Benefit of using polymerase chain reaction to test blood donations will be considerable.
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Biomedical subjects
Publications and source records attributed to J Barbara.
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In an ongoing study we evaluated 71 males and 32 females attending our sexually transmitted diseases (STD) clinic. Intraurethral or endocervical swab specimens were cultured for Neisseria gonorrhea (NG), Ureaplasma urealyticum (UU), Mycoplasma homines (MH), Herpes simplex virus (HSV) and Chlamydia trachomatis (CT), using an ELISA technique and the polymerase chain reaction (PCR). HIV antigen, hepatitis B (HBV) and Treponema pallidum (TP) seropositivity were tested by ELISA. Mean age was 33.4 and range 15-72 years. 83 patients (81%) used condoms only rarely, 35 (35%) had multiple sexual partners and 83 (81%) were treated empirically prior to evaluation. Dysuria and urethral discharge were found in 47 (45.6%), of whom 34 (33%) were males; the majority of females were asymptomatic. A specific etiology for STD was found in 53 patients (51.4%) and 1/3 had more than 1 pathogen. CT, UU, MH, HSV, NG and TV were found in 27, 24, 5, 3, 2 and 1, respectively. 8 patients were seropositive for HBV and 1 for TP; all were seronegative for HIV. CT was the most prevalent pathogen found. All patients with STD symptoms should be screened for all sexually transmitted pathogens, since many of them have more than 1 pathogen. STD clinics in Israel should be developed in conjunction with microbiology laboratories for better management of STD in the community.
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Blood samples from 9,215 blood donors in three U.K. centres (North London, Bristol and Manchester) were tested for their alanine aminotransferase (ALT) level and the presence of anti-HBc and anti-HCV. This paper presents the results of the ALT and anti-HBc tests. The prevalence of ALT > 45 IU/l was 3.1% overall (North London 3.06%, Bristol 4.56% and Manchester 1.97%). Manchester results were skewed by the methodology used for ALT measurement, highlighting the need for standard test methods. Anti-HBc was detected using the Wellcome enzyme-immunosorbent assay (EIA) and confirmatory testing was performed using a radioimmunoassay (RIA) and the Corecell haemagglutination assay. Repeat reactive rates were 0.9, 0.79 and 0.94% for North London, Bristol and Manchester, respectively, with an overall rate of 0.9%. The confirmed positive rate was 0.73, 0.53 and 0.65% for the three centres with an overall rate of 0.63%. Donors with an ALT > 45 IU/l, or with confirmed anti-HBc, were interviewed with a medical questionnaire for risk factors. The major contributing factors in donors with a raised ALT were alcohol consumption and obesity.
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Untreated urine specimens from 358 patients (344 attending genito-urinary medicine clinics, 14 haemophiliacs) and 353 blood donors were tested blind by a simple IgG-capture particle-adherence test (GACPAT) and a rapid IgG-capture enzyme-linked immunosorbent assay (GACELISA) for antibody to human immunodeficiency virus (anti-HIV). All 158 urine specimens from seropositive subjects were anti-HIV positive by GACPAT and 157 of them (99.4%) were positive by GACELISA. Tests on 553 urine specimens from seronegative subjects gave two repeatable false-positive reactions by GACPAT (0.4%) and none by GACELISA. By means of a modified procedure anti-gp160 was detected by commercial western blot in the urine of 44 of 45 seropositive subjects examined. IgG-capture assays will detect anti-HIV in unconcentrated urine and so allow a diagnosis in circumstances when blood sampling is impracticable.
Two infants were considered to have acquired cytomegalovirus (CMV) infection from blood transfusions screened for the presence of CMV antibody by a haemagglutination assay. Further samples from the same donors were tested by a latex agglutination test; six of 18 (33%) previously believed seronegative were found to be seropositive.
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A 30-yr-old man with chronic granulocytic leukaemia received a bone marrow transplant from his histocompatible sister in December 1982. His post-transplant course was complicated by Grade III graft-versus-host disease and multiple infectious episodes until his death from pneumonia on d + 190. He was later found to be seropositive for anti-HIV at the time of his death. Retrospective analysis of stored sera showed a transient period of seropositivity from d + 11 to d + 20 thought to reflect passive transfer of antibody from a blood product transfused prior to d + 11 when he was also exposed to infectious virus. He remained seronegative until d + 78 when anti-HIV was again found. Seropositivity persisted until his death and was attributed to endogenous antibody response. Although it is unclear whether his clinical course was due to AIDS, exposure of an immunosuppressed patient to HIV may be associated with more rapid development of clinical disease.
Serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (gamma-GT) activities were measured in over 2000 north London blood donors. The results were compared with those from the United States. The percentage of the total donor population with ALT activities above 40 IU/l in 1986 was greater than that found in our earlier studies in 1973 and 1982 (4.6% compared with 2.8% and 3.1%, respectively). There was a noticeable difference in the ALT distribution between male and female donors: mean +2.25 SD for male donors was 55.3 IU/l, while that for female donors was 30.8 IU/l at 37 degrees C. In stability studies the optimal temperature for short term storage (10 days) was 4 degrees C (6.4% loss of activity after 10 days). Surprisingly, storage at lower temperatures (-35 degrees C and -80 degrees C) resulted in greater loss of activity.
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