Lymphocytic Choriomeningitis Virus in Person Living with HIV, Connecticut, USA, 2021.

Lymphocytic choriomeningitis virus is an underreported cause of miscarriage and neurologic disease. Surveillance remains challenging because of nonspecific symptomatology, inconsistent case reporting, and difficulties with diagnostic testing. We describe a case of acute lymphocytic choriomeningitis virus disease in a person living with HIV in Connecticut, USA, identified by using quantitative reverse transcription PCR.

Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019.

During 3 weeks in 2019, 4 human cases of Eastern equine encephalitis (EEE) were diagnosed at a single hospital in Connecticut, USA. The cases coincided with notable shifts in vector–host infection patterns in the northeastern United States and signified a striking change in EEE incidence. All 4 cases were geographically clustered, rapidly progressive, and neurologically devastating.

Electronic Health Record-Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency.

The authors evaluated the effectiveness of an electronic health record (EHR)-based reflex urine culture testing algorithm on urine test utilization and diagnostic yield in the emergency department (ED). The study implemented a reflex urine culture order with EHR decision support. The primary outcome was the number of urine culture orders per 100 ED visits.

Graft loss among renal-transplant recipients with early reduction of immunosuppression for BK viremia.

Aim: To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.

Methods: We performed a retrospective analysis of consecutive kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyoma-virus associated nephropathy (PyVAN). Recipient plasma was screened for BKV DNA quantitative polymerase chain reaction (PCR) at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function.

Characterizing Patients with Very-Low-Level HIV Viremia: A Community-Based Study.

Objective: Very-low-level viremia (VLLV) is a relatively new concept in the realm of human immunodeficiency virus (HIV) care. Newer generation assays are now able to detect plasma HIV RNA Viral Load (VL) levels as low as 20 copies/mL. The authors characterized patients with VLLV (VL between 20 and 50 copies/mL) in order to identify possible risk factors associated with virologic failure and poor clinical outcomes.

Laboratory Diagnosis of Zika Virus Infection.

Context: -The rapid and accurate diagnosis of Zika virus infection is an international priority.

Objective: -To review current recommendations, methods, limitations, and priorities for Zika virus testing.

Data Sources: -Sources include published literature, public health recommendations, laboratory procedures, and testing experience.

Parvovirus B19.

Primary parvovirus B19 infection is an infrequent, but serious and treatable, cause of chronic anemia in immunocompromised hosts. Many compromised hosts have preexisting antibody to B19 and are not at risk. However, upon primary infection, some patients may be able to mount a sufficient immune response to terminate active parvovirus B19 infection of erythroid precursors.

Immunoglobulin M for Acute Infection: True or False?

Immunoglobulin M (IgM) tests have clear clinical utility but also suffer disproportionately from false-positive results, which in turn can lead to misdiagnoses, inappropriate therapy, and premature closure of a diagnostic workup. Despite numerous reports in the literature, many clinicians and laboratorians remain unaware of this issue. In this brief review, a series of virology case examples is presented.

Laboratory diagnosis of viral infection.

Since the last volume on this topic, viral diagnosis has made tremendous strides, moving from the margin to the mainstream of clinical care. For many years, conventional virus isolation was the mainstay of viral diagnosis since it was sensitive and “open-minded.” However, growth in conventional cell culture entails an inherent delay that limits its clinical impact.

Atypical hand-foot-and-mouth disease associated with coxsackievirus A6 infection.

Background: Hand-foot-and-mouth disease (HFMD) is an acute viral illness commonly caused by coxsackievirus (CV)-A16 and enterovirus 71 infections. Recently, atypical HFMD has been reported in association with CV-A6, an uncommon enterovirus strain.

Objective: We sought to describe the clinical features of atypical HFMD associated with CV-A6 infection and its diagnostic laboratory evaluation.

Diagnostic tests for influenza infection.

Purpose Of Review: The 2009 H1N1 pandemic focused attention on the speed and accuracy of influenza diagnostic methods. This review provides an update on current tests and new developments.

Recent Findings: Widely used rapid antigen tests and immunofluorescence tests were generally less sensitive for 2009 H1N1 influenza than for seasonal influenza.

Developments in immunologic assays for respiratory viruses.

In most hospitals, clinics, and doctor's offices, immunologic assays are the only tests performed on site for the diagnosis of respiratory viruses. More than other methods, immunoassays have been shown to affect patient management and save costs, aiding early administration of antiviral therapy, reduction in unnecessary tests and antibiotics, and earlier discharges. This article discusses the major immunologic methods employed for respiratory virus diagnosis, recent developments in immunoassays and sample collection, and current test algorithms.

CSF IgH gene rearrangement analysis in isolated post-transplant lymphoproliferative disorder of the central nervous system.

Isolated post-transplant lymphoproliferative disorder (PTLD) of the central nervous system is rare and its diagnosis can be challenging. A biopsy is usually required in order to distinguish the disease from opportunistic infections. We present a case in whom immunoglobulin heavy chain gene rearrangement analysis of cerebrospinal fluid (CSF) was instrumental in establishing the diagnosis.

Rapid HIV testing of women in labor: too long a delay.

For HIV-infected women who have not received antiretroviral treatment or transmission prophylaxis in pregnancy, starting antiretrovirals in labor or soon after birth can still decrease the risk of perinatal transmission. There is, therefore, potential benefit in conducting rapid HIV testing in labor, but hospitals are seldom prepared to conduct such testing. We compared protocols for rapid HIV testing at 2 hospitals to determine what proportion of women had results back early enough to intervene if results had been positive.