[Diagnosis of adenovirus infections].
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Biomedical subjects
Publications and source records attributed to R Wigand.
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Guinea pigs were infected cutaneously with HSV1 and treated topically with acyclovir or phosphonoformic acid (0.1% to 0.5% solution), or with a combination of both. The therapy was clinically effective and the virus content in the skin diminished. Virus harvests from skin areas in no case showed increased drug resistance, as tested by plaque reduction.
From the stool of a Dutch girl, a new virus (LJ) was isolated that by morphological, biological, and immunological criteria was a human adenovirus. Because of its hemagglutinating activity for rat and human red blood cells and its DNA restriction enzyme pattern, the virus was classified as a member of subgenus D. It was distinct in neutralization tests from all other human adenoviruses. The hemagglutinin was antigenically similar to that of adenoviruses 13 and 39, but the DNA differed from that of these two species. It is proposed to call virus LJ candidate Mastadenovirus h 38. Two other viruses belonging to the same new species were isolated in the USA.
The possibility of a rapid diagnosis of adenovirus conjunctivitis was studied by demonstrating genus-specific adenovirus hexon antigen or antihexon IgA antibodies in conjunctival secretions by an ELISA. Hexon was found in 44% of about 100 patients with adenovirus conjunctivitis, proven by virus isolation, antihexon in 53%, either one or both in 69% of the conjunctival swabs from the acute phase. Hexon was found in the acute phase more frequently, antihexon in the convalescent phase. In patients with conjunctivitis of different etiology no hexon was found, whereas antihexon IgA was found in a few cases.
In February and March 1981, eight patients and two nurses in a women's ward (internal medicine) fell ill with gastroenteritis. Because faecal samples were not available during the acute phase, the diagnosis was made by demonstrating complement-binding antibodies and rotavirus-specific IgM, with 14 persons on the same ward without gastroenteritis serving as controls. The illness took a mild course. All patients had watery diarrhoea and abdominal pain, four had nausea or vomiting, but only one had fever. Thus even in adults with gastroenteritis rotavirus infection should be considered in the differential diagnosis.
About 200 antigenically related adenoviruses were isolated from cases of infantile diarrhoea in the Netherlands and North-West Germany. The viruses were fastidious and failed to replicate serially in human diploid fibroblasts and in primary human embryonic kidney cells. A number of strains were established in HeLa, HEp-2, Graham (293), cynomolgus monkey kidney, and Chang conjunctival cells. The viruses were mammalian adenoviruses by the usual criteria. No relationship to the 39 known human adenovirus species was found, either by neutralization tests or by haemagglutination inhibition tests. Neutralization tests showed two distinct variants, represented by strains Tak and Dugan. The variants were identical in haemagglutination inhibition tests. DNA restriction enzyme analysis showed Tak and Dugan to have considerably different genomes, indicating that these variants should be classified as different species (Wadell et al, 1983). It is proposed that the variants should be called Mastadenovirus h 40 (with reference strains Dugan and Hovi X) and Mastadenovirus h 41 (with reference strain Tak). Neutralization and haemagglutination inhibition tests demonstrated that the viruses from Glasgow and Helsinki (Hovi X) described by Johansson et al [1980] and by Kidd and Madeley [1981] belong to these two adenovirus species.
Thirty-four out of 64 faecal samples with adenovirus particles, as seen by electron microscopy, were found to contain adenovirus 40 or 41 by direct isolation and neutralization in Chang's conjunctival cells, mostly within one week. (Ad40 and 41 candidate viruses are serologically related.) 6 other adenovirus species were isolated; 6 samples gave equivocal results, and 18 were negative. A genus-specific ELISA with an antihexon coat yielded positive results in 40 out of 55 samples; the test failed to identify adenovirus antigen in 10 out of 17 specimens, which were found negative by culture. All of them were negative by immunfluorescence of inoculated Chang cell cultures. Hence the failures are probably due to insufficient amount of virus in the samples. The predominance of only two adenovirus species associated with gastroenteritis in children and the ease of cultivating and identifying them should help to elucidate their etiological significance.
Cutaneous infection of guinea pigs with HSV1 was topically treated from 2 to 6 days post infection with 7 antiherpetic substances. Phosphonoformic acid and acyclovir were found to be highly effective; trifluorothymidine, thymine arabinoside, ethyldeoxyuridine, and adenine arabinoside monophosphate all had some therapeutic effect in decreasing order, whereas iododeoxyuridine was ineffective. The efficacy of treatment was evaluated from cutaneous lesion scores by the Wilcoxon rank test. The substances were combined in marginally effective concentrations. From the 21 combinations, acyclovir + phosphonoformic acid, acyclovir + thymine arabinoside, and phosphonoformic acid + thymine arabinoside suggested a synergistic interaction, which appeared significant for acyclovir + phosphonoformic acid.
