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Biomedical subjects

M C Croxson

Publications and source records attributed to M C Croxson.

At least 19 recordsLinked to original sources
PubMed1998

Chickenpox monoarthritis: demonstration of varicella-zoster virus in joint fluid by polymerase chain reaction.

A case of chickenpox monoarthritis is described. The presence of varicella zoster virus (VZV) within the joint was demonstrated by the detection of viral DNA in synovial fluid at a time when peripheral blood cells were negative. This strongly suggests a direct role of VZV in causing monoarthritis complicating chickenpox. The use of the polymerase chain reaction allows more rapid (2 days) confirmation of the diagnosis. Early enough diagnosis would raise the question of using acyclovir to shorten the duration of arthritis.

Antibodies, Viral↗
PubMed1997

Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome.

OBJECTIVES: The frequency and characteristics of the long term sequelae of herpes simplex encephalitis were assessed after treatment with acyclovir. METHODS: Patients were included if they were treated with acyclovir and the diagnosis of herpes simplex encephalitis was confirmed by culture of herpes simplex virus (HSV) from the brain, an increase in the CSF HSV antibody titre, or detection of HSV deoxyribonucleic acid in the CSF. Each patient's medical records were reviewed and surviving patients were interviewed and examined. RESULTS: A diagnosis of herpes simplex encephalitis was confirmed in 42 patients. Five patients (12%) died in the first month. Three patients (7%) had severe neurological sequelae and died after a longer interval. All but one of the 34 surviving patients had neurological symptoms, an abnormal neurological examination, or both. Twenty patients (48%) performed everyday activities as well as before herpes simplex encephalitis; nine patients (21%) were living independently, but were functioning at a lower level than before the illness; and five patients (12%) had a severe neurological deficit. Twenty nine of the 34 survivors were assessed six months to 11 years after herpes simplex encephalitis. The most common long term symptoms were memory impairment (69%), personality and behavioural abnormalities (45%), and epilepsy (24%). Short term memory impairment (70%), anosmia (65%), and dysphasia (41%) were the most common signs. CONCLUSIONS: Although acyclovir has reduced the mortality of herpes simplex encephalitis, 30% of this group of patients either died or had a severe neurological deficit. The other 70% of the patients regained independence in activities of daily living, but most of these people had persistent neurological symptoms, signs, or both.

Acyclovir↗
PubMed1997

Anterior opercular syndrome, caused by herpes simplex encephalitis.

Bilateral frontal and parietal opercular lesions cause a syndrome characterized by paralysis of the masticatory, facial, pharyngeal, and tongue muscles (the anterior opercular syndrome). The anterior opercular syndrome can occur in patients with herpes simplex encephalitis (HSE), but in most of these patients the diagnosis of HSE was not confirmed. We describe the anterior opercular syndrome in four patients with HSE. In two of these patients, the anterior opercular syndrome dominated the clinical picture, but in the other two patients it was overshadowed by other manifestations of HSE. The diagnosis of HSE was confirmed by detection of herpes simplex virus (HSV) DNA in the CSF (two patients), culture of the HSV from a brain biopsy (one patient), and elevated HSV antibody titers in the CSF (one patient). Our patients made a partial recovery. Acute onset of weakness of masticatory, facial, pharyngeal, and glossal muscles, accompanied by fever, headache, and partial motor seizures of the face should suggest HSE.

Adolescent↗
PubMed1994

Demonstration of herpes simplex type 2 in the cerebrospinal fluid of two patients with recurrent lymphocytic meningitis.

AIMS: To investigate the aetiology of recurrent lymphocytic meningitis in two patients with a past history of recurrent genital herpes simplex infection. METHODS: Cerebrospinal fluid (CSF) obtained from two patients during an acute recurrent episode of lymphocytic meningitis was analysed by polymerase chain reaction for the presence of herpes simplex DNA. RESULTS: In both patients, the acute CSF was positive for herpes simplex type 2 DNA. A second CSF obtained 2 weeks later from one patient was negative for HSV DNA: CONCLUSIONS: Herpes simplex type 2 may be an important cause of recurrent lymphocytic meningitis. Available evidence suggests that viral DNA is cleared from the CSF between episodes and supports active viral replication as the pathological mechanism. The recurrences of meningitis need not coincide with clinical recurrences of genital herpes.

