immunochromatographic test (ICT) (Unigold; Trinity. Biotech, Ireland) were also ... these assays have been shown to reduce the HIV window period by 45 days.
Indian Journal of Medical Microbiology, (2014) 32(3): 344354
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Correspondence
!"#$%& '($)*)+%& ,-."/& )..-/(0%12)%/23& +)4-$& "/*)5(03& *%$*& )/& 2,4(/)2& ,%'"*)*)$& 6& patient Dear Editor, F#!#%!8(7$ ()$ ->#%8@%$ +7!8?(=8#-$ +A+87-!$ "&G+7$ 8GG&7(=#@%8#7%B$ *86&-$ .CDE3$ 8-$ !"#$ >68G+6B$ G#+7-$ ()$ routine laboratory diagnosis of HIV infection. Rapid tests or enzyme linked immunosorbent assays (ELISA) are the basic serological methods used to screen antiHIV antibodies. In addition to these tests, new “4thgeneration” HIV tests either in ELISA or chemiluminescent microparticlebased immunoassay (CMIA) format are introduced to detect both HIV p24 antigen and antibody in a single immunoassay to shorten the diagnostic window.[1] Currently, these assays are widely used for routine laboratory diagnosis of HIV in numerous laboratories throughout the world. As the ->#%8@%8!B$ ()$ !"#-#$ -%6##787A$ !#-!-$ 8-$ ,8G8!#=4$ 5#-!#67$ blot (WB) or line immunoblot assay (LIA) test is used as +$ %(7@6G+!(6B$ !#-!$ )(6$ +,,$ +7!8'CDE$ 6#+%!8*#$ -#6&G$ 87$ !"#$ screening test. Recently, “4thgeneration” CMIA HIV test has been introduced in Bangladesh for routine diagnosis of HIV infection. According to existing published literatures; !"8-$ 8-$ !"#$ @6-!$ 6#>(6!$ ()$ )+,-#$ +7!8'CDE$ >(-8!8*#$ !#-!$ 6#-&,!$ in a chronic hepatitis B virus (HBV) patient. The aim of our report is to describe a case of false positive HIV test result detected by CMIA and discuss how other laboratory tests may help to diagnose such cases correctly. Patient was a 63yearold male, admitted in a Private Hospital in Dhaka City, Bangladesh for elective coronary angiogram (CAG). He had the complaints of shortness of breath, mild chest pain and fatigue, which was relieved by taking rest. Electrocardiography and echocardiography with colour Doppler report revealed some abnormalities and exercise tolerance test was also positive. He was advised to undergo CAG and was asked to take some routine investigations. On investigations, the patient was found nondiabetic, mildly anaemic (8.1 g/dl) and positive for both hepatitis B surface antigen (HBsAg) and antiHIV antibody. On further testing his other HBV markers i.e. hepatitis B e antigen (HBeAg), antiHBc immunoglobulin M (IgM), antiHBsAg and HBVdeoxyribonucleic acid were found to be negative except antiHBc (total) and antiHBeAg, which indicates that this patient was in asymptomatic chronic HBV carrier stage. As the patient was positive for HIV antibody, he 5+-$ 6#)#66#=$ !($ !"#$ CDE$ 6#)#66+,$ %#7!6#$ )(6$ %(7@6G+!8(7$ and further management. The LIA (INNOLIA™ HIV I/II Score/Innogenetics, Belgium) was performed at the F#>+6!G#7!$+-$CDE$%(7@6G+!(6B$!#-!$+7=$5+-$7(7'6#+%!8*#$ against all the HIV antigens used in this assay. Particle
Agglutination Test (Capillus, HIV1/HIV2) and a rapid immunochromatographic test (ICT) (Unigold; Trinity Biotech, Ireland) were also negative. On history, the patient denied use of intravenous drug or any highrisk sexual behaviour and had no history of receiving any blood or blood products. His wife and two sons were negative for antiHIV antibody. On checking the previous reports of the patient, it was observed that the HIV antibody test was performed at a private hospital with a 4th generation CMIA (Abbott Architect, ci 8200). As per the assay protocol developed by the manufacturers, the assay result is presented as ratios of specimen signals to !"#$ %&!'())$ *+,-$ ./01234$ 5"#6#$ +7$ /012$ 6+!8($ 9$ :;+7!$ 6#-&,!$ 6##G>"+-8-$ !"#$ 7##=$ ()$ %(7@6G87A$ CDE$ positive test result by WB or LIA.
