Lyndon S. Oshiro

Etiology and outcome of diarrhea after marrow transplantation: A prospective study

BACKGROUND/AIMS Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. METHODS Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and gene-probe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. RESULTS One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea. CONCLUSIONS Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.

AIDS-associated retroviruses (ARV) can productively infect other cells besides human T helper cells

We have examined the host range of AIDS-associated retroviruses (ARV) that are known to infect human T cells of the helper subset. We have observed that the virus cannot infect fibroblast and epithelial cell lines of many different animal species. It is infectious and replicates efficiently in peripheral mononuclear cells (PMC) of chimpanzee and at low levels in baboon and rhesus monkey PMC. Most importantly, it has been found to replicate in established lines of human B cells, monocytes, and promyelocytes. This ability to infect these other cell types appears to be associated, in most cases, with the presence of the Leu 3 T helper cell antigen on the cell surface. Other mechanisms for virus infection, however, may be involved. The results suggest that ARV will be found in other cells of AIDS patients, besides T cells, and that these cells could be the reservoir for continual virus spread in the host. Variations in the replicative ability of ARV isolates in human cells have also been noted; they could reflect potentially important pathogenic differences among these human retroviruses.

Infection by the Retrovirus Associated with the Acquired Immunodeficiency Syndrome: Clinical, Biological, and Molecular Features

Peripheral mononuclear cells from more than 160 persons from groups at risk for the acquired immunodeficiency syndrome (AIDS) have yielded AIDS-associated retroviruses (ARV). Antibodies to ARV can also be found in these risk groups. Antibody-negative, virus-positive persons have been identified with early infection or possible viremia with immune complex formation. Established lines of human T and B cells, monocytes, and promyelocytes have been infected with ARV. Moreover, infectious virus has been recovered from macrophages cultured from the blood of some persons with AIDS. The cytopathic effects of ARV in T cells is associated with the accumulation of unintegrated viral forms in the infected cells. The ARV has also been isolated from plasma, serum, saliva, semen, urine, cerebrospinal fluid, and brain tissue. All these results reflect the wide host range of ARV and support its role in neurologic abnormalities seen in some patients. Molecular studies of independent ARV isolates indicate a polymorphism of nucleotide sequences, particularly in the viral envelope region. All these features place ARV in the lentivirus subfamily of human retroviruses.

Chronic Progressive Panencephalitis Due to Rubella Virus Simulating Subacute Sclerosing Panencephalitis

Late-onset chronic progressive panencephalitis developed in a 12-year-old boy with congenital rubella syndrome from whose brain rubella virus was isolated. Progressive dementia began at eight, and ataxia, choreiform movements, myoclonic seizures, and fine perimacular pigmentation appeared at 11 years of age. The cerebrospinal fluid was minimally pleocytotic and had a total protein of 156 mg per deciliter, of which 52 per cent was gamma globulin. Electroencephalography demonstrated generalized medium and occasional high-voltage slowing without burst suppression. The antibody titer to rubella virus (hemagglutination inhibition) was 1:8192 in serum and 1:256 in cerebrospinal fluid. Antibody titer to measles virus (complement fixation) was less than 1:8 in serum. Microscopical study of biopsied brain tissue at the age of 11 disclosed panencephalitis similar to subacute sclerosing panencephalitis, but with perivascular deposits and without inclusion bodies. Rubella virus was isolated from the brain by cocultivation with CV-1 cells.

The isolation and characterization of a Norwalk virus-specific cDNA.

Norwalk virus, an important cause of epidemic, acute, nonbacterial gastroenteritis in adults and children, has eluded adaptation to tissue culture, the development of an animal model, and molecular cloning. In this study, a portion of the Norwalk viral genome encoding an immunoreactive region was cloned from very small quantities of infected stool using sequence-independent single primer amplification. Six overlapping complementary DNA (cDNA) clones were isolated by immunologic screening. The expressed recombinant protein from a representative clone reacted with six of seven high titer. Norwalk-specific, postinfection sera but not with corresponding preinfection sera. Nucleic acid sequence for all clones defined a single open reading frame contiguous with the lambda gt11-expressed beta-galactosidase protein. Only oligonucleotide probes specific for the positive strand (defined by the open reading frame) hybridized to an RNaseA-sensitive, DNaseI-resistant nucleic acid sequence extracted from Norwalk-infected stool. Furthermore, RNA extracted from serial postinfection, but not preinfection, stools from three of five volunteers hybridized to a Norwalk virus cDNA probe. Clone-specific oligonucleotide probes hybridized with cesium chloride gradient fractions containing purified Norwalk virion. In conclusion, an antigenic, protein-coding region of the Norwalk virus genome has been identified. This epitope has potential utility in future sero- and molecular epidemiologic studies of Norwalk viral gastroenteritis.

