Juan A. Embil

Congenital cytomegalovirus infection in two siblings from consecutive pregnancies.

Both the first and second infants of a young mother had congenital cytomegalovirus infection. The first child had severe cytomegalic inclusion disease and died at age 30 days. The second, born within a year, had viruria at birth and continued to excrete cytomegalovirus at 8½ months; at 5 months she also had viremia. Although congenital cytomegalovirus infection in more than one sibling may be rare, the possibility of its occurrence should not be overlooked; infants born to the mother of a previously affected child should be subjected to long-term follow-up. It is probable that if a healthy adult woman, who is a chronic cytomegalovirus carrier, becomes pregnant, the infection may be passed transplacentally to the fetus.

Sequential cervical specimens and the isolation of Chlamydia trachomatis: factors affecting detection.

For 260 consecutive patient visits by women to a clinic for sexually transmitted diseases, four cervical specimens were cultured in duplicate for detection of Chlamydia trachomatis. Sixty-one positive results were detected by at least one of the four specimens; the first two specimens detected 67-69% and the last two 80-82% of the 61 positives. The difference in these isolation rates is statistically significant (P = 0.003). Duplicate cultures of the same specimen did not significantly increase detection rates. A combination of two specimens could increase the number detected by 44.7% beyond the results of a single-specimen culture. Contamination rates were higher for the first two specimens. Routine cleaning of the cervical canal with a swab before the taking of specimens should reduce contamination and increase the probability of obtaining infected cells when they are present.

Liver necrosis, adenovirus type 2 and thymic dysplasia

An association between adenovirus and liver cell damage, although suspected, has not been frequently demonstrated in the human. In this presentation the necropsy of a two month old female infant with thymic dysplasia will be reported who died with liver necrosis in the absence of pulmonary changes. Sections of the liver showed numerous Feulgen-positive intranuclear inclusions with a distinct mosaic-like pattern on high magnification. Adenovirus was isolated from the liver and identified as type 2 by hemagglutination-inhibition and neutralisation tests. Electronmicroscopy of the liver showed considerable multiplication of the virus in most of the liver cells. The characteristic para-crystalline array of the virions could frequently be seen. The appearance of the virion, its size, and cellular distribution was typical of an adenovirus. This appears to be the first instance in which adenovirus has actually been shown by electron-microscopy in the human liver, and the third instance in which liver necrosis due to adenovirus was associated with thymic dysplasia.

Prevalence of antibodies to hepatitis A antigen in patients attending a clinic for treatment of sexually transmitted diseases.

Samples of serum from 970 people in Nova Scotia, Canada, were tested by radioimmunoassay for determination of the prevalence of antibodies to hepatitis A antigen (anti-HA). Volunteer blood donors aged 16--26 years or 51 years old or older provided 575 samples. Other samples were obtained from 152 students accepted for nursing training at the Victoria General Hospital, Halifax, Nova Scotia, and from 243 patients of the Special Urology (sexually transmitted diseases) clinic of the hospital. Percentages of samples positive for anti-HA were determined according to classification of the donors by age, rural vs. urban location, sex, and attendance at the clinic. Samples were positive for 43.4% of the male patients and 45.8% of the female patients at the clinic, 13.8% of the student nurses, 12.6% of the young blood donors, and 69.1% of the older blood donors. A higher prevalence of anti-HA in donors was associated with increased age, urban environment, and attendance at a clinic for treatment of sexually transmitted diseases.

Concurrent oral and genital infection with an identical strain of herpes simplex virus type 1. Restriction endonuclease analysis.

The virus isolated from concurrent genital and oropharyngeal lesions of a male patient was identified as herpes simplex virus type 1 (HSV-1) by rate neutralization and biological marker tests. Analysis by digestion with restriction endonuclease revealed that isolates from the penis and anterior pillars had identical patterns, similar to those of prototype HSV-1. Data indicate that a person can be infected with the same strain of HSV-1 in two different sites at the same time.

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

&NA; An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.

Association of cytomegalovirus and herpes simplex virus infections of the cervix in four clinic populations

The rates of isolation of cervical cytomegalovirus (CMV) and herpes simplex virus (HSV) were compared for populations of four different clinics attended by a total of 1,755 women. The prevalence of CMV infection could be predicted by the prevalence of HSV infection, with CMV being 2.5 times as prevalent as HSV in each population. The overall infection rates for CMV and HSV were 4.1% and 1.7%, respectively. The 252 women attending the Sexually Transmitted Disease Clinic had significantly higher rates of CMV and HSV infection (12.5% and 5.6%, respectively) than populations attending the other clinics. A strong relationship between marital status and CMV infection was observed. The estimated relative risk for single compared to married women was 2.9. These data verify the importance of the sexual route of transmission in the epidemiology of cervical infection with CMV.

Levels of cytomegalovirus seropositivity in homosexual and heterosexual men.

The prevalence of antibodies to cytomegalovirus (CMV) among 57 homosexual men (77.2%) was significantly higher than that among 155 heterosexual men (32.3%) attending a sexually transmitted disease clinic. The difference in prevalences was most pronounced in those under 30 years of age. No difference in CMV seroprevalence was observed between the heterosexual patients and a control group of blood donors. The geometric mean titer of seropositive homosexuals (1:79) was significantly higher than that of heterosexuals (1:28) in both younger and older age groups. These data suggest that homosexual men are exposed to CMV at a much earlier age than heterosexuals and that homosexuals experience frequent reactivation or reinfection with CMV.