5. Isaacman SH. Positive HIV antibody test results after !6#+!G#7!$ 58!"$ "#>+!8!8-$ U$ 8GG&7#$ A,(?&,87;$ HVIV$ 1989;262:209.
9:;&&>/?"4=&:&@"5"$$-. Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
7%8%4%/2%$ 1. Weber B, Fall EH, Berger A, Doerr HW. Reduction of diagnostic window by new fourthgeneration human 8GG&7(=#@%8#7%B$ *86&-$ -%6##787A$ +--+B-;$ H$ 1,87$ I8%6(?8(,$ 1998;36:22359. J;$ K8G$/4$L##$HC4$1"(8$HM4$K8G$HI4$K8G$C/;$N+,-#'>(-8!8*#$6+!#$ of a “fourthgeneration” HIV antigen/antibody combination assay in an area of low HIV prevalence. Clin Vaccine Immunol 2010;17:16424. O;$ P+6%Q+$ R4$ R(6G($ S4$ P8G#7($ 14$ =#$ L(G+-$ HP4$ S+*+66($ F;$ T#6)(6G+7%#$ ()$ +7$ +&!(G+!#=$ "&G+7$ 8GG&7(=#@%8#7%B$ virus (HIV) antigen/antibody combined assay for prenatal -%6##787A$ )(6$ CDE$ 87)#%!8(7$ 87$ >6#A7+7!$ 5(G#7;$ H$ I#=$ Microbiol 2009;58:152930. 4. Lee DA, Eby WC, Molinaro GA. HIV false positivity after hepatitis B vaccination. Lancet 1992;339:1060.
*Corresponding author (email: ) Received: 01092013 Accepted: 02102013
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A(..%/$"#&"/0&%/+)4(/.%/*"#&+"/2(.32)/B4%$)$*"/*&Enterococcus faecium isolated )/& ,($')*"#& $%**)/C$D& E%/(*3')2& 0)+%4$)*3=& "/*).)24(5)"#& 4%$)$*"/2%& "/0& +)4-#%/2%& *4")*$ Dear Editor,
vicinity of the patient and the general areas in patients’ rooms.
At the University Hospital of Londrina, Paraná, Brazil, cultures of stools are examined weekly for all patients housed in intensive care units and for all patients found to be colonised or infected with vancomycinresistant enterococci (VRE), as part of the hospital surveillance study for multidrugresistant microorganisms. A total of 24 nonduplicates vancomycinresistant Enterococcus faecium (VREfm) isolated in this hospital during 2009 and 2010 were included in this study. Fourteen isolates were recovered from stool cultures of rectal swab specimens. All patients were adults and the underlying clinical conditions at admission were as follows: stroke (6/14, 42.8%), diabetes (3/14, 21.4%), malignancy (2/14, 14.3%) and one patient each had paraplegy, AIDS and Chagas disease. Most of them were hospitalised due to pneumonia (7/14, 50.0%), sepsis (4/14, 28.6%), one patient each had ulcerations in the ankle and sacral region and one underwent eye surgery. Overall, 13 patients (92.9%) received previous broadspectrum antibiotic therapy and central venous catheters, and mechanical ventilation were used for 10 patients (71.4%). Ten bacterial isolates were obtained by rubbing premoistened swabs over the sites in the immediate
All isolates were shown to be resistant to vancomycin and teicoplanin, and the antimicrobial resistance mechanism is mediated by the vanA genes, which is consistent with our previous study with VREfm isolated at the hospital settings during 20022007.[1] All isolates also showed resistance to erythromycin that was mediated by ermB gene, which seems to be more widely distributed among VRE isolates.[2] Besides the glycopeptides and erythromycin resistance, all 8-(,+!#-$ 5#6#$ +,-($ 6#-8-!+7!$ !($ +G>8%8,,87$ +7=$ %8>6(W(X+%87$ that are characteristics of hospitaladapted E. faecium.[3] The Repetitive Extragenic Palindromic elementsPCR[4] detected 13 different clusters among the isolates, and 16 (66.7%) 5#6#$ %,&-!#6#=$ 87$ @*#$ A#7(!B>#-;$ R"#$ (!"#6$ #8A"!$ .OO;OY3$ 8-(,+!#-$"+=$&78Z$?+7=87A$>6(@,#-;$V,,$8-(,+!#-$"+6?(&6#=$ at least one putative virulence marker and the prevalence was as follows: efaA, 100%; esp, 75%; gelE, 41.7%. The genes acm, cylA and hyl were not detected in this study [Table 1]. The prevalence of E. faecium harbouring multiple antimicrobial resistance and putative virulence genes alert us for the potential risk of infection in hospitalised
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