Chikungunya‐Wolbachia interplay in Aedes albopictus

A severe Chikungunya (CHIK) outbreak recently hit several countries of the Indian Ocean. On La Réunion Island, Aedes albopictus was incriminated as the major vector. This mosquito species is naturally co‐infected with two distinct strains of the endosymbiont Wolbachia, namely wAlbA and wAlbB, which are increasingly attracting interest as potential tools for vector control. A PCR quantitative assay was developed to investigate Wolbachia/mosquito host interactions. We show that Wolbachia densities are slightly decreased in CHIK virus (CHIKV)‐infected females. We measured the impact of CHIKV replication on a lysogenic virus: WO bacteriophage. Our data indicate that WO is sheltered by wAlbB, likely at a single copy per bacteria, and that CHIKV replication is not a physiological stress triggering WO entrance into the lytic cycle.     

Real-time polymerase chain reaction for diagnosis and quantitation of negative strand of chikungunya virus

Quantitative real-time polymerase chain reaction (qRT-PCR) is useful for diagnosis and studying virus replication. We developed positive- and negative-strand qRT-PCR assays to detect nsP3 of chikungunya virus (CHIKV), a positive-strand RNA alphavirus that causes epidemic fever, rash, and arthritis. The positive- and negative-strand qRT-PCR assays had limits of quantification of 1 and 3 log₁₀ RNA copies/reaction, respectively. Compared to a published E1 diagnostic assay using 30 laboratory-confirmed clinical samples, the positive-strand nsP3 qRT-PCR assay had higher R² and efficiency and detected more positive samples. Peak viral load of 12.9 log₁₀ RNA copies/mL was reached on day 2 of illness, and RNA was detectable up to day 9, even in the presence of anti-CHIKV IgM. There was no correlation between viral load and persistent arthralgia. The positive-strand nsP3 assay is suitable for diagnosis, while the negative-strand nsP3 assay, which uses tagged primers to increase specificity, is useful for study of active viral replication kinetics.     

The Intolerable Burden of Chikungunya: What’s New, What’s Needed?

Chikungunya virus (CHIKV) is an emerging arthropod born virus belonging to genus Alphavirus and family Togaviridae with a +(ve) sense single stranded RNA of 11.8?Kb as genome. CHIKV infections are not new, its presence was felt in the early nineteenth century but it was confined mostly to few regions in Africa and Asia. The recent outbreak which erupted in Asia and many European countries was due to combinatorial effect of various factors like climatic changes, due to global warming, that helped the vector population. Mutations in the viral genome, mostly E1 gene played a major role in the adaptation of the virus to mosquitoes, causing epidemics. Human behavioral factors like travel from endemic to non endemic regions, lack of proper sanitation and awareness on arthropod borne diseases resulted in the massive CHIKV epidemics all over the world. Especially in India, various reports came from many states but the worst affected states being Andhra Pradesh, Tamilnadu, Maharashtra, Karnataka and Kerala. CHIKV is not a fatal disease but some deaths have been reported in different parts of the globe. CHIKV not only affected the human health, but also had a heavy impact on the individual and national economy. CHIKV vaccines studies are raising hope for the effective treatment against the CHIKV infection. Till then the population and further growth of vectors for Chikungunya (Aedes aegypti and Aedes albopictus mosquitoes) can be controlled by proper sanitation practices and public awareness on the arthropod borne diseases.     

Development of an internally controlled, homogeneous polymerase chain reaction assay for the simultaneous detection and discrimination of herpes simplex virus types 1 and 2 and varicella-zoster virus

Homogeneous polymerase chain reaction (PCR) technology is being used increasingly in the diagnosis of infectious disease. The sensitivity and specificity of PCR is being coupled to the ease-of-use and multiplexing capacity of homogeneous methodologies to provide rapid and accurate differential diagnoses. This technology is applicable to the diagnosis of infections with the human herpes viruses, herpes simplex virus 1 (HSV 1), HSV 2 and varicella-zoster virus (VZV). Our aim was to develop and evaluate a homogeneous PCR assay which combines the following features: the assay can detect and distinguish HSV types 1 and 2 and VZV, can be performed on untreated clinical samples, contains internal control reagents to monitor for inhibitors in the sample and allows automatic assignment of viral genotypes. Primers and probes specific for HSV and VZV genes were combined and optimized in a multiplex PCR. An internal control was designed which allowed use of the VZV primers and a human factor V gene DNA template. The assay was evaluated on an initial cohort of 66 clinical swab samples, with results determined by visual inspection of melt curves. Parameters obtained from this study were used to assign genotypes automatically to a second group of 85 clinical swab samples. Optimization of reagents produced melt curve peaks of sufficient height and symmetry for automatic genotype assignment. In the initial cohort of 66 samples, 63 returned concordant results, one sample produced an aberrant peak due to sequence variation and the remaining two samples were positive on re-test. Automatic genotype assignment of the second group of 85 samples resulted in correct identification of 79 samples, with two further aberrant peaks, and two samples positive on retest. The development of this assay should facilitate the rapid detection of herpes viruses from clinical swab samples.     

