No abstract available.
Hepatitis C/*diagnosis ; Hepatitis C Antibodies/*blood ; Humans ; Immunoenzyme Techniques ; RNA, Viral/*blood ; Viremia/*diagnosis

BACKGROUND: The presence of serum varicella zoster virus (VZV) immunoglobulin M and G (IgM and IgG) aid diagnosis of and confirmation of immunization against varicella and herpes zoster. However, the relationship between serum VZV IgM and IgG and the clinical characteristics of VZV infection remains unclear. OBJECTIVE: We evaluated quantitative changes in serum VZV IgM and IgG in accordance with the clinical features of varicella, herpes zoster, and disseminated herpes zoster compared with a normal control group. METHODS: A total of 922 patients were classified into 3 groups: varicella, herpes zoster, and disseminated herpes zoster. We assessed serum VZV IgM and IgG titers in association with age, severity of skin lesions, duration of skin lesions, immune status, and neurologic complications. RESULTS: In patients with varicella and herpes zoster, serum antibody titer varied significantly depending on age and the duration of skin lesions. A high serum VZV IgM titer was related to varicella or disseminated herpes zoster viremia. In herpes zoster, elevated antibody titers, especially VZV IgM, were associated with severe skin lesions and the presence of neurologic complications. CONCLUSION: Serologic data for varicella and herpes zoster varied according to clinical features. A high serum VZV IgM titer was associated with an unfavorable clinical course of herpes zoster.
Chickenpox* ; Diagnosis ; Herpes Zoster* ; Herpesvirus 3, Human* ; Humans ; Immunization ; Immunoglobulin G ; Immunoglobulin M* ; Immunoglobulins* ; Skin ; Viremia

BACKGROUND/AIMS: Hepatitis C virus (HCV) RNA testing can be performed using qualitative or quantitative assays, and it is still unclear which is more useful as a primary test in patients positive for anti-HCV. The present study evaluated the usefulness of anti-HCV signal-to-cutoff ratio (S/CO ratio) for predicting HCV RNA results. METHODS: Patients on whom a qualitative HCV RNA test was performed due to a positive anti-HCV enzyme immunoassay were enrolled. Patients were divided into viremia and no-viremia groups according to HCV RNA results. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of anti-HCV S/CO for a diagnosis of viremia. RESULTS: In total, 487 patients were enrolled. HCV RNA was positive in 301 subjects (61.8%). Age, serum ALT level, and anti-HCV S/CO ratio were significantly different between the viremia and no-viremia groups. By ROC curve analysis, anti-HCV S/CO ratio (area, 0.989; 95% confidence interval, 0.981 to 0.998) accurately predicted the presence of viremia, with a cutoff value of 10.9 (sensitivity, 94.4%; specificity, 97.3%). CONCLUSIONS: Anti-HCV S/CO ratio was found to be highly accurate at predicting HCV viremia. The anti-HCV S/CO ratio can be used to determine whether a quantitative or qualitative HCV RNA test should be used to confirm HCV viremia in patients with a positive anti-HCV by the following criteria: if the anti-HCV S/CO ratio is <10.9, a qualitative HCV RNA test can be used, and if the anti-HCV S/CO ratio is > or =10.9 a quantitative HCV RNA test can be performed.
Adult ; Aged ; Female ; Hepatitis C/*diagnosis ; Hepatitis C Antibodies/*blood ; Humans ; Immunoenzyme Techniques ; Male ; Middle Aged ; RNA, Viral/*blood ; Viremia/*diagnosis

OBJECTIVETo investigate the value of C-reactive protein (CRP) on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSWe retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using receiver-operating characteristic curve (ROC). The incidence of transplant-related complications, overall survival, and relapse rate of the patients were analyzed with respect to the CRP level.

RESULTSThe clinical reference value of CRP for diagnosing bacteremia was 23.3 mg/L (AUC=0.735 [95% CI: 0.623-0.848], P=0.001), which had a diagnostic sensitivity and specificity of 0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to have delayed neutrophil reconstitution and platelet engraftment by 0.71 days (P=0.237) and 4.09 days (P=0.048), respectively, and had a significantly higher incidence of bacteremia (17.1% vs 53.5%, P=0.001) and CMV viremia (37.1% vs 72.1%, P=0.003) within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute graft versus host disease (aGVHD) showed no significant difference between the two groups (41.9% vs 22.9%, P=0.094; 14.0% vs 5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively). During the follow-up for a median of 318 (7-773) days in high-CRP group and for 299 (78-747) days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the low-CRP group (42.5% vs 78.4%, P=0.022), and tended to have a higher 2-year cumulative relapse rate (52.3% vs 19.8%, P=0.235). Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for post-transplant bacteremia within 100 days (OR=5.090 [95% CI: 1.115 -23.229], P=0.036).