Characterization of a new strain of HHV-6 (HHV-6SF) Recovered from the saliva of an HIV-infected individual

An isolate of the human herpesvirus-6 (HHV-6SF) recovered from the saliva of an HIV-infected individual differs in its cellular host range and certain genomic properties from other HHV-6 strains described. HHV-6SF replicates in adult peripheral blood mononuclear cells (PMC) substantially better than in fetal cord blood PMC and can be grown only in the MT-4 established T cell line. It preferentially infects CD4+ lymphocytes but can replicate in CD8+ cells and peripheral blood macrophages. It also infects neuroblastoma cells and cell lines derived from the gastrointestinal tract. These latter results suggest that this herpesvirus could play a role in disorders affecting these tissues. Finally, the restriction enzyme pattern of HHV-6SF differs from that of other HHV-6 strains. The identification of this distinct HHV-6 strain could indicate an unusual biologic variation among viral isolates thus far not observed with other herpesviruses.

Prevalence of acute enteric viral pathogens in acquired immunodeficiency syndrome patients with diarrhea

Abstract Diarrhea due to enteric pathogens is an important complication of advanced human immunodeficiency virus infection. Whereas numerous bacterial and parasitic agents have been implicated, the role of pathogenic enteric viruses is less clear. Stools from 153 human immunodeficiency virus seropositive men were tested by electrophoresis, enzyme-linked immunosorbent assay, and immune electron microscopy for the presence of rotaviruses (group A and non-group A), adenoviruses, and Norwalk agent. Virus was detected in 9% of the patients with acquired immunodeficiency syndrome, 3% of the patients with acquired immunodeficiency syndromerelated complex, and none of the seropositive men without these diagnoses. Virus detection was not more likely in stool from patients with diarrhea.

Viruslike particles in muscle from a patient with amyotrophic lateral sclerosis.

An electron microscopic study of muscle and central nervous tissues from a case of amyotrophic lateral sclerosis showed crystalline arrays of 20 to 24 nm viruslike particles in muscle. The particles were located between the myofibrils, adjacent to the Z bands, and near the perinuclear region, but were never seen within the nucleus. Cell cultures from the same muscle specimens showed no such particles. Central nervous system tissues and cultures also failed to show viruslike particles. The cultures were negative by the indirect fluorescent antibody technique with serums from patients with amyotrophic lateral sclerosis. The nature of these particles or their relationship to amyotrophic lateral sclerosis is unknown.

Direct detection of Molluscum contagiosum virus in clinical specimens by in situ hybridization using biotinylated probe.

Molluscum contagiosum virus (MCV) is an unclassified poxvirus which has recently become recognized as causing a major sexually transmitted disease. At present no assay is available for specific detection of MCV because the virus cannot be serially propagated in cell culture. Since MCV produces an abortive, limited growth with some cytopathic effect in certain cell lines, we were able to develop an in situ hybridization assay for detection of MCV genome in clinical specimens. Human fetal diploid lung cell monolayers were infected with clinical specimens, and after proper incubation and fixation in paraformaldehyde, hybridization was performed under full stringency conditions with a molecularly cloned biotinylated probe. Only MCV infected cells showed homology to the MCV probe with a purple-brown cytoplasmic staining. Additionally, we have described an in situ hybridization assay for direct detection of MCV genome in formalin-fixed, paraffin-embedded biopsies. Characteristic intracytoplasmic Molluscum bodies (Henderson-Paterson bodies) were detected in stratum spinosum cells of the epidermis. Striking staining similarities have been observed between in situ hybridization and haematoxylin-eosin cytostaining. These procedures are the first successful identification of MCV genome in clinical samples by molecular hybridization, with sensitivity and specificity equal to or greater than electron microscopy.

Cyclic expression of antigen and infectious virus in a BHK cell line (0-853) persistently infected with an SSPE strain of measles virus.

Establishment and characteristics of a baby hamster kidney cell line (BHK 0-853) persistently infected with a subacute sclerosing panencephalitis (SSPE) strain of measles virus (Lec strain) is described. The persistent infection was easily and repeatedly established and no special conditions were required. There was a predictable fluctuation in expression of virus intracellular and membrane antigens which varied from greater than 90% to less than 1% of the cells demonstrating these antigens during the first 6 or 7 passages. Thereafter, fluctuation of antigen and infectious virus expression continued in an unpredictable fashion.