Battegay, M.

Courvoisier, S.

Grob, H.

Itin, P.

Weisser, M.

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596 Eur J Clin Microbiol Infect Dis, Volume 17, 1998 References 1. Glezen WP, Denny FW: Epidemiology of acute lower respi- ratory disease in children. New England Journal of Medicine (1973) 288:498-505 2. Chanock RM, Parrott RH: Acute respiratory disease in infancy and childhood: present understanding and prospects for prevention. Pediatrics (1965) 36:21-39 3. Lipson SM, Krilov LR: Comparison of the rapid second generation directigenR EIA with cell culture and immuno- fluorescence for the detection of respiratory s ncytial virus in nasopharyngeat aspirates. Clinical and Diagnostic Virology (1994) 2:105-112 4. Ray CG, Minnich LL: Efficiency of immunofluorescence for rapid detection of common respiratory viruses. Journal of Clinical Microbiology (1987) 25:355-357 5. Rothbarth Phil, Hermus M-C, Schrijnemakers P: Reliability of two new test kits for rapid diagnosis of respiratory syncy- tial virus infection. Journal of Clinical Microbiology (1991) 29 : 824-826 6. Krilov LR, Lipson SM, Barone SR, Kaplan MH, Ciamician Z, Harkness SH: Evaluation of a rapid diagnostic test for respi- ratory syncytial virus (RSV): potential for bedside diagnosis. Pediatrics (1994) 93:903-906 7. Swierkosz EM, Flanders R, Melvin L, Miller JD, Kline MW: Evaluation of the Abbott TESTPACK RSV enzyme immu- noassay for detection of respiratory syncytial virus in naso- pharyngeal swab specimens. Journal of Clinical Microbiology (1989) 27:1151-1154 8. Thomas EE, Book L: Comparison of two rapid methods for detection of respiratory s ncytial virus (RSV) (TestPack RSV and Ortho RSV ELISA) with direct immunofluorescence and virus isolation for the diagnosis of pediatric RSV infection. Journal of Clinical Microbiology (1991) 291632-635 9. Dominguez EA, Taber LH, Couch RB: Comparison of rapid diagnostic techniques for respiratory syncytial virus and influenza A virus respiratory infections in young children. Journal of Clinical Microbiology (1993) 31:2286-2290 I0. Wren CG, Bate B J, Masters HB, Lauer BA: Detection of respiratory syncytial virus antigen in nasal washings by Abbott TestPack enzyme immunoassay. Journal of Clinical Microbiology (1990) 28 : 1395-1397 Relationship between Erythema of the Proximal Nailfold in HIV-Infected Patients and Hepatitis C Virus Infection S. Courvoisier, H. Grob, M. Weisser, P.H. Itin, M. Battegay Periungual erythema was first described in HIV- infected patients in 1995 by our group [1]. In 1996 Pechere et al. [2] presented nine patients with periun- gual erythema, all of whom were serologically positive S. Courvoisier, H. Grob, P.H. Itin Department ofDermatology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland M. Weisser, M. Battegay (IE~) Outpatient Department of Internal Medicine, University Hospital Basel, Petersgraben 4,CH-4031 Basel, Switzerland for hepatitis C virus (HCV) antibodies. All had active viral hepatitis, and in six patients hepatitis C-RNA was found. In the nine patients we reported, only four had a serological test positive for HCV [3]. However. the percentage of HCV infections may have been underes- timated, as serological tests for HCV were not performed in all patients who had no signs of chronic liver disease. To give a description of the course of disease and a possible relationship with HCV. we present an overview of 21 patients, eight of whom have been presented earlier [3, 4]. Through 30 June 1997. we documented periungual erythema in 22 of 540 (4.1%) HIV-infected patients. HIV-infected persons were examined routinely every 6 months by a dermatologist. Demographic. linical, and laboratory data of the 21 patients we analysed are shown in Table 1. Asymptomatic erythema was restricted to the distal part of the fingers in nine patients and to the distal part of the toes m 10 patients and was found in both sites in two patients. Some patients had telangiectases. Marked palmar erythema was observed in nine patients. Periungual erythema was documented at two consecutive consultations or repeatedly in nine patients: in four of these patients. the erythema disappeared. The HIV viral load at the time of diagnosis was avail- able for 19 patients; it showed no correlation with the presence of periungual erythema (Table 1)i Serological data regarding HCV infection was at least partly avail- able for 20 patients. Serological tests for HCV (second- generation EIA; Abbott, USA) were confirmed as positive in 12 patients and were negative in five patients, in one patient the confirmatory test (Dediscan; Sanofi, France) for HCV was questionaNe. This patient also had cryogtobulinemia, a complication that can occur during HCV infection [5]. In three patients serological testing for HCV was either not done or was not available. Chronic hepatopathy docu- mented by elevated liver enzymes was seen in seven patients. No patient tested positive for hepatitis B surface antigen, which indicates that all were free of acute or chronic hepatitis B infection. In our series of 21 patients, 12 had documented HCV infection. In one other