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Evidence of hepatitis C virus in cervical smears
60
Letters
Evidence
of Hepatitis
C Virus
in Cervical
to the
Smears
Sir-.
‘I‘hc‘ tiepalitis C’ \?rus (I 1CV) has hwn recognized as bciiig Ihc mosl frcqucnt citusc 01’ noti-A and non-K hepatitis. Ltili~rlunalely. iO-50% ol’ all routra of Iransniission retnain unwrktin. ‘I’hc ederil to c\,hich sexual Iransniission accounts for cast’s of t1C’V \vith no pat-enteral exposure is conlroversial anti is still under discussion. Some authors h:t\,c rcportcd little or no It-ansmission.’ Lvhile others ha1.e presented data suggesting that HCl’ is sexuall!; lransniitted.2 The issue of perinatall!~ ~r;insk-ed Hepalitis C’ atid the link to inlkction rates iii vertical mother-to-chil(i Iransmission. particularly in HI\’ coittl’eclctf \v0111c’t1. ’ is still contro~~ersial. i\s part of 2 preventive prograninic in our clinic. wonien \vitti childbearing potential displaying increased bilirubin and transantinase levels \l’c’re submitted to a Hepatitis .A. 13. c’ II~I\V. HI<\‘. HC’\!) and 1111’ serological screening. Six wonwn. who \vere I’OLIII~ 10 he tiC’\‘-seropositi\,c Lvith enzyme-linked inniunosorbent assay (Fl.lS:\) (,Abbott HC\: EliI 2nd Ckneralion, ,\hhott Diagnostics IIivision. II.. I’.S.A.I. but tl,\\‘, HI<\’ and HI\:ncgati\~c. ww-c included in our sludy for further investigaliort. Koulindy p~rli~rnicd cytological analysis 01’ cervical I’:tpanicolaou (PAP) sntcwrs rcwaled iio cellular changes cottsistcnt l\rith possihlc \riral or other infections. It1 orticr 10 address the question 01’ whcthcr Ioc;~l genital tract associalion 01‘ tIC’\! tiiighl contribute to scxual/pcrinat~tl Irat1st1iissioti. wc dc9~clopeti ;t me1 hod li)r detcctirtg IICY KY/\ by rcwrsc 1t-atisct~iplas~-~~ol~~ii~~r~ts~ chain reaction (KTIY’K I in
Editor
ccr\kiil snic’arx (C’S). Sitiw sc\wal l~lood cell types Iiiivc’ recciitl!. been reported to contain I I(‘\‘,’ the internal ITI-I’(‘11 protoc~ol‘ for routinclv obtained scruni ~viis opliniized for- the Iii-d slag:e 01‘ testing ot \\,hole peripheral blood iL2’l’B) samples.” This test procedllr-e liw nialerial cont;iitiirig cells was I’itrthet adaptctl \z,hc‘rc su~ahs were used to obtain C’S li-om tnenstrualion and \,agin~tl-disch~tr~~-~r~~ \2vnien. ,,\n identical sampling prowtiurc \~;Is carried oul subsequently lo obtain material liar our routiticly pet-formed cc’rviciil PAI sincar atialysis. 11 I-e\~ealcd rcprcsentati\,e anioi~nls 01 cpilhelial cells with a11 atltnixturc of non-epithelial cc~lls. c.g. red blood cells (KM’: er\dit-ocytes). \vhite blood cells 1\\‘I’,(‘: Ieul\ocytes). normal vaginal Ilord (e.g. baclcr-ial. haei1ioglohin itlb: prolein-hacligro~ttii. Iii atltiition. tlircct dctectiori 01 haetnoglobin b!. histochctnical I’AI’ stairtit1g oU C’S conlirntctl a good corrcl;iliori bcl~vccri the reddish background ot’ C’S a5 ;iii intiir.ator (11‘ tlte presence of blood and Hh niixturc~: Ihis cati hc exprcssccl iii percenlages regarding the rclati\,c an1outtts 01’ cpithclial cer\rical cells I SL‘C ‘l‘ablc I ), SIvabs \z.ilh C’S Ivet-c’ lr-aitskrrcd irnrnediately allet- satnplir1g inlo separate tubes containing lysis solution. I
~‘ot~tatiiitiation of C’S ~vitli may have occurt-cd. This kind with blood cdls is. pi-ohahlv
blood Ii-otn local minimal lesions d~on~atnination of cervical cells as in ‘natural’ sexual practice too.
