1442
Laboratory investigation and blood cultures
ruled
By immunofluorescence antibodies were found for nephropathia epidemica (NE) at a titre of 512 (IgG); the titre for the Hanta type (Korean haemorrhagic fever) was 128 (IgG). By ELISA, with nucleocapsid antigen, the IgG titre for NE was 3212 units (normal below 100). IgM antibodies to NE and Hantaan were also detected. The IgG titre for Hanta type was only 88 units (normal below 100). of the virus.
Upon questioning the patient said that before
onset
he had
regularly walked his dog in forested areas. The acute renal failure in this case represents oligosymptomatic haemorrhagic fever with renal syndrome. We suggest that Hantavirus infection be excluded by serology in every case of acute renal failure of unknown origin. Departments of Medicine/Nephrology and Virology, University of Heidelberg, 6900 Heidelberg 1, Germany
MARTIN ZEIER KONRAD ANDRASSY LOTHAR ZÖLLER EBERHARD RITZ
1. Lähdevirta J.
Nephropathia epidemica in Finland: a clinical, histological epidemiological study. Ann Clin Res 1971; 3 (suppl 8): 1-154.
and
2. Editorial. Hantavirus disease. Lancet 1990; 336: 407. 3. van der Groen G. Haemorrhagic fever with renal syndrome: recent developments. Ann Soc Belge Med Trop 1985; 65: 121-35. 4. van Ypersele de Strihou CG, van der Groen G, Desmyter J. Nephropathie à Hantavirus en Europe occidentale: ubiquite des fièvres hèmorrhagiques avec syndrome renal. In: Crosnier J, Funck-Brentano J-L, Bach J-F, Grunfeld J-P, eds. Acutalités nephrologiques de l’Hôpital Necker. Paris: Flammarion, 1985.
Cryptococcus neoformans var gattii SIR,-Dr Ellis and Ms Pfeiffer (Oct 13, p 923) provide a fascinating of the ecology of Cryptococus neoformans var gattii. Cryptococcal meningitis is the commonest cause of chronic meningitis in adults admitted to Port Moresby General Hospital, Papua New Guinea, with 129 confirmed cases between 1978 and 1987.15of 6 isolates tested at this hospital proved to be C neoformans var gattii. There has been no evidence of immunosuppression (including HIV infection) in Papua New Guinea patients with cryptococcal meningitis, but the reported lower virulence of C neoformans var gattii has not been noted. All the patients with the 5 confirmed isolates had severe meningitis-3 had papillitis on fundoscopy, and 2 died during the first admission. The river red gum, Eucalyptus camaldulensis, is unlikely to be the host tree for C neoformans var gattii in Papua New Guinea since it is not indigenous to this country.2 An attempt to introduce the species in the Whagi Valley has been unsuccessful. Three indigenous eucalypts are common in the Papuan region where most cases of cryptococcus are seen: E papuana, E alba, and E confertiflora.2 These three species are also indigenous in Australia but are 3 restricted to the northern regions The possibility therefore arises that one or more of these eucalypts, besides E camaldulensis, is host to C neoformans var gattii in the Northern Territory where there is a high frequency of this infection in Australian aboriginals.4 account
Menzies School of Health Research, PO Box 41096, Casuarina, Northern Territory 0811, Australia
BART CURRIE
Conservation Commission, Northern Territory
TOM VIGUS GREG LEACH
Fairfield
Hospital for Infectious Diseases,
Fairfield, Victoria
Congenital hydrocephalus due to
out
septicaemia. Serological tests for systemic vasculitis were negative. Hantavirus serology proved recent infection with the Puumula type
BRIAN DWYER
intrauterine HTLV-I infection SIR,-Human T-cell lymphotropic virus type I (HTLV-1) causes adult T-cell leukaemia/lymphoma (ATLL) and HTLV-Iassociated myelopathy (HAM). The major route of HTLV-I infection is generally thought to be postnatal transmission via breast milk.l.2 The detection of the HTLV-I antigen in cord blood lymphocytes has pointed to vertical transmission via germinal cells or transplacental or ascending infection We report a male infant with congenital hydrocephalus probably due to intrauterine HTLV-I infection. A 20-day-old infant (born at term, birthweight 3800 g) was admitted to our hospital because of macrocephalus, which had been diagnosed on ultrasonography at 36 weeks’ gestation; his head circumference at birth was 37 cm ( + 2.1SD). His family history was unremarkable. He was breastfed for only 1 week. Cranial computed tomography showed enlarged third and lateral ventricles. In addition, magnetic resonance imaging and ultasonongraphy revealed bilateral multiple cysts in the subependymal germinal matrix. Serum IgM was raised (47 mg/dl). TORCH screening of serum and cerebrospinal fluid was negative (toxoplasma, rubellaIgM, cytomegalovirus-IgM, and herpes simplex virus-IgM). Physical and neurological examinations were normal, apart from macrocephalus. Other laboratory tests were also normal. We diagnosed congenital hydrocephalus due to intrauterine infection. The baby showed slightly delayed motor development, but his head circumference increased in the normal range. His mother did not feel well enough to feed him and had lumbar pain soon after the delivery. About 6 weeks later her gait became slightly uncertain and she was incontinent. When the boy was 11 months old, she was diagnosed as having HTLV-I associated myelopathy. His serum anti-HTLV-1 titre 2560. Viral neurotropic infection in utero causing subependymal germinal matrix cysts has been well documented."We therefore conclude that our infant patient had congenital hydrocephalus due to intrauterine HTLV-I infection. We suggest that anti-HTLV should be looked for in patients with congenital neurotropic infection.
Division of Child Neurology, Tottori University Hospital, 86 Nishi-Machi, Yonago 683,
Japan
HITOSHI KAWAHARA JUN TOHYAMA MASUMI INGAKI KOUSAKU OHNO
1. Ando Y, Nakano S, Saito K, et al. Transmission of adult T-cell leukemia retrovirus (HTLV-I) from mother to child: comparison of bottle- with breast-fed babies Jpn J Cancer Res (Gann) 1987; 78: 322-24. 2. Tsuji Y, Doi H, Yamabe T, et al. Prevention of mother to child transmission of human T-lymphotropic virus-type I. Pediatrics 1990; 86: 11-17. 3. Komuro A, Hayami M, Fuju H, et al. Vertical transmission of adult T-cell leukemia virus. Lancet 1983;i: 240. 4. Shaw CM, Alvord EC Jr. Subependymal germinolysis. Arch Neurol 1974; 31: 374-81. 5. Shackelford GD, Fulling KH, Grasier CM. Cysts of the subependymal germinal matrix sonographic demonstration with pathologic correlation. Radiology 1983, 149: 117-21.
Anti-HCV false
positivity in malaria
SIR,-Dr Wong and colleagues report (Sept 22, p 750) a high rate of false-positive results for antibodies to hepatitis C virus (HCV) in serum samples from presumably healthy volunteers living in a malaria endemic area, with Chiron/Ortho ELISA. They also cast doubt on the test’s reliability in seroepidemiological analysis. We have investigated HCV infection in 65 male and 29 female patients (mean age 28 years; range 20-40) with Plasmodium falciparum malaria, admitted to Mbalmayo hospital, 40 km south of Yaounde, Cameroon. Samples were collected in 1987 and stored at 20°C until testing. Serum samples were screened for antibody to HCV with the Ortho-ELISA test and repeatedly reactive specimens were also tested with Abbott anti-HCV ELISA and Chiron’s recombinant immunoblot assay (RIBA). In addition, autoantibodies to extractable nuclear antigen (ENA) were measured -
P, John R, Naraqi S. Cryptococcal meningitis: a disease of the rural population Papua New Guinea. 23rd annual medical symposium of the Medical Society of Papua New Guinea (Madang, September, 1987; abstr). 2. Gressitt JL. Biogeography and ecology of New Guinea. The Hague Dr W Junk 1. Temu
in
Publishers, 1982: 437-56. 3. Boland DJ. Forest trees of Australia. Melbourne: Thomas Nelson, 1957: 208, 240,418. 4. Ellis DH. Cryptococcus neoformans var gatti in Australia. Clin Microbiol 1987; 24: J
430-31.
with an ELISA test.! 59 (63%) samples were positive with Ortho-ELISA in two repeated analyses; of these, 16 had an absorbance value over 24
Laboratory investigation and blood cultures
ruled
By immunofluorescence antibodies were found for nephropathia epidemica (NE) at a titre of 512 (IgG); the titre for the Hanta type (Korean haemorrhagic fever) was 128 (IgG). By ELISA, with nucleocapsid antigen, the IgG titre for NE was 3212 units (normal below 100). IgM antibodies to NE and Hantaan were also detected. The IgG titre for Hanta type was only 88 units (normal below 100). of the virus.
Upon questioning the patient said that before
onset
he had
regularly walked his dog in forested areas. The acute renal failure in this case represents oligosymptomatic haemorrhagic fever with renal syndrome. We suggest that Hantavirus infection be excluded by serology in every case of acute renal failure of unknown origin. Departments of Medicine/Nephrology and Virology, University of Heidelberg, 6900 Heidelberg 1, Germany
MARTIN ZEIER KONRAD ANDRASSY LOTHAR ZÖLLER EBERHARD RITZ
1. Lähdevirta J.
Nephropathia epidemica in Finland: a clinical, histological epidemiological study. Ann Clin Res 1971; 3 (suppl 8): 1-154.
and
2. Editorial. Hantavirus disease. Lancet 1990; 336: 407. 3. van der Groen G. Haemorrhagic fever with renal syndrome: recent developments. Ann Soc Belge Med Trop 1985; 65: 121-35. 4. van Ypersele de Strihou CG, van der Groen G, Desmyter J. Nephropathie à Hantavirus en Europe occidentale: ubiquite des fièvres hèmorrhagiques avec syndrome renal. In: Crosnier J, Funck-Brentano J-L, Bach J-F, Grunfeld J-P, eds. Acutalités nephrologiques de l’Hôpital Necker. Paris: Flammarion, 1985.
Cryptococcus neoformans var gattii SIR,-Dr Ellis and Ms Pfeiffer (Oct 13, p 923) provide a fascinating of the ecology of Cryptococus neoformans var gattii. Cryptococcal meningitis is the commonest cause of chronic meningitis in adults admitted to Port Moresby General Hospital, Papua New Guinea, with 129 confirmed cases between 1978 and 1987.15of 6 isolates tested at this hospital proved to be C neoformans var gattii. There has been no evidence of immunosuppression (including HIV infection) in Papua New Guinea patients with cryptococcal meningitis, but the reported lower virulence of C neoformans var gattii has not been noted. All the patients with the 5 confirmed isolates had severe meningitis-3 had papillitis on fundoscopy, and 2 died during the first admission. The river red gum, Eucalyptus camaldulensis, is unlikely to be the host tree for C neoformans var gattii in Papua New Guinea since it is not indigenous to this country.2 An attempt to introduce the species in the Whagi Valley has been unsuccessful. Three indigenous eucalypts are common in the Papuan region where most cases of cryptococcus are seen: E papuana, E alba, and E confertiflora.2 These three species are also indigenous in Australia but are 3 restricted to the northern regions The possibility therefore arises that one or more of these eucalypts, besides E camaldulensis, is host to C neoformans var gattii in the Northern Territory where there is a high frequency of this infection in Australian aboriginals.4 account
Menzies School of Health Research, PO Box 41096, Casuarina, Northern Territory 0811, Australia
BART CURRIE
Conservation Commission, Northern Territory
TOM VIGUS GREG LEACH
Fairfield
Hospital for Infectious Diseases,
Fairfield, Victoria
Congenital hydrocephalus due to
out
septicaemia. Serological tests for systemic vasculitis were negative. Hantavirus serology proved recent infection with the Puumula type
BRIAN DWYER
intrauterine HTLV-I infection SIR,-Human T-cell lymphotropic virus type I (HTLV-1) causes adult T-cell leukaemia/lymphoma (ATLL) and HTLV-Iassociated myelopathy (HAM). The major route of HTLV-I infection is generally thought to be postnatal transmission via breast milk.l.2 The detection of the HTLV-I antigen in cord blood lymphocytes has pointed to vertical transmission via germinal cells or transplacental or ascending infection We report a male infant with congenital hydrocephalus probably due to intrauterine HTLV-I infection. A 20-day-old infant (born at term, birthweight 3800 g) was admitted to our hospital because of macrocephalus, which had been diagnosed on ultrasonography at 36 weeks’ gestation; his head circumference at birth was 37 cm ( + 2.1SD). His family history was unremarkable. He was breastfed for only 1 week. Cranial computed tomography showed enlarged third and lateral ventricles. In addition, magnetic resonance imaging and ultasonongraphy revealed bilateral multiple cysts in the subependymal germinal matrix. Serum IgM was raised (47 mg/dl). TORCH screening of serum and cerebrospinal fluid was negative (toxoplasma, rubellaIgM, cytomegalovirus-IgM, and herpes simplex virus-IgM). Physical and neurological examinations were normal, apart from macrocephalus. Other laboratory tests were also normal. We diagnosed congenital hydrocephalus due to intrauterine infection. The baby showed slightly delayed motor development, but his head circumference increased in the normal range. His mother did not feel well enough to feed him and had lumbar pain soon after the delivery. About 6 weeks later her gait became slightly uncertain and she was incontinent. When the boy was 11 months old, she was diagnosed as having HTLV-I associated myelopathy. His serum anti-HTLV-1 titre 2560. Viral neurotropic infection in utero causing subependymal germinal matrix cysts has been well documented."We therefore conclude that our infant patient had congenital hydrocephalus due to intrauterine HTLV-I infection. We suggest that anti-HTLV should be looked for in patients with congenital neurotropic infection.
Division of Child Neurology, Tottori University Hospital, 86 Nishi-Machi, Yonago 683,
Japan
HITOSHI KAWAHARA JUN TOHYAMA MASUMI INGAKI KOUSAKU OHNO
1. Ando Y, Nakano S, Saito K, et al. Transmission of adult T-cell leukemia retrovirus (HTLV-I) from mother to child: comparison of bottle- with breast-fed babies Jpn J Cancer Res (Gann) 1987; 78: 322-24. 2. Tsuji Y, Doi H, Yamabe T, et al. Prevention of mother to child transmission of human T-lymphotropic virus-type I. Pediatrics 1990; 86: 11-17. 3. Komuro A, Hayami M, Fuju H, et al. Vertical transmission of adult T-cell leukemia virus. Lancet 1983;i: 240. 4. Shaw CM, Alvord EC Jr. Subependymal germinolysis. Arch Neurol 1974; 31: 374-81. 5. Shackelford GD, Fulling KH, Grasier CM. Cysts of the subependymal germinal matrix sonographic demonstration with pathologic correlation. Radiology 1983, 149: 117-21.
Anti-HCV false
positivity in malaria
SIR,-Dr Wong and colleagues report (Sept 22, p 750) a high rate of false-positive results for antibodies to hepatitis C virus (HCV) in serum samples from presumably healthy volunteers living in a malaria endemic area, with Chiron/Ortho ELISA. They also cast doubt on the test’s reliability in seroepidemiological analysis. We have investigated HCV infection in 65 male and 29 female patients (mean age 28 years; range 20-40) with Plasmodium falciparum malaria, admitted to Mbalmayo hospital, 40 km south of Yaounde, Cameroon. Samples were collected in 1987 and stored at 20°C until testing. Serum samples were screened for antibody to HCV with the Ortho-ELISA test and repeatedly reactive specimens were also tested with Abbott anti-HCV ELISA and Chiron’s recombinant immunoblot assay (RIBA). In addition, autoantibodies to extractable nuclear antigen (ENA) were measured -
P, John R, Naraqi S. Cryptococcal meningitis: a disease of the rural population Papua New Guinea. 23rd annual medical symposium of the Medical Society of Papua New Guinea (Madang, September, 1987; abstr). 2. Gressitt JL. Biogeography and ecology of New Guinea. The Hague Dr W Junk 1. Temu
in
Publishers, 1982: 437-56. 3. Boland DJ. Forest trees of Australia. Melbourne: Thomas Nelson, 1957: 208, 240,418. 4. Ellis DH. Cryptococcus neoformans var gatti in Australia. Clin Microbiol 1987; 24: J
430-31.
with an ELISA test.! 59 (63%) samples were positive with Ortho-ELISA in two repeated analyses; of these, 16 had an absorbance value over 24
