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Viral loads in primary varicella zoster virus infection
Abstracts were first treated with imaged-percutaneous drainage (PD) along with proper antibiotic therapy while 6 of them had repeated PD and 5 were undergone open surgery. Staphylococci were the most common pathogen that was cultured from the abscess sites. Poor outcomes (relapse or expired) were statistically related to age >60. However spine involvement, secondary or bilateral abscess did not influence the outcomes. Conclusion: Psoas abscess is an uncommon but important differential diagnosis in patients presenting with fever, low back pain, lower abdominal and hip pain and requires careful investigations and management.
307 12 months); saquinavir (3 patients: 7.6 months); indinavir (1 patient: 5 months). Discussion: There does not appear to be a correlation between ARVs and cryptogenic liver disease, although ddI was utilized most frequently and for the longest duration in our cohort. The aetiology of this condition remains unclear and larger studies are needed. With the advent of non invasive tests such as fibroscan, routine screening for fibrosis should be considered in all patients with potential fibrotic liver disease.
Poster Presentation 9 Poster Presentation 8 CRYPTOGENIC LIVER DISEASE IN HIV INFECTED PATIENTS TREATED WITH ANTI-RETROVIRAL DRUGS THN Wong, Lionel Tan, Charlotte Wing, Mark Nelson Chelsea and Westminster Hospital, London, United Kingdom Introduction: Cryptogenic liver cirrhosis can be defined as cirrhosis in the absence of active hepatitis B or C replication or other common causes of liver disease. Uncommon in HIV patients, it has been suggested to occur in association with didanosine (ddI). Methods: We retrospectively reviewed all liver biopsies performed in HIV positive patients at our hospital from 2004 -2007. We collected data on hepatitis B and C infection, autoimmune screen, a1-antitrypsin, iron and copper studies, alcohol history and anti-retroviral (ARV) history. We then analysed those without a defined cause of cirrhosis to ascertain a possible link between ARV therapy and liver disease. Results: 90 liver biopsies were performed during this period. 12 patients (9 males) were classified as having cryptogenic liver cirrhosis and all had biopsies due to abnormal liver function tests or clinical presentation suggestive of cirrhosis. Mean age 45 years (range 39e65). Mean time from HIV diagnosis was 10 years. Mean CD4 count at biopsy was 261 cells/mm3 (range 57e702). Histologically these biopsies showed: portal fibrosis (7); cholangiopathy (2); sclerosing cholangitis (1); steatohepatitis (1) and stage 5 cirrhosis (1). All patients were triple ARV drug class experienced. The mean duration of treatment with ARV therapy prior to biopsy were as follows: NRTIs: didanosine (9 patients: 71 months); zidovudine (8 patients: 55 months); stavudine (5 patients: 46 months); tenofovir (5 patients: 45 months); lamivudine (8 patients: 42 months); abacavir (4 patients: 20.8 months); emtricitabine (4 patients: 10 months) NNRTIs: efavirenz (6 patients: 52 months); nevirapine (4 patients: 39 months) PIs: nelfinavir (2 patients: 52 months); ritonavir (5 patients: 20 months); lopinavir (2 patients: 15.5 months); fosamprenavir (3 patients: 13 months); atazanavir (5 patients:
VIRAL LOADS IN PRIMARY VARICELLA ZOSTER VIRUS INFECTION Gathsaurie Malavige 1, Lousie Jones 1, Antony Black 1, Ananda Wijewickrama 2, Suranjith Seneviratne 3, Satheeka Kamaladasa 4, Graham Ogg 1 1
MRC Human Immunology unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom 2 Infectious diseases Hospital, Colombo, Sri Lanka 3 Department of Clinical Immunology, Manchester Royal Infirmary, Oxford Street, Manchester, United Kingdom 4 University of Sri Jayawardanapura, Colombo, Sri Lanka Introduction: Factors resulting in severe primary varicella zoster virus (VZV) infection are poorly understood. VZV viral load has not been previously studied in relation to severity of primary infection. We describe the association of viral loads with clinical disease severity in a group of adult patients with primary VZV infection. Methods: Quantitative PCR was performed to determine the viral loads in whole blood and serum from adult patients with chickenpox from Sri Lanka. Results: Viral loads were significantly higher among patients with severe infection when compared to those with mild infection (p < 0.001) and viral loads showed significant correlation with the clinical disease severity score (p < 0.001, r ¼ 0.61). As well as whole blood, virus was also detected from serum but the viral loads were several folds lower than detected in whole blood. However a significant correlation was seen between the viral loads in blood and serum (p < 0.001, r ¼ 0.99). Discussion: Whole blood VZV load correlates with primary disease severity score.