unlikely to contribute signilicantly to the HC’V RNA titre in CS. since even in patients (5 and 6) with very highly positive \2W samples. tie 1ICV RFCA could be detected in C’S (Table I). Iktection ol’ the six most common genotvpes ( 1a. 1 h. 2a. 211 .?c. 3a. ih. 4. 5. h) ol’all internal R’I’IY’R H&-positive materials (serum. \1’1’13. C’S) in duplicate layout revealed tiu disagreement bctnwn cot-responding samples obtained from each woman I’l’ablc I). In order to illuminate a possible relationship bctwcen the local prcsencc ol’ HC1’ in C’S and the risk 01‘ sexual-perin~ttal transmission. detection 01‘ HCT K.2A by KY-WK combined ~‘ith highly scnsiti\,c and specific hybridization techniques was pcrfot-med. To the best ol’ our knowledge testing for HCY RNA in C’S has not yet hwn repot-ted. tiCI’ RNA could clearly he dctectcd in C’S with three dilkrent methods. These frrcts demonstratr that a local ccwical presence of the virus in hepatitis
C
positive
wotnw
does
occur,
thus
ofkring
some
cvidcncc fat- the risk 01‘possible sexual transmission. Combining epitiemioloSi~~tl data \l’ith results from KIT-lY’R testing of HC\’ KY;\ in C'S c0~1ld be itti ~iserul source of additional infortnation on the signilicaticc 01’ hepatitis C’ as ii sexuall~~/perinatall~ tratismittcd disease.
References
Specific Serological
IgG Avidity Screening
- A Supplementary for Toxoplasmosis
Assay in in Pregnancy
Sir, l’rimary .l’oxoplasma inkction acquired it-t pregnancy may result in severe morbidity or u\‘en death ol’ the Ittus. C’ongenital toxoplasmosis can be prevented by infortning women on how to a\wid inli’ction during pregnancy. or by routine serological screening of pregnant women for recent Toxoplastna inkction. which renders prenatal diagnosis and timely treatment possible. Kecent infection can be dctectcd by dilkrent set-ological tests. The diagnosis of’ primary Toxoplasma inkction is olicn challenging because of the extrcmc variability or the humoral itnmune response and dil’l’wcnces in t hc titnc ol’ appearance and persistence of antibodies. IgM antibodies alone. or both Ighl and IgA antibodies are well kno\vn to ilidicatc acute infection. ighl antibodies appear as early as 5 days alter infection, reaching their maximutn lc~,cls about I tnonth later.
Letters
Evidence
of Hepatitis
C Virus
in Cervical
to the
Smears
Sir-.
‘I‘hc‘ tiepalitis C’ \?rus (I 1CV) has hwn recognized as bciiig Ihc mosl frcqucnt citusc 01’ noti-A and non-K hepatitis. Ltili~rlunalely. iO-50% ol’ all routra of Iransniission retnain unwrktin. ‘I’hc ederil to c\,hich sexual Iransniission accounts for cast’s of t1C’V \vith no pat-enteral exposure is conlroversial anti is still under discussion. Some authors h:t\,c rcportcd little or no It-ansmission.’ Lvhile others ha1.e presented data suggesting that HCl’ is sexuall!; lransniitted.2 The issue of perinatall!~ ~r;insk-ed Hepalitis C’ atid the link to inlkction rates iii vertical mother-to-chil(i Iransmission. particularly in HI\’ coittl’eclctf \v0111c’t1. ’ is still contro~~ersial. i\s part of 2 preventive prograninic in our clinic. wonien \vitti childbearing potential displaying increased bilirubin and transantinase levels \l’c’re submitted to a Hepatitis .A. 13. c’ II~I\V. HI<\‘. HC’\!) and 1111’ serological screening. Six wonwn. who \vere I’OLIII~ 10 he tiC’\‘-seropositi\,c Lvith enzyme-linked inniunosorbent assay (Fl.lS:\) (,Abbott HC\: EliI 2nd Ckneralion, ,\hhott Diagnostics IIivision. II.. I’.S.A.I. but tl,\\‘, HI<\’ and HI\:ncgati\~c. ww-c included in our sludy for further investigaliort. Koulindy p~rli~rnicd cytological analysis 01’ cervical I’:tpanicolaou (PAP) sntcwrs rcwaled iio cellular changes cottsistcnt l\rith possihlc \riral or other infections. It1 orticr 10 address the question 01’ whcthcr Ioc;~l genital tract associalion 01‘ tIC’\! tiiighl contribute to scxual/pcrinat~tl Irat1st1iissioti. wc dc9~clopeti ;t me1 hod li)r detcctirtg IICY KY/\ by rcwrsc 1t-atisct~iplas~-~~ol~~ii~~r~ts~ chain reaction (KTIY’K I in
