in 113/142 patients (79.6%) referred by the GP. The remainder were negative by all laboratory tests for Varicella-Zoster virus and 50% of those were later proven ~~
Conclusions: Accurate and prompt diagnosis of Shingles is necessary to initiate specific antiviral treatment. Our data show in 20% of cases an incorrect clinical diagnosis was made. Laboratory confErnation may be a useful adjunct in these cases and PCR of vesicle fluid appears to be the most sensitive test. We are investigating features of the rash and associated pain that may improve clinical diagnosis.
P37 Case Note Documentation and tbe Risk of Viral Haemorrhagic Fever (VHF) in Travelers. R.Fair, G.D.Barlow, A.Seaton& D.Nathwani. Tayside University Hospitals, Dundee. Method A retrospective case note analysis over a 2 year period. Results Of the 1 I4 patients included in the study 17( 15%) were considered to be of no risk, 65(570/o) of minimum risk, 32(28%) of moderate risk and none of high risk for a VHF according to the 1997 ACDP guidelines. Of the patients travelling to areas where malaria prophylaxis was considered necessary (n=IO2) 32% did not take prophylaxis and in 16% there was no record in the case notes. Subsequently 3S0/o(15/65) of the minimum risk group and 62%(24/32) of the moderate risk group were diagnosed as having malaria. There was no documentation of pre-travel immunizations in 55%(63/l 14) of case notes. The reason for travel and exposure to either an urban or rural environment was not recorded in 12%( 14/l 14) and 40%(46/l 14) of case notes respectively. The exposure status to rodents and nonhuman primates was documented in just 2%(2/97) of case notes from minimum and moderate risk patients. Discussion The public health consequences of a missed diagnosis of VHF are potentially disastrous. It is therefore vital that physicians dealing with such travelers can elicit, record and interpret travel information. We have demonstrated that this is not the case, even in a regional infectious disease unit, and this is likely to reflect the situation across the UK in general.
FIS 99 Abstracts
P34
P35 QUANTITATIVE CMV PCR: LIGHTENTING THE LOAD. A. J. Turner, A. M. Keams, P. R. Seiders, R. Freeman, J. Wheeler and M. Steward, Public Health Laboratory, General Hospital, Newcastle upon Tyne, NE4 6BE, UK CMV infection can lead to a number of clinical manifestations in the immunocompromised. The detection of CMV by PCR provides the potential for rapid diagnosis, and quantitation may identify those patients needing therapy and monitor its efficacy. The LightCyclerTM performs real-time PCR, such that the viral load in a specimen can be determined by the use of quantitative standards. In addition, sequence specific detection of PCR products can be achieved by the use of fluorescently labelled probes. Using primers directed against the glycoprotein B gene, a quantitative PCR (QPCR) assay for CMV on the LightCycler has been developed, which has an overall sensitivity of c. 10 copies, and a dynamic range of 2x103 - 5x10* copies/ml. Its performance is comparable to that of our ‘in-house’ qualitative assay, with the added advantages of speed (results are available in 40min), specificity (enhanced by use of a hybridisation probe), and results which are quantitative. Data will be presented on the testing of blindcoded collections of clinical material from other centres to evaluate the assay more extensively, and assessment of the robustness of the assay following its use in other laboratories.
P36 CHIKUNGUNYA FEVER AS A RISK FACTOR FOR ENDEMIC BURKITT’S LYMPHOMA IN MALAWI C van den Bosch’,G.Lloyd2,P.Kazembe3,Depts. of Virology’, Royal Postgraduate Medical School,Faculty of Medicine, University of London, Dept.of Paediatrics,‘.‘. Kamuzu Central Hospital, Malawi and ‘PHLS, C.A.M.R., Porton Down. Objective: To carry out a case control study to assess the possible role of Chikungunya Virus as a risk factor for endemic Burkitt’s Lymphoma (eBL). Method: Prospective case-control study of eBL patients with 2 sets of age and sex-matched controls was carried out in Malawi. Sera from 108 eBL patienls.1 11 hospital, and 97 local controls were screened for antibodies to Chikungunya Virus using 1gG and 1gM Elisas. Mantel-Haenszcl odds ratios were calculated. Results: Antibodies to Chikungunya were found in JJ (40.7%) of eBL patients on admission, another 25 seroconverted during their first admission and 5 with missing values seroconverted during their 1”’ or 2”d admission. A total of 74 (68.5%) of patients were seropositive by their 3’d admission. 52 (46.8%) hospital and 49 (50.5%) local controls also had Chikungunya virus antibodies. Conclusion: eBL patients were significantly more likely to bc seropositive from Chikungunya virus antibodies than either hospital (OR=2.36. 95% C.I. = 1.28-4.56. p=O.O02) or local controls (OR=2.28, 95% C.I. = 1.1-i-5.07. pO.009).
DIAGNOSIS OF SHINGLES IN GENERAL PRACTICE. PR.Smith, J. McGie, K. Hawrami, S. Argent, H. Mistry, J. Breuer, Dept of Virology, Barts & the London NHS Trust. Objectives: Shingles is a significant cause of morbidity in \ the community and antiviral therapy is shown to he effective in alleviating symptoms when given early after onset. Sensitivity of clinical diagnosis and laboratory tests is being investigated. Methods: A prospective study of Shingles in patients presenting to GPs in East London was carried out. Patients diagnosed with Shingles were referred for confirmation using electron microscopy/ immunofluorescence (EM/IF), culture and PCR of vesicle fluid. Results: A diagnosis of Shingles was confirmed in 113/142 patients (79.6%) referred by the GP. The remainder were negative by all laboratory tests for Varicella-Zoster virus and 50% of those were later proven ~~
Conclusions: Accurate and prompt diagnosis of Shingles is necessary to initiate specific antiviral treatment. Our data show in 20% of cases an incorrect clinical diagnosis was made. Laboratory confErnation may be a useful adjunct in these cases and PCR of vesicle fluid appears to be the most sensitive test. We are investigating features of the rash and associated pain that may improve clinical diagnosis.
P37 Case Note Documentation and tbe Risk of Viral Haemorrhagic Fever (VHF) in Travelers. R.Fair, G.D.Barlow, A.Seaton& D.Nathwani. Tayside University Hospitals, Dundee. Method A retrospective case note analysis over a 2 year period. Results Of the 1 I4 patients included in the study 17( 15%) were considered to be of no risk, 65(570/o) of minimum risk, 32(28%) of moderate risk and none of high risk for a VHF according to the 1997 ACDP guidelines. Of the patients travelling to areas where malaria prophylaxis was considered necessary (n=IO2) 32% did not take prophylaxis and in 16% there was no record in the case notes. Subsequently 3S0/o(15/65) of the minimum risk group and 62%(24/32) of the moderate risk group were diagnosed as having malaria. There was no documentation of pre-travel immunizations in 55%(63/l 14) of case notes. The reason for travel and exposure to either an urban or rural environment was not recorded in 12%( 14/l 14) and 40%(46/l 14) of case notes respectively. The exposure status to rodents and nonhuman primates was documented in just 2%(2/97) of case notes from minimum and moderate risk patients. Discussion The public health consequences of a missed diagnosis of VHF are potentially disastrous. It is therefore vital that physicians dealing with such travelers can elicit, record and interpret travel information. We have demonstrated that this is not the case, even in a regional infectious disease unit, and this is likely to reflect the situation across the UK in general.