Analysis of cross-reactivity between flaviviruses with sera of patients with Japanese encephalitis showed the importance of neutralization tests for the diagnosis of Japanese encephalitis

Japanese encephalitis (JE) is one of the most important viral encephalitis in Asia. JE is caused by the Japanese encephalitis virus (JEV), which belongs to the genus Flavivirus, family Flaviviridae. The diagnosis of JE is usually based on serological assays, and it has been reported that cross-reactivity between flaviviruses has complicated the interpretations of results from serological assays. Therefore, analysis of the cross-reactivity is an important subject for serological diagnosis of JE and other diseases caused by flaviviruses. In the present study, the cross-reactivity of the sera of patients with JE to other flaviviruses was analyzed using enzyme-linked immunosorbent assay (ELISA) and neutralization tests. Sixteen serum samples were collected from patients with JE and were tested for: i) IgM antibody against West Nile virus (WNV), dengue virus (DENV), zika virus (ZIKV), and tick-borne encephalitis virus (TBEV) using IgM-ELISA, ii) IgG antibody against DENV and TBEV using IgG-ELISA, and iii) neutralization tests with DENV 1–4, ZIKV, TBEV, and WNV. Out of the 16 samples tested using ELISA, 11 and 14 samples were positive for IgM and IgG, respectively, against at least one of the other flaviviruses. In neutralization tests, neutralizing potency against DENV, ZIKV, or TBEV was not detected in any samples. Although 13 samples showed neutralizing potency against WNV, their neutralizing antibody titers were equal to or less than one-eighth of those against JEV. These results show that neutralization tests are more specific than ELISA, indicating the importance of the neutralization tests in the diagnosis of JE.     

Detection of pandemic (H1N1) 2009 influenza virus by allele discrimination

BackgroundThe pandemic (H1N1) 2009 has become a threat of public health. To manage rapidly increased infections and disease control, a simple and reliable first-line screening test for viral infection is on urgent demand.MethodsThrough comprehensive bioinformatics analysis, a single nucleotide polymorphism in nucleoprotein gene which differentiates swine lineage virus and human seasonal H1N1 virus was selected as target. A TaqMan probe-based allele discrimination analysis was designed to analyze clinical samples. In total, 93 clinical specimens and 39 viral isolates were used to test the assay efficacy. Traditional viral culture and molecular analysis were used as gold standard.ResultsThe testing results showed that the established assay has high sensitivity and specificity (92% and 100%) for pandemic (H1N1) 2009. The assay could detect as low as 5 copies of NP gene of pandemic (H1N1) 2009 or 2 viral particles of human seasonal H1N1.ConclusionThis assay can be used as a first-line screening and confirmation test for pandemic (H1N1) 2009 virus and human seasonal flu in one-tube reaction. The assay can serve as a convenient method to reduce the burden of PCR manipulation for diagnostic laboratories when large amount of samples need to be analyzed in a short time.     

登革病毒TaqManMGB实时荧光定量PCR检测方法的建立及初步应用

目的建立登革病毒TaqMan实时荧光定量PCR快速检测方法及应用于临床。方法根据1～4型登革病毒3’端非编码区的一段高度保守序列,设计一套型通用的引物和TaqManMGB探针,以4个血清型登革病毒标准株为标准,以日本乙脑病毒和丙肝病毒作阴性对照,以包含登革病毒2型标准株（DENV-2NGC株）3’非编码区349bD片段的质粒DNA作标准品,对引物和TaqManMGB探针的特异性、灵敏度进行分析,从而建立登革病毒实时荧光定量PCR检测方法。用该法对登革病毒野毒株和10份登革病毒患者血清进行检测。结果TaqMan实时荧光定量PCR检测的1～4型登革病毒标准株及野毒株均为阳性,日本乙脑病毒和丙肝病毒均为阴性;检测灵敏度可达到每反应2个基因拷贝;检测的10份登革患者血清样本中,8份检测结果为阳性。结论TaqManMGB实时荧光定量PCR方法是一个快速、特异性强、敏感性高的检测登革病毒的方法,适用于登革病毒的临床早期诊断。     