Poster Presentation 10 HEPATITIS D VIRUS (HDV) INFECTION IS NOT UNCOMMON IN SOUTH EAST LONDON Javeed Ahmed 1, Ranjababu Kulasegaram 2, Terry Wong 3, CY William Tong 1 1
Infection and Immunology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
307 12 months); saquinavir (3 patients: 7.6 months); indinavir (1 patient: 5 months). Discussion: There does not appear to be a correlation between ARVs and cryptogenic liver disease, although ddI was utilized most frequently and for the longest duration in our cohort. The aetiology of this condition remains unclear and larger studies are needed. With the advent of non invasive tests such as fibroscan, routine screening for fibrosis should be considered in all patients with potential fibrotic liver disease.
Poster Presentation 9 Poster Presentation 8 CRYPTOGENIC LIVER DISEASE IN HIV INFECTED PATIENTS TREATED WITH ANTI-RETROVIRAL DRUGS THN Wong, Lionel Tan, Charlotte Wing, Mark Nelson Chelsea and Westminster Hospital, London, United Kingdom Introduction: Cryptogenic liver cirrhosis can be defined as cirrhosis in the absence of active hepatitis B or C replication or other common causes of liver disease. Uncommon in HIV patients, it has been suggested to occur in association with didanosine (ddI). Methods: We retrospectively reviewed all liver biopsies performed in HIV positive patients at our hospital from 2004 -2007. We collected data on hepatitis B and C infection, autoimmune screen, a1-antitrypsin, iron and copper studies, alcohol history and anti-retroviral (ARV) history. We then analysed those without a defined cause of cirrhosis to ascertain a possible link between ARV therapy and liver disease. Results: 90 liver biopsies were performed during this period. 12 patients (9 males) were classified as having cryptogenic liver cirrhosis and all had biopsies due to abnormal liver function tests or clinical presentation suggestive of cirrhosis. Mean age 45 years (range 39e65). Mean time from HIV diagnosis was 10 years. Mean CD4 count at biopsy was 261 cells/mm3 (range 57e702). Histologically these biopsies showed: portal fibrosis (7); cholangiopathy (2); sclerosing cholangitis (1); steatohepatitis (1) and stage 5 cirrhosis (1). All patients were triple ARV drug class experienced. The mean duration of treatment with ARV therapy prior to biopsy were as follows: NRTIs: didanosine (9 patients: 71 months); zidovudine (8 patients: 55 months); stavudine (5 patients: 46 months); tenofovir (5 patients: 45 months); lamivudine (8 patients: 42 months); abacavir (4 patients: 20.8 months); emtricitabine (4 patients: 10 months) NNRTIs: efavirenz (6 patients: 52 months); nevirapine (4 patients: 39 months) PIs: nelfinavir (2 patients: 52 months); ritonavir (5 patients: 20 months); lopinavir (2 patients: 15.5 months); fosamprenavir (3 patients: 13 months); atazanavir (5 patients:
VIRAL LOADS IN PRIMARY VARICELLA ZOSTER VIRUS INFECTION Gathsaurie Malavige 1, Lousie Jones 1, Antony Black 1, Ananda Wijewickrama 2, Suranjith Seneviratne 3, Satheeka Kamaladasa 4, Graham Ogg 1 1
MRC Human Immunology unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom 2 Infectious diseases Hospital, Colombo, Sri Lanka 3 Department of Clinical Immunology, Manchester Royal Infirmary, Oxford Street, Manchester, United Kingdom 4 University of Sri Jayawardanapura, Colombo, Sri Lanka Introduction: Factors resulting in severe primary varicella zoster virus (VZV) infection are poorly understood. VZV viral load has not been previously studied in relation to severity of primary infection. We describe the association of viral loads with clinical disease severity in a group of adult patients with primary VZV infection. Methods: Quantitative PCR was performed to determine the viral loads in whole blood and serum from adult patients with chickenpox from Sri Lanka. Results: Viral loads were significantly higher among patients with severe infection when compared to those with mild infection (p < 0.001) and viral loads showed significant correlation with the clinical disease severity score (p < 0.001, r ¼ 0.61). As well as whole blood, virus was also detected from serum but the viral loads were several folds lower than detected in whole blood. However a significant correlation was seen between the viral loads in blood and serum (p < 0.001, r ¼ 0.99). Discussion: Whole blood VZV load correlates with primary disease severity score.
Poster Presentation 10 HEPATITIS D VIRUS (HDV) INFECTION IS NOT UNCOMMON IN SOUTH EAST LONDON Javeed Ahmed 1, Ranjababu Kulasegaram 2, Terry Wong 3, CY William Tong 1 1
Infection and Immunology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom