63
4 weeks and back titrations showed adequate serum concentrations. She remained haemodynamically stable and was discharged on ciprofloxacin for a further two weeks. The identity of the organism was confirmed as a group G2 coryneform by API Laboratory Products (Basingstoke), a company specialising in organism identification. She. has remained well since discharge. Group G2 coryneform infections are rare.’ The first of only two reports of clinical infection was a case of prosthetic mitral and aortic valve endocarditis in a middle-aged man.2 The second was a man with a disseminated intravascular coagulopathy who proved to have in the peripheral blood numerous polymorphs containing this organism.3 There have been six reported cases of septic arthritis due to diphtheroid organisms,’ all of which responded well to antimicrobial therapy; none was complicated by endocarditis. As far as we are aware septic arthritis due to group G-2 coryneform organisms has not been described. It is not clear in our case if the
VIRUS ISOLATION BY CO-CULTIVATION WITH STIMULATED CORD BLOOD LYMPHOCYTES AND ENV-SPECIFIC DNA AMPLIFICATION BY PCR
endocarditis was primary or secondary to diphtheroid septicaemia. This case highlights the difficulties of recognising clinically significant infections due to diphtheroids. University Departments of Dermatology and Clinical Microbiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
A. G.
QUINN J. S. COMAISH S. J. PEDLER
Coyle MB, Lipsky BA. Coryneform bacteria m infectious diseases: clinical and laboratory aspects. Clin Microbiol Rev 1990; 3: 227-46. 2. Austin GA, Hill ED. Endocarditis due to Corynebacterium CDC group G2. J Infect Dis 1983; 147: 1106. 3. Lawrence CS, Brown ST, Freundlich LF. Peripheral blood smear bacillaemia. Am J Med 1988; 85: 111-13. 4. Valenstein PA, Klein A, Ballow C, Greene W. Corynebacterium xerosis septic arthritis. Am J Clin Pathol 1988; 89: 569-71. 1.
Long-lasting viability of HIV after patient’s death SIR,-HIV has been isolated in vitro from a patient 18 h after death1 and more recently viable HIV has been detected at necropsy up to 6 days after death.2 We report three further cases in which viable HIV-1 was isolated 2-5, 35, and 11days after death from necropsy material. Case 1 (M, 43; homosexual). Tested HIV-antibody positive in May, 1988. Shortly afterwards he was found dead at home from a drug overdose. No further details of case-history available. Case 2 (F, 24; Afro-Caribbean origin, sickle cell anaemia). HIV infection was diagnosed in 1986 as the cause of persistent lymph-node swelling. She had had several blood transfusions. In 1988 she was delivered of a girl who is still HIV antibody and HIV culture positive. In 1989 the woman had oral candidosis and chest infections. In February, 1990, she collapsed and died the same day. Streptococcus pneumoniae was grown from a blood culture taken shortly before death. Case 3 (M, 39; homosexual). Diagnosed as HIV positive in 1986. He had fever, oral candidosis and tuberculosis in 1990 and a very severe cytomegalovirus retinitis, leading to blindness in 1991. He was under prolonged treatment with zidovudine, tuberculostatic drugs, and ganciclovir. In early 1991 he became increasingly disoriented and eventually unconscious and died in March with
pyogenic bronchopneumonia. At necropsy blood, CSF, and various tissues were removed and frozen unfixed at - 70°C or fixed in 4% formaldehyde. The time to necropsy was 2’5, 3’5, and 11 days, respectively. Between necropsy and virus culture/frozen storage only 1 ’5-2 h elapsed in the first two cases; tissues and body fluids in case 3 were kept at 4°C overnight before culture. The main pathological findings were drug overdose, and severe bacterial atypical bronchopneumonia, with evidence of bronchopneumonia histological cytomegalovirus pneumonitis, respectively. Attempts to grow HIV from tissues and fluids were by co-cultivation with stimulated cord blood lymphocytes. We looked for syncytia, did indirect immunofluorescence tests (IIFT) with sheep polyclonal gpl20-specific serum (provided through the AIDSDirected Programme of the MRC), and tested material with a commercial p24 core antigen ELISA (DuPont). DNA was
*Reverse
conscriptase step preceding PCR.
amplified by the polymerase chain primers specific for env.4
reaction
(PCR) with nested
In all cases HIV co-cultivation was successful and proviral DNA detected in all tissues and body fluids investigated (table); a more detailed report is in preparation. Thus HIV remains viable for a considerable time in a dead body and great care is required when handling unfixed, HIV-infected post-mortem tissues and body fluids. was
We thank Dr C. Ellis, Prof A. Geddes, Dr J. Innes, and Dr M. Wood for their patients’ records. Supported by grant from MRC AIDS Directed Programme. access to
Regional Virus Laboratory, East Birmingham Hospital, Birmingham B9 5ST, UK
J. BALL
Midland Centre for Neurosurgery, and Neurology, Smethwick
H. WHITWELL
U. DESSELBERGER
Henry K, Dexter D, Sannerud K, Jackson B, Balfour H Jr. Recovery of HIV at autopsy. N Engl J Med 1989; 321: 1833-34. 2. Nyberg M, Suni J, Haltia M. Isolation of human immunodeficiency virus (HIV) at autopsy one to six days post mortem. Am J Clin Pathol 1990; 94: 422-25. 3. Ulrich PP, Busch MP, El-Beik T, et al. Assessment of human immunodeficiency virus expression in cocultures of peripheral blood mononuclear cells from healthy seropositive subjects. J Med Virol 1988; 25: 1-10. 4. Simmonds P, Balfe P, Ludlam CA, Bishop JO, Leigh Brown AJ. Analysis of sequence diversity in hypervariable regions of the external glycoprotein of human immunodeficiency virus type 1. J Virol 1990; 64: 5840-50. 1.
AIDS prevention and family SIR,-Rwanda,
a
planning
small, densely populated (for Africa),
landlocked country, is facing two formidable challenges-AIDS and population growthl,2-that strain the country’s already hardpressed agricultural economy. The HIV-1 seroprevalance rate in Rwanda is estimated to be 2% for the country as a whole and it could be as high as 18% in urban centres2 which, though containing only 6% of the total population, are growing quickly. The average number of births per woman was estimated at 86 in 1983 and the population doubling time is less than 20 years. Even a sharp increase in HIV seroprevalence in rural areas would have, via deaths from AIDS,3 only a limited impact on the rate of natural population increase (from 37% per annum to
3-0%, perhaps).
challenge is to stop the spread of HIV and to expand family-planning services. An AIDS awareness campaign, a national screening programme for blood transfusions, and condom promotion, under the auspices of the National AIDS Programme, have achieved encouraging results. The National Office of Population (ONAPO) has greatly increased awareness of the demographic problems of Rwanda but the impact on contraceptive practices has been modest. At the end of 1988 the proportion of The
4 weeks and back titrations showed adequate serum concentrations. She remained haemodynamically stable and was discharged on ciprofloxacin for a further two weeks. The identity of the organism was confirmed as a group G2 coryneform by API Laboratory Products (Basingstoke), a company specialising in organism identification. She. has remained well since discharge. Group G2 coryneform infections are rare.’ The first of only two reports of clinical infection was a case of prosthetic mitral and aortic valve endocarditis in a middle-aged man.2 The second was a man with a disseminated intravascular coagulopathy who proved to have in the peripheral blood numerous polymorphs containing this organism.3 There have been six reported cases of septic arthritis due to diphtheroid organisms,’ all of which responded well to antimicrobial therapy; none was complicated by endocarditis. As far as we are aware septic arthritis due to group G-2 coryneform organisms has not been described. It is not clear in our case if the
VIRUS ISOLATION BY CO-CULTIVATION WITH STIMULATED CORD BLOOD LYMPHOCYTES AND ENV-SPECIFIC DNA AMPLIFICATION BY PCR
endocarditis was primary or secondary to diphtheroid septicaemia. This case highlights the difficulties of recognising clinically significant infections due to diphtheroids. University Departments of Dermatology and Clinical Microbiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
A. G.
QUINN J. S. COMAISH S. J. PEDLER
Coyle MB, Lipsky BA. Coryneform bacteria m infectious diseases: clinical and laboratory aspects. Clin Microbiol Rev 1990; 3: 227-46. 2. Austin GA, Hill ED. Endocarditis due to Corynebacterium CDC group G2. J Infect Dis 1983; 147: 1106. 3. Lawrence CS, Brown ST, Freundlich LF. Peripheral blood smear bacillaemia. Am J Med 1988; 85: 111-13. 4. Valenstein PA, Klein A, Ballow C, Greene W. Corynebacterium xerosis septic arthritis. Am J Clin Pathol 1988; 89: 569-71. 1.
Long-lasting viability of HIV after patient’s death SIR,-HIV has been isolated in vitro from a patient 18 h after death1 and more recently viable HIV has been detected at necropsy up to 6 days after death.2 We report three further cases in which viable HIV-1 was isolated 2-5, 35, and 11days after death from necropsy material. Case 1 (M, 43; homosexual). Tested HIV-antibody positive in May, 1988. Shortly afterwards he was found dead at home from a drug overdose. No further details of case-history available. Case 2 (F, 24; Afro-Caribbean origin, sickle cell anaemia). HIV infection was diagnosed in 1986 as the cause of persistent lymph-node swelling. She had had several blood transfusions. In 1988 she was delivered of a girl who is still HIV antibody and HIV culture positive. In 1989 the woman had oral candidosis and chest infections. In February, 1990, she collapsed and died the same day. Streptococcus pneumoniae was grown from a blood culture taken shortly before death. Case 3 (M, 39; homosexual). Diagnosed as HIV positive in 1986. He had fever, oral candidosis and tuberculosis in 1990 and a very severe cytomegalovirus retinitis, leading to blindness in 1991. He was under prolonged treatment with zidovudine, tuberculostatic drugs, and ganciclovir. In early 1991 he became increasingly disoriented and eventually unconscious and died in March with
pyogenic bronchopneumonia. At necropsy blood, CSF, and various tissues were removed and frozen unfixed at - 70°C or fixed in 4% formaldehyde. The time to necropsy was 2’5, 3’5, and 11 days, respectively. Between necropsy and virus culture/frozen storage only 1 ’5-2 h elapsed in the first two cases; tissues and body fluids in case 3 were kept at 4°C overnight before culture. The main pathological findings were drug overdose, and severe bacterial atypical bronchopneumonia, with evidence of bronchopneumonia histological cytomegalovirus pneumonitis, respectively. Attempts to grow HIV from tissues and fluids were by co-cultivation with stimulated cord blood lymphocytes. We looked for syncytia, did indirect immunofluorescence tests (IIFT) with sheep polyclonal gpl20-specific serum (provided through the AIDSDirected Programme of the MRC), and tested material with a commercial p24 core antigen ELISA (DuPont). DNA was
*Reverse
conscriptase step preceding PCR.
amplified by the polymerase chain primers specific for env.4
reaction
(PCR) with nested
In all cases HIV co-cultivation was successful and proviral DNA detected in all tissues and body fluids investigated (table); a more detailed report is in preparation. Thus HIV remains viable for a considerable time in a dead body and great care is required when handling unfixed, HIV-infected post-mortem tissues and body fluids. was
We thank Dr C. Ellis, Prof A. Geddes, Dr J. Innes, and Dr M. Wood for their patients’ records. Supported by grant from MRC AIDS Directed Programme. access to
Regional Virus Laboratory, East Birmingham Hospital, Birmingham B9 5ST, UK
J. BALL
Midland Centre for Neurosurgery, and Neurology, Smethwick
H. WHITWELL
U. DESSELBERGER
Henry K, Dexter D, Sannerud K, Jackson B, Balfour H Jr. Recovery of HIV at autopsy. N Engl J Med 1989; 321: 1833-34. 2. Nyberg M, Suni J, Haltia M. Isolation of human immunodeficiency virus (HIV) at autopsy one to six days post mortem. Am J Clin Pathol 1990; 94: 422-25. 3. Ulrich PP, Busch MP, El-Beik T, et al. Assessment of human immunodeficiency virus expression in cocultures of peripheral blood mononuclear cells from healthy seropositive subjects. J Med Virol 1988; 25: 1-10. 4. Simmonds P, Balfe P, Ludlam CA, Bishop JO, Leigh Brown AJ. Analysis of sequence diversity in hypervariable regions of the external glycoprotein of human immunodeficiency virus type 1. J Virol 1990; 64: 5840-50. 1.
AIDS prevention and family SIR,-Rwanda,
a
planning
small, densely populated (for Africa),
landlocked country, is facing two formidable challenges-AIDS and population growthl,2-that strain the country’s already hardpressed agricultural economy. The HIV-1 seroprevalance rate in Rwanda is estimated to be 2% for the country as a whole and it could be as high as 18% in urban centres2 which, though containing only 6% of the total population, are growing quickly. The average number of births per woman was estimated at 86 in 1983 and the population doubling time is less than 20 years. Even a sharp increase in HIV seroprevalence in rural areas would have, via deaths from AIDS,3 only a limited impact on the rate of natural population increase (from 37% per annum to
3-0%, perhaps).
challenge is to stop the spread of HIV and to expand family-planning services. An AIDS awareness campaign, a national screening programme for blood transfusions, and condom promotion, under the auspices of the National AIDS Programme, have achieved encouraging results. The National Office of Population (ONAPO) has greatly increased awareness of the demographic problems of Rwanda but the impact on contraceptive practices has been modest. At the end of 1988 the proportion of The