广东省肇庆市2014-2015年登革病毒分子分型及初步溯源研究

目的 了解广东省肇庆市2014-2015年登革病毒（DENV）的基因型别和可能的输入来源。方法 收集登革热临床诊断病例急性期血清,对实时荧光反转录-聚合酶链反应（RT-PCR）检测阳性标本进行病毒培养,分离株进行E基因扩增与序列测定,用Mega 5.1软件进行分子分型和系统进化树构建。结果 409份样品中147份实时荧光RT-PCR检测阳性（35.94%）,其中2014年阳性144份（39.99%）,以DENV 1（139/361）为主;2015年阳性3份（6.25%）,以DENV 3（2/48）为主。共获得22株DENV分离株,其中20株为2014年DENV 1型的genotype Ⅰ和Ⅲ,与2013-2014年广州、佛山市分离株核苷酸同源性分别为99.40%~100.00%和99.20%~100.00%,与新加坡、泰国、马来西亚和印度尼西亚分离株亲缘关系次之;2株为2015年DENV 3的genotype Ⅲ,与近年新加坡和印度尼西亚分离株的核苷酸同源性为98.20%~99.70%。结论 广东省肇庆市2014年暴发流行的DENV 1为genotype Ⅰ和Ⅲ,可能由广州市和佛山市输入,2015年散发的DENV 3为genotype Ⅲ,由佛山市输入,疫情毒株可能源于新加坡、印度尼西亚等东南亚流行株。     

Development and comparative evaluation of SYBR Green I-based one-step real-time RT-PCR assay for detection and quantification of West Nile virus in human patients

The recent outbreaks of West Nile Virus (WNV) in the Northeastern American continents and other regions of the world have made it essential to develop an efficient protocol for surveillance of WN virus. Nucleic acid based techniques like, RT-PCR have the advantage of sensitivity, specificity and rapidity. A one step single tube Env gene specific real-time RT-PCR was developed for early and reliable clinical diagnosis of WNV infection in clinical samples. The applicability of this assay for clinical diagnosis was validated with 105 suspected acute-phase serum and plasma samples from the recent epidemic of mysterious fever in Tamil Nadu, India in 2009–10. The comparative evaluation revealed the higher sensitivity of real-time RT-PCR assay by picking up 4 additional samples with low copy number of template in comparison to conventional RT-PCR. All the real-time positive samples further confirmed by CDC reported TaqMan real-time RT-PCR and quantitative real-time RT-PCR assays for the simultaneous detection of WNV lineage 1 and 2 strains. The quantitation of the viral load samples was done using a standard curve. These findings demonstrated that the assay has the potential usefulness for clinical diagnosis due to detection and quantification of WNV in acute-phase patient serum samples.     

利用实时荧光定量-聚合酶链反应方法检测粪便标本中的伤寒沙门菌

目的 建立针对粪便标本中伤寒沙门菌的检测方法,评价该方法的特异性、敏感性及检测下限,以提高感染人群粪便标本中伤寒沙门菌的检出率。 方法 根据伤寒沙门菌特异基因STY1633设计特异性引物,优化反应条件,建立实时荧光定量-聚合酶链反应(real-time fluorescent quantitative polymerase chain reaction,qPCR)反应体系。利用92株常见的非伤寒病原菌及44株伤寒沙门菌的染色体DNA评价该方法的特异性和灵敏性,并对伤寒沙门菌的粪便模拟标本进行检测下限评价,同时利用10份伤寒患者粪便标本及48份其他病原所致发热和/或伴腹泻的患者粪便标本进行特异性、敏感性验证。 结果 利用本方法检测的伤寒沙门菌纯菌及伤寒患者标本均扩增阳性,其余的非伤寒沙门菌、致腹泻的其他5种肠道致病菌及引起发热症状的8种常见非肠道病原菌纯菌及相应患者标本均扩增阴性。在对纯伤寒沙门菌DNA检测中,qPCR法的最低检测限为500 fg/反应,相当于97个拷贝/反应。以粪便模拟样品提取DNA为模板的检测中,增菌前检测下限达104 cfu/g,增菌后可达50 cfu/g。 结论 基于STY1633基因的实时荧光定量PCR方法在检测粪便中的伤寒沙门菌中具有很好的特异性、灵敏度,为伤寒沙门菌的快速诊断及某些不明原因发热及腹泻症状的病原初步鉴定提供了新的简便型手段,对于伤寒的早期诊断及预防控制提供了技术支持。     