CONCLUSIONA high CRP level on transplantation day can be indicative of a high risk of early post-transplant bacteremia and CMV viremia and also a poor prognosis following allo-HSCT.

Bacteremia ; diagnosis ; C-Reactive Protein ; chemistry ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Mycoses ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Viremia ; diagnosis

BACKGROUND: Virologic diagnosis of hepatitis C virus (HCV) infection is based on the use of sero-logic assays detecting specific anti-HCV antibodies, and then definitive diagnosis is made by detecting HCV RNA. Recently, newly developed Track-C (total HCV core antigen) test using an enzyme immunoassay (EIA) can detect and quantify total HCV core antigen in the peripheral blood of HCV-infected patients. In this study, the usefulness of Track-C test for the detection of HCV viremia was investigated by comparing the results with those of the HCV RNA test. METHODS: The study group consisted of 159 sera including 72 anti-HCV positive sera. The Track-C test was performed by enzyme immunoassay (Ortho Clinical Diagnostics, USA) with pretreatment for the dissociation of antigen-antibody complex. HCV RNA test was performed by HCV in house RT-nested PCR method. Results were calculated for the sensitivity, specificity and efficiency by comparing to each other. RESULTS: The efficiency between HCV RNA and Track-C was 77.4% for the 72 anti-HCV positivesera. Comparing with the results of HCV RNA, Track-C assay showed the sensitivity and specificity of 56.0% and 96.4%, respectively. Track-C assay demonstrated a relatively good linearity (R2=0.9836) and reproducibility (CV=4.4%) at high concentrations. CONCLUSIONS: Although the sensitivity of Track-C assay was not as high as that of HCV RT-PCR, a positive Track-C assay suggests the presence of HCV viremia, especially at higher concentrations. Track-C assay, therefore, may be used as a simple and supplementary test for HCV viremia and for follow-up monitoring.
Antigen-Antibody Complex ; Diagnosis ; Follow-Up Studies ; Hepacivirus ; Hepatitis C Antibodies ; Humans ; Immunoenzyme Techniques ; Polymerase Chain Reaction ; RNA ; Sensitivity and Specificity ; Viremia

Polyomavirus BK viral allograft nephritis is a great challenge in posttransplant management and graft survival because of difficulty in diagnosing and treatment. Initial treatment usually involves reducing immunosuppressive medications. However if concomitant acute rejection exist, it is more challenging in managing these patients, because acute rejection requires increase in immunosuppression. We present a case of a 35-year-old man who developed BK viral allograft nephritis and concomitant acute rejection 3 months after transplantation. BK viral allograft nephritis was missed in diagnosis and only pulse steroids for anti-rejection therapy was done. Initially, renal function was improved, but 4 months later, he presented with deterioration in renal function. Second renal biopsy showed BK allograft nephritis without rejection. BK viral DNA in plasma by PCR and urinary decoy cell were also positive. Reduction in immunosuppression by discontinuing mycophenolate mofetil stabilized the deterioration in renal function, however it failed to clear viremia.
Adult ; Allografts* ; Biopsy ; BK Virus* ; Diagnosis ; DNA, Viral ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation ; Nephritis ; Nephritis, Interstitial* ; Plasma ; Polymerase Chain Reaction ; Polyomavirus ; Steroids ; Viremia

Objective: To determine the optimal cutoff value of Epstein-Barr virus (EBV) DNA load that can assist in the diagnosis of post-transplant lymphoproliferative disease (PTLD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: The data of patients with EBV infection after haplo-HSCT from January to December 2016 were retrospectively analyzed. Through constructing the receiver operating characteristic (ROC) curve and calculating the Youden index to determine the cutoff value of EBV-DNA load and its duration of diagnostic significance for PTLD. Results: A total of 94 patients were included, of whom 20 (21.3% ) developed PTLD, with a median onset time of 56 (40-309) d after transplantation. The median EBV value at the time of diagnosis of PTLD was 70,400 (1,710-1,370,000) copies/ml, and the median duration of EBV viremia was 23.5 (4-490) d. Binary logistic regression was used to analyze the peak EBV-DNA load (the EBV-DNA load at the time of diagnosis in the PTLD group) and duration of EBV viremia between the PTLD and non-PTLD groups. The results showed that the difference between the two groups was statistically significant (P=0.018 and P=0.001) . The ROC curve was constructed to calculate the Youden index, and it was concluded that the EBV-DNA load ≥ 41 850 copies/ml after allogeneic hematopoietic stem cell transplantation had diagnostic significance for PTLD (AUC=0.847) , and the sensitivity and specificity were 0.611 and 0.932, respectively. The duration of EBV viremia of ≥20.5 d had diagnostic significance for PTLD (AUC=0.833) , with a sensitivity and specificity of 0.778 and 0.795, respectively. Conclusion: Dynamic monitoring of EBV load in high-risk patients with PTLD after haplo-HSCT and attention to its duration have important clinical significance, which can help clinically predict the occurrence of PTLD in advance and take early intervention measures.
Humans ; Epstein-Barr Virus Infections/diagnosis* ; Herpesvirus 4, Human/genetics* ; Retrospective Studies ; Viremia ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Lymphoproliferative Disorders/etiology* ; DNA, Viral ; Viral Load