patient, HCV infection was highly probable. In five patients erological testing for HCV was negative. Therefore, it is possible that condi- tions other than HCV may also contribute to erythema. One patient (no. 11) who tested negative serologically for HCV and HBV but who was a known alcohol abuser with elevated liver enzyme values had periun- gual and palmar erythema. Another patient (no. 15) with a history of alcohol abuse and recurrent pancrea- titis had no signs of chronic liver disease. In the remaining three patients with negative HCV serological tests, no sign of chronic hepatopathy was found. In Eur J Clin Microbiol Infect Dis, Volume 17, 1998 597 Table 1 Clinical and labora- tory findings in patients with HIV infection and periungual erythema Patient Age in Focus of >lx* Mode of CDC CD4+T HIV viral HCV no. years/sex infection transmission classi- cell count load anti- fication in I*1 (copies/ml) bodies 1 36/m F/T/P yes iv C3 160 23993 pos 2 40/m T no iv B1 608 3847 pos 3 35/f T no iv B3 190 793404 pos 4 32/m T/P no iv/msm C3 100 413 pos 5 31/f F/P yes iv C3 157 750000 pos 6 30/f T/P yes iv B2 374 766 pos 7 38/m F yes iv B3 260 < 244 pos 8 33/m F no msm A2 370 38515 neg 9 39/m T no iv B3 45 122085 nd 10 38/f F yes iv C3 57 15474 prob 11 58/m T/P no bi C3 5 169254 neg 12 33/m T no iv C3 30 40271 pos 13 34/m F no iv C2 260 < 274 pos 14 31/m T/P yes iv B3 119 < 418 pos 15 35/m T yes hetero B3 170 206167 ueg 16 29/f F/P yes iv B2 310 na na 17 56/m F no msm B2 270 nd neg 18 57/m T no msm C3 20 45060 neg 19 28/f F no iv A1 851 1329 pos 20 33/m F/P no iv C3 135 165616 na 21 36/f F/T/P yes iv C3 95 4467 pos * Diagnosis was established in more than one consultation bi, bisexual; CDC, Centers for Disease Control; F, fingers; HCV, hepatitis C virus; hetero, hetero- sexual intercourse; iv, intravenous drug abuse; msm, men having sex with men; na, not available; nd, not done; neg, negative; P, palmar erythema; pos, positive; prob, probable; T, toes these three pat ients per iungual  e ry thema was seen only once, and in two of them it d i sappeared  before  the next fo l low-up visit. However ,  it is also possib le that the serological  test for HCV was falsely negat ive [6]. A l l  pat ients descr ibed by Pech6re et al. [2] were intrave- nous drug users or a lcohol  abusers. Interest ingly,  all of our pat ients who were intravenous drug users had posi- tive serological  tests for HCV.  There  was no correla-  t ion between diagnosis of the per iungual  e ry thema nd the activity of the H IV  infect ion expressed by the actual viral load. We conclude that per iungual  e ry thema in H IV- in fected  pat ients is most often associated with HCV infection with or wi thout  concomitant  activity and non-virus- induced chronic l iver disease. Other  associat ions are suggested, especial ly  in t ransient  per iungual  erythema.  Possibly, non-organ-speci f ic  autoant ibod ies  in H IV  infection [7] p lay a role in the pathogenes is  of per iun-  gual erythema,  ref lect ing the large spectrum of anti- bodies found in H IV - in fec ted  patients.  4. Itin PH, Gilli L, Ntiesch R, Courvoisier S, Battegay M, Rufli T, Gasser P: Erythema of the proximal nail fold in HIV-infected patients. Journal of the American Academy of Dermatology (1996) 35:631-633 5. Levey JM, Bjornsson B, Banner B, Kuhns M, Malhotra R, Whitman N, Romain PL, Cropley TG, Bonkovsky HL: Mixed cryoglobulinemia in chronic hepatitis C infection. Medicine (1994) 73:53-67 6. Sugitani M, Inchauspe G, Shindo M, Prince AM: Sensitivity of serological assays to identify blood donors with hepatitis C viraemia. Lancet (1992) 339:1018-1019 7. Muller S, Richalet P, Laurent-Crawford A, Barakat S, Riviere Y, Porrot F, Chamaret S, Briand JP, Montagnier L, Hovanes- sian A: Autoantibodies typical of non-organ-specific autoim- mune diseases in HIV-seropositive patients. AIDS (1992) 6: 933-942 Intrauterine Rubella Virus Infection Despite Expected Maternal Immunity W. Bossart,  D. Nada l  References 1. Itin PH, Gilli L, NiJesch R, Courvoisier S, Battegay M, Rufli T, Gasser P: Erythema of the proximal nail fold a further cuta- neous clue to HIV infection? Dermatology (1995) 191:176 2. Pech~re M, Krischer J, Rosay A, Hirschel B, Saurat JH: Red fingers syndrome in patients with HIV and hepatitis C infec- tion. Lancet (1996) 348:196-197 3. Battegay M, Itin PH: Red fingers syndrome in HIV patients. Lancet (1996) 348:763 Screening for immunity  against the rubel la  virus is an essential  part  of the prenata l  care of pregnant  women.  W. Bossart (1E) Institute of Medical Virology, University of Zurich, Gloriastrasse 30, CH-8028 Zurich, Switzerland D. Nadal University Children's Hospital, Infectious Disease Unit, University of Zurich, Steinwiesstrasse 75,CH-8032 Zurich, Switzerland 

Relationship between erythema of the proximal nailfold in HIV-infected patients and hepatitis C virus infection

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Relationship between erythema of the proximal nailfold in HIV-infected patients and hepatitis C virus infection

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