Adult↗
PubMed1994

Identification of human immunodeficiency virus type 2 in a New Zealand resident.

AIMS: To determine the human immunodeficiency virus (HIV) types infecting a West African immigrant to New Zealand. To develop an HIV type 2 specific polymerase chain reaction (PCR). METHODS: The HIV antibody status of the patient was determined using both HIV-1 and dual HIV-1 and 2 enzyme immuno assays (EIA). Western blot with HIV-2 and HIV-1 and 2 strips was used as a confirmatory assay. DNA from white blood cells was extracted and HIV proviral DNA amplified using either primers specific to the HIV-2 gag region (VB305 and VB312) or to HIV-1 gag (SK38/39) and env (SK68/69) regions. Amplified products were electrophoretically resolved, southern blotted and probed with specific oligonucleotide probes. RESULTS: The patient serum was strongly reactive for HIV antibodies by EIA and showed multiple reactivity when tested by western blot against both HIV-1 and HIV-2 proteins. DNA was only amplified with primers specific to HIV-2 and the 298 bp product hybridized with an HIV-2 specific probe. No HIV-1 DNA was amplified from the patient. CONCLUSION: This individual is infected with HIV-2 and has most likely developed antibodies that cross-react with HIV-1. We believe this is the first report of an HIV-2 infected individual in New Zealand.

AIDS Serodiagnosis↗
PubMed1993

Unlinked anonymous monitoring of HIV prevalence at sexually transmitted disease clinics.

AIM: To determine the prevalence of HIV infection among patients attending the four sexually transmitted disease (STD) clinics in two metropolitan areas of New Zealand. METHODS: The population studied comprised everyone who attended between August 1991 and August 1992 because of concern about a possible new episode of an STD and who had a blood specimen taken for hepatitis B (or syphilis) serology. The study involved unlinked anonymous testing of left-over blood specimens, following ethical guidelines that have been proposed internationally. RESULTS: Among 8478 specimens tested, 23 (2.7 per 1000) were found to be HIV positive. The seroprevalence rates per 1000 among women, heterosexual men, and homosexual or bisexual men were 1.1, 1.3, and 44, respectively. All but five of the infected people were either known to be HIV positive or had an identifiable test during their clinic attendance. CONCLUSIONS: The seroprevalence rates are similar to those reported from STD clinics in England, and suggest that heterosexual transmission of HIV infection has not yet been extensive in New Zealand.

Adolescent↗
PubMed1993

A polymerase chain reaction assay of cerebrospinal fluid in patients with suspected herpes simplex encephalitis.

A polymerase chain reaction (PCR) was used to detect herpes simplex virus (HSV) deoxyribonucleic acid (DNA) in CSF of 109 patients with possible herpes simplex encephalitis. HSV DNA was found in 20/109 patients. In 14 of these patients the diagnosis was confirmed by a rise in CSF antibodies, isolation of HSV from the brain, or both. In 3 patients CSF antibodies did not rise and 3 patients did not have a follow up lumbar puncture or a brain biopsy. In 19/20 patients HSV DNA was present in the first CSF specimen. The virus was identified as HSV I in 15 patients and HSV II in 4; the virus was not typed in the other patient. A possible diagnosis of herpes simplex encephalitis was not confirmed in the 89 PCR-negative patients. HSV DNA was present in CSF of 3 patients who had meningitis with herpetic genital infections but it was not found in 24 patients with other neurological diseases. The results suggest that the detection of HSV DNA in CSF using a PCR assay will be an accurate method of early diagnosis of herpes simplex encephalitis.

Adolescent↗
PubMed1993

Identification of cytomegalovirus in vitreous using the polymerase chain reaction.