BACKGROUND: Post-transplant lymphoproliferative disease (PTLD) is one of the major complications of organ transplantation, especially in children with Epstein-Barr virus (EBV) viremia (EV). We performed a retrospective study to evaluate risk factors for PTLD in children with EV. METHODS: Among 199 pediatric kidney transplantation (KT) recipients at our center from January 2001 to October 2015, records of those with EBV viral loads of > 1,000 copies/mL and/or PTLD were reviewed. RESULTS: Diagnosis of PTLD was made in seven patients (PTLD group), and 39 patients had EV only (EV only group). The median time from KT to EV and PTLD diagnosis was 6.7 (range 0.4–47.8) months and 8.2 (range, 2.8–98.9) months, respectively. There were no significant differences between the groups in terms of sex, age at transplantation, donor type, EBV viral load, or EV-free duration after KT. Higher tacrolimus level before EV (hazard ratio, 44.5; P = 0.003) was an independent risk factor for PTLD in multivariate Cox regression analysis. Six patients with a high EBV load (median 171,639 copies/mL) were treated with preemptive rituximab (RTX) therapy, resulting in transient reduction of EBV load. None of these patients developed PTLD (median follow-up 51.5 months); however, two had neutropenia and two developed infection requiring hospital admission. CONCLUSION: In pediatric KT recipients, higher tacrolimus levels were associated with a higher incidence of PTLD. Conversely, those who received preemptive RTX for EV did not develop PTLD.
Allografts ; Child ; Diagnosis ; Follow-Up Studies ; Herpesvirus 4, Human ; Humans ; Incidence ; Kidney Transplantation ; Kidney ; Neutropenia ; Organ Transplantation ; Retrospective Studies ; Risk Factors ; Rituximab ; Tacrolimus ; Tissue Donors ; Transplants ; Viral Load ; Viremia

OBJECTIVETo develop a rapid, cost effective RT-PCR method for the mass scale diagnosis of such diseases at the viremia stage to find out the actual disease burden in that area.

METHODSFor this purpose, cases with the history of only short febrile illness were considered. Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome (AES) were selected.

RESULTSOut of 157 samples, 42 and 74 were detected as dengue and chikungunya, respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.

CONCLUSIONSThis cost effective RT-PCR method can detect the total positive cases that remain undetected by ELISA method. Moreover, this method is capable to detect the viral RNA from patients' sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.

Antibodies, Viral ; blood ; Arbovirus Infections ; diagnosis ; virology ; Arboviruses ; genetics ; Chikungunya Fever ; diagnosis ; virology ; Dengue ; diagnosis ; virology ; Encephalitis Virus, Japanese ; genetics ; Encephalitis, Japanese ; diagnosis ; virology ; Fever ; diagnosis ; virology ; Humans ; Immunoglobulin M ; blood ; Mass Screening ; RNA, Viral ; blood ; Reverse Transcriptase Polymerase Chain Reaction ; economics ; methods ; Sensitivity and Specificity ; Viremia ; diagnosis ; virology

We report five cases of cytomegalovirus infection in immunocompromised patients which were detected by either cytomegalovirus antigenemia assay or in situ hybridization. Four cases had leukemia and the other had chronic renal failure. All the three BMT recipients suffered from GvHD. Interestingly, there was an unique case of CMV disease without a history of BMT, which reminded us that CMV could attack immunocompromised patients who had not undergone transplantation, too. Four out of five cases died. We think that cytomegalovirus infection or disease should not be regarded as a minor problem in post-transplantation infection in Korea.
Adolescent ; Adult ; Antigens, Viral/*blood ; *Bone Marrow Transplantation ; Case Report ; Cytomegalovirus/*immunology ; Cytomegalovirus Infections/complications/*diagnosis ; Fatal Outcome ; Graft vs Host Disease/complications ; Human ; Immunocompromised Host ; In Situ Hybridization ; Kidney Failure, Chronic/complications ; Kidney Transplantation ; Leukemia/*complications/therapy ; Leukemia, Lymphocytic, Acute, L2/complications/therapy ; Leukemia, Myelocytic, Acute/complications/therapy ; Leukemia, Myeloid, Chronic/complications/therapy ; Male ; Viremia/*diagnosis