Adenovirus 8 (Ad 8, strain 1127) has the general structural features of an adenovirus; it produces the genus-specific hexon antigen. The fiber length of 12 nm corresponds to that of other subgenus D adenoviruses. In hemagglutination-inhibition, Ad 8 is related to Ad9 and Ad 15/H9. The slow multiplication, compared to most other subgenus D viruses, was shown not to be caused by an extended growth cycle, but appears to be due to an inefficient virus release into the medium. After restriction analysis with the enzymes Sma I and Bgl II, the typical fragment patterns of species from subgenus D were obtained, while very different patterns emerged from the analysis with Hind III, Bam HI, and Bst E II endonucleases. Several strains of Ad 8 produced more penton-associated toxin than Ad 15/H9 used as reference virus from subgenus D, which could explain the "clumping CPE" caused by Ad 8. Ad 8 toxin was neutralized by antisera from many adenovirus species. The poor virus yield of Ad 8 was not improved by removing soluble viral or cellular substances; all other attempts to improve virus yield by varying the conditions of cell culture also failed.
Treatment of cell cultures with iododeoxyuridine (IUdR) before virus inoculation may enhance the subsequent virus multiplication. This effect was studied in seven kinds of cell cultures with seven human adenoviruses from six subgenera. IUdR (50 micrograms/ml) was added 24 h after the seeding of cells, left for 2 days, and removed before virus inoculation. IUdR had no effect on cell proliferation. Viral cytopathic effect was enhanced in many instances by IUdR pretreatment. However, virus multiplication was enhanced weakly in only four cases [adenovirus 7 in Vero, African green monkey kidney, cynomolgus monkey kidney; adenovirus 4 (Ad4) in HeLa cells], and strongly only for Ad4 in Vero cells, which are semipermissive for Ad4. IUdR pretreatment of Vero cells shortened the replication cycle for Ad4 and increased sensitivity for minimal virus concentrations about 1000-fold. From immunofluorescence experiments it appears that more than one infectious particle is required to infect an untreated Vero cell.
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101 paired sera from patients with proved adenovirus infections (mostly conjunctivitis) were tested quantitatively by counter immunoelectrophoresis, with hexon of adenovirus 5 as a genus-specific antigen, in comparison with complement-fixation. Both methods were equally sensitive to demonstrate antibodies; also the titers showed a marked correlation. The number of titer rises, however, was higher in counter immunoelectrophoresis; the titer rises mostly occurred around the 10th day after onset of disease. No differences between patients infected with different adenovirus types were found.
Erythrocyte preparations from man, rat, and monkey, fixed by glutaraldehyde (0.06%, final concentration, 30 min room temperature), remained agglutinable by various human adenoviruses. While incomplete adenovirus hemagglutinins from species of subgenera A, C, and E did not react with fixed blood cells, the numerous species of subgenera B and D, in which hemagglutination and hemagglutination-inhibition are essential for identification, did so. Fixed blood cells were also agglutinable by indirect hemagglutinins of adenovirus 9 and 11; hence, hemagglutination-enhancement tests with fixed blood cells are feasible. Fixed blood cells remained stable and agglutinable up to one year; they could also be lyophilized.
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The inhibition of herpes simplex virus type 1 (strain McIntyre) by two anti-herpes substances applied in combination was studied by means of a CPE inhibition method In Vero cell microcultures. The following substances were studied: AraA monophosphate, thymine arabinoside, ethyldeoxyuridine, acycloguanosine (acyclovir). 3-fluorothymidine, phosphonoformic acid. Most substance pairs showed a moderate degree of synergism. Two additive interactions and one case of antagonism was observed. Human fibroblast interferon, combined with the antiherpes substances, showed an additive interaction with AraAMP, but synergism with the others.
Antigenic relationships between adenoviruses of subgenus D were determined by neutralization tests in HeLa cell cultures by CPE inhibition. For cross-testing, several antisera of the same species were tested against the prototype viruses. 39 wild strains belonging to 12 different virus species were also studied. Marked variation in the degree of cross-neutralization between individual sera of the same species was often observed. However, virus strains within a species mostly showed identical serological reactions. Hence, antigenic specificity appears to be a fairly constant property of any one species. Strong cross-neutralizations between species are presumably due to a relationship of the hexon (hexon) antigen, whereas weak cross-neutralizations found between viruses related by hemagglutination-inhibition are due to the gamma (fiber) antigen. Viruses related to adenovirus 15 (Mastadenovirus h 15) showed a variety of cross-reactions in neutralization tests. In view of the new species definitions of adenoviruses and to facilitate identification, changes in the classification of Ad 15, 25, 29, and 15/H9 are proposed. The prototypes of Ad 13, 15, 25, 29, and 30 have been cloned by terminal dilution.
Fourteen patients with confirmed adenovirus (kerato-) conjunctivitis were treated at random with either exogenous interferon alpha (Le) (3 x 10(6) IU/ml, 1 drop daily) or with albumin. We observed no clinically relevant therapeutic effects. However, interferon seemed to exert a prophylactic effect on uninflamed fellow eyes. The prophylactic potency of interferon in adenovirus (kerato-)conjunctivitis should be evaluated in further controlled trials.