A presumptive clinical diagnosis of cytomegalovirus (CMV) retinitis was made in two patients presenting with atypical ophthalmologic findings. The diagnosis was confirmed by finding specific CMV DNA sequences in sampled vitreous fluid using a polymerase chain reaction (PCR) based assay. Neither of these patients yielded CMV on culture or PCR of peripheral blood leucocytes, nor was CMV present in tears or urine of either patient. Serum antibody titres were stable and did not help in establishing the diagnosis. This report suggests that CMV retinitis can occur in the absence of disseminated CMV disease.

AIDS-Related Opportunistic Infections↗
PubMed1992

Polymerase chain reaction in detection of CMV DNA in renal allograft recipients.

This study investigates the use of polymerase chain reaction (PCR) in comparison with viral culture and serology for monitoring of cytomegalovirus (CMV) infection in 21 consecutive renal allograft recipients treated with a quadruple immunosuppression protocol. In addition, an attempt is made to explore the significance of quantitation of CMV signals obtained from peripheral blood leucocytes. CMV infection developed in 16 patients with seven of these patients having organ involvement. All of these 16 patients had a fourfold rise in antibody titres as well as positive identification of CMV DNA in peripheral blood leucocytes by PCR. Blood viral cultures were negative in two of these patients. All five patients who remained PCR negative also remained culture negative with no antibody change. PCR detected CMV infection on average 15 days and 20 days earlier than viral culture and serology respectively. All except one of the patients with CMV organ involvement had an initial peak of CMV DNA followed by prolonged carriage of detectable CMV. The majority of patients with fever only or asymptomatic CMV infection had a transient peak of CMV DNA. A high incidence of CMV disease with organ involvement occurred in seronegative recipients of kidneys from seropositive donors (3/5) and in seropositive recipients of kidneys from seronegative donors (3/7). OKT3 was associated with a higher incidence of CMV organ involvement compared to Antilymphocytic globulin (3/5 v 4/16) but there was a higher incidence of CMV mismatched patients in the OKT3 treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Reactivation of hepatitis B virus infection with an unusual pattern of serological markers.

A 73-year-old man presented with acute hepatitis, judged to be a reactivation of hepatitis B virus infection. His serum samples during a follow-up time of 16 months showed an unusual pattern of serological markers. He was consistently HBeAg positive, HBsAg fluctuated just under the cut-off value and he had a low level of circulating anti-HBs. By electron microscopy numerous aggregates of surface antigen particles, but not complete virions were seen. He was HBV DNA positive by hybridization. The complete precore and core genes and a region of the surface gene were amplified from his serum by PCR. These findings emphasize the need for expanded serological testing in some patients with acute clinical hepatitis.

Acute Disease↗
PubMed1991

HIV-1 infection status in two HIV-1 antibody positive infants determined using the polymerase chain reaction.

The HIV-1 infection status of two HIV-1 antibody positive infants born to HIV-1 infected mothers was determined using the polymerase chain reaction. HIV-1 genomic sequences were not detected in the white blood cells of either infant suggesting that they were not infected. HIV-1 genomic sequences were detected in the white blood cells of the mothers of both infants and in cells from the one surviving father. These results confirm the value of the PCR detection method for assessing the HIV-1 infection status of infants born to HIV-1 antibody positive mothers.

Female↗
PubMed1991

Murine typhus in Kaukapakapa?

We report a patient who had not been outside New Zealand with a fever and maculopapular rash. Serology suggested acute murine typhus due to R typhi. This is the first reported case in New Zealand from a nontraveller.

Female↗
PubMed1991

Brain biopsy in the management of focal encephalitis.

The value of a brain biopsy in diagnosis and management of suspected herpes simplex encephalitis was studied in 29 patients (16 prospectively and 13 retrospectively). The biopsy showed herpes simplex encephalitis in eight, culture-negative encephalitis in 14, and was normal in three patients. It provided an alternative diagnosis in four patients, for two of whom curative treatment was available. The biopsy was complicated by a fatal intracranial haemorrhage in one patient. The low yield of alternative diagnoses suggests that a brain biopsy is not justified in the routine investigation of focal encephalitis.

Adolescent↗