Cloning and expression of an envelope gene of West Nile virus and evaluation of the protein for use in an IgM ELISA

West Nile virus (WNV) is a neurotropic flavivirus that has emerged globally as a significant cause of viral encephalitis. The early confirmatory diagnosis of WNV infections is important for timely clinical management and epidemiologic control in areas where multiple flaviviruses are endemic. The coexistence of WNV along with other members of flaviviruses like dengue and Japanese encephalitis in India has complicated the serodiagnosis due to cross-reactive antigens. In the present study, the development and evaluation of a highly sensitive and specific IgM enzyme-linked immunosorbent assay (ELISA) using the recombinant envelope protein (rWNV-Env) for rapid, early, and accurate diagnosis of WNV are reported. The gene coding for the envelope protein of WNV was cloned and expressed in pET 28a vector followed by purification of recombinant protein by affinity chromatography. An indirect IgM microplate ELISA using purified rWNV-Env protein was optimized having no cross reactivity with healthy human serum. Furthermore, the specificity of this assay was confirmed by cross checking with serum samples obtained from patients with dengue and Japanese encephalitis viruses. The comparative evaluation of this rWNV-Env protein–specific IgM ELISA with plaque reduction neutralization test assay using 105 acute phase of clinical samples revealed 95% concordance with sensitivity and specificity of 92% and 97%, respectively. The positive and negative predictive values of recombinant-based Env ELISA were 94% and 96%, respectively. The recombinant envelope protein–based WNV-specific ELISA reported in this study will be useful for rapid screening of large numbers of clinical samples in endemic areas during outbreaks.     

Pitfalls in Diagnosing Hypoglycemia Due to Exogenous Insulin: Validation and Utility of an Insulin Analog Assay

ObjectiveTo overcome the limitations of commercially available insulin immunoassays which have variable detection of analog insulin and can lead to clinically discordant results and misdiagnosis in the workup of factitious hypoglycemia.Patients and MethodsWe performed analytical validation of a liquid chromatography high resolution accurate mass (LC-HRAM) immunoassay to detect insulin analogs. We completed clinical assessment using a large cohort of human serum samples from 78 unique individuals, and subsequently used the assay in the evaluation of eight individuals with high diagnostic suspicion for factitious hypoglycemia.ResultsThe performance characteristics show that the LC-HRAM immunoassay can be applied to detect five commonly used synthetic insulin analogs (lispro, glulisine, aspart, glargine metabolite, and detemir) in human serum. Our clinical cases show that this assay could be used in the diagnosis of factitious hypoglycemia by identifying the analog insulin(s) in question.ConclusionThe LC-HRAM immunoassay reported here overcomes a gap in our diagnostic pathway for hypoglycemia. The results obtained from our studies suggest that this method is appropriate for use in clinical laboratories when factitious hypoglycemia is considered as a differential diagnosis.     

Dengue vaccine breakthrough infections reveal properties of neutralizing antibodies linked to protection

The 4 serotypes of dengue virus (DENV1–4) are mosquito-borne flaviviruses that infect humans. Live attenuated tetravalent DENV vaccines are at different phases of clinical testing. DENV vaccine developers have relied on neutralizing antibodies (NAbs) as a correlate of protection. A leading tetravalent vaccine (Dengvaxia) stimulated NAbs to the 4 DENV serotypes, yet overall vaccine efficacy was low in children who were DENV seronegative at baseline before vaccination. We compared the properties of (a) NAbs induced by WT DENV1 or DENV3 infections, which are strongly correlated with protection from repeat infections, and (b) NAbs induced by Dengvaxia in individuals who subsequently experienced DENV1 or DENV3 breakthrough infections. WT infections induced NAbs that recognized epitopes unique (type specific) to each serotype, whereas the vaccine stimulated qualitatively different NAbs that recognized epitopes conserved (crossreactive) between serotypes. Our results indicate that, among children who were DENV-seronegative at baseline, unbalanced replication of the DENV type 4 vaccine component in the tetravalent vaccine stimulates Abs capable of crossneutralizing DENV1 and DENV3 in vitro, but not protecting in vivo. In DENV-seronegative individuals who are vaccinated, we propose that type-specific NAbs are a better correlate of protection than total levels of NAbs.