Editor
ccr\kiil snic’arx (C’S). Sitiw sc\wal l~lood cell types Iiiivc’ recciitl!. been reported to contain I I(‘\‘,’ the internal ITI-I’(‘11 protoc~ol‘ for routinclv obtained scruni ~viis opliniized for- the Iii-d slag:e 01‘ testing ot \\,hole peripheral blood iL2’l’B) samples.” This test procedllr-e liw nialerial cont;iitiirig cells was I’itrthet adaptctl \z,hc‘rc su~ahs were used to obtain C’S li-om tnenstrualion and \,agin~tl-disch~tr~~-~r~~ \2vnien. ,,\n identical sampling prowtiurc \~;Is carried oul subsequently lo obtain material liar our routiticly pet-formed cc’rviciil PAI sincar atialysis. 11 I-e\~ealcd rcprcsentati\,e anioi~nls 01 cpilhelial cells with a11 atltnixturc of non-epithelial cc~lls. c.g. red blood cells (KM’: er\dit-ocytes). \vhite blood cells 1\\‘I’,(‘: Ieul\ocytes). normal vaginal Ilord (e.g. baclcr-ial. haei1ioglohin itlb: prolein-hacligro~ttii. Iii atltiition. tlircct dctectiori 01 haetnoglobin b!. histochctnical I’AI’ stairtit1g oU C’S conlirntctl a good corrcl;iliori bcl~vccri the reddish background ot’ C’S a5 ;iii intiir.ator (11‘ tlte presence of blood and Hh niixturc~: Ihis cati hc exprcssccl iii percenlages regarding the rclati\,c an1outtts 01’ cpithclial cer\rical cells I SL‘C ‘l‘ablc I ), SIvabs \z.ilh C’S Ivet-c’ lr-aitskrrcd irnrnediately allet- satnplir1g inlo separate tubes containing lysis solution. I
~‘ot~tatiiitiation of C’S ~vitli may have occurt-cd. This kind with blood cdls is. pi-ohahlv
blood Ii-otn local minimal lesions d~on~atnination of cervical cells as in ‘natural’ sexual practice too.
unlikely to contribute signilicantly to the HC’V RNA titre in CS. since even in patients (5 and 6) with very highly positive \2W samples. tie 1ICV RFCA could be detected in C’S (Table I). Iktection ol’ the six most common genotvpes ( 1a. 1 h. 2a. 211 .?c. 3a. ih. 4. 5. h) ol’all internal R’I’IY’R H&-positive materials (serum. \1’1’13. C’S) in duplicate layout revealed tiu disagreement bctnwn cot-responding samples obtained from each woman I’l’ablc I). In order to illuminate a possible relationship bctwcen the local prcsencc ol’ HC1’ in C’S and the risk 01‘ sexual-perin~ttal transmission. detection 01‘ HCT K.2A by KY-WK combined ~‘ith highly scnsiti\,c and specific hybridization techniques was pcrfot-med. To the best ol’ our knowledge testing for HCY RNA in C’S has not yet hwn repot-ted. tiCI’ RNA could clearly he dctectcd in C’S with three dilkrent methods. These frrcts demonstratr that a local ccwical presence of the virus in hepatitis
C
positive
wotnw
does
occur,
thus
ofkring
some
cvidcncc fat- the risk 01‘possible sexual transmission. Combining epitiemioloSi~~tl data \l’ith results from KIT-lY’R testing of HC\’ KY;\ in C'S c0~1ld be itti ~iserul source of additional infortnation on the signilicaticc 01’ hepatitis C’ as ii sexuall~~/perinatall~ tratismittcd disease.
References
Specific Serological
IgG Avidity Screening
- A Supplementary for Toxoplasmosis
Assay in in Pregnancy
Sir, l’rimary .l’oxoplasma inkction acquired it-t pregnancy may result in severe morbidity or u\‘en death ol’ the Ittus. C’ongenital toxoplasmosis can be prevented by infortning women on how to a\wid inli’ction during pregnancy. or by routine serological screening of pregnant women for recent Toxoplastna inkction. which renders prenatal diagnosis and timely treatment possible. Kecent infection can be dctectcd by dilkrent set-ological tests. The diagnosis of’ primary Toxoplasma inkction is olicn challenging because of the extrcmc variability or the humoral itnmune response and dil’l’wcnces in t hc titnc ol’ appearance and persistence of antibodies. IgM antibodies alone. or both Ighl and IgA antibodies are well kno\vn to ilidicatc acute infection. ighl antibodies appear as early as 5 days alter infection, reaching their maximutn lc~,cls about I tnonth later.