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Background: Polymerase chain reaction (PCR) is used to detect viruses in the cerebrospinal fluid (CSF) of patients with neurological disease. However, data to assist its use or interpretation are limited. Objective: We investigated factors possibly influencing viral detection in CSF by PCR, which will also help clinicians interpret positive and negative results. Methods: CSF from patients with was tested for human herpesviruses types 1–6, JC virus, enteroviruses, and Toxoplasma gondii . The likelihood of central nervous system (CNS) infection was classified as likely, possible, or unlikely. PCR findings in these categories were compared using single variable and logistic regression analysis. Results: Of 787 samples tested, 97 (12%) were PCR positive for one or more viruses. Of episodes likely to be CNS viral infections, 30% were PCR positive compared to 5% categorised as unlikely. The most frequent positive findings were Epstein Barr virus (EBV), enteroviruses, and herpes simplex virus (HSV). Enteroviruses and HSV were found predominantly in the likely CNS viral infection group, whereas EBV was found mainly in the unlikely group. Positive PCR results were more likely when there were 3–14 days between symptom onset and lumbar puncture, and when CSF white cell count was abnormal, although a normal CSF did not exclude a viral infection. Conclusions: The diagnostic yield of PCR can be maximised by using sensitive assays to detect a range of pathogens in appropriately timed CSF samples. PCR results, in particular EBV, should be interpreted cautiously when symptoms cannot readily be attributed to the virus detected.

Correctly identifying Koplik’s spots is not an easy feat, as noted in Spitzer’s excellent letter.12 Koplik’s spots are still thought to be pathognomonic for measles, but oral lesions, similar in appearance to Koplik’s spots, can be found in other illnesses, such as parvovirus B12 infection.3 Zenner and Nacul’s study included reporting of “Koplik’s spots” by clinicians with variable levels of experience and did not include independent assessment …

What you need to know A 23 year old woman has fever, flu-like symptoms, diarrhoea, and a rash that has spread from her face to her body. She cannot recall being in contact with anyone unwell and has not recently travelled or taken any drugs. She reports missing vaccinations as a child because her parents were concerned about safety. On examination she has a maculopapular blanching rash on her face and chest. Measles was suspected and confirmed with serology that was positive for immunoglobulin M antibodies to the measles virus. Reverse transcription polymerase chain reaction on a throat swab detected measles virus RNA. Measles is widely perceived as a disease of early childhood, despite almost two thirds of recent cases in the United Kingdom being in those aged 15 and older.1 Patients typically present with fever, cough, coryza, and conjunctivitis, followed two to four days later by a characteristic erythematous maculopapular rash that spreads downwards from the face (figs 1⇓ and 2⇓).2 Patients are infectious from four days before to four days after the onset of rash. Koplik’s spots—whitish lesions …

Introduction We report the impact of host and viral factors on treatment outcome in the first 53 patients who have completed therapy for CHC with either telaprevir or boceprevir, in combination with pegylated-interferon and ribavirin (PEG/R) at our centre. Methods Patients were treatment naive or experienced with F3 or F4 fibrosis, CHC genotype1 and HCV RNA > 10,000 IU/ml. Data were collected on host and viral factors including single nucleotide polymorphisms (SNPs) in the IL28B gene noncoding region at sites rs12979860 and rs8099917. Results 53 patients (42 Caucasian, 32 F4) were treated with TVR (n = 41) and BOC (n = 12). Seven patients were treatment naive. Subtyping was unattainable in 2 patients. Thus far, 18 patients (34%) have failed treatment and the remainder are being evaluated for SVR (24 patients with SVR-4 to date). HCV viral negativity at triple therapy week 4 was associated with treatment success in patients with rs12979860CC and rs8099917TT and rs12979860non-CC and rs8099917non-TT (OR 20.2 P-value Conclusion In our prospective cohort of CHC patients with advanced fibrosis treated with PIs, HCV RNA negativity at triple therapy week 4 and both IL28B genotypes were independent predictors of treatment outcome. Despite similar rates of early viral suppression, our preliminary data indicate more favourable end of treatment results for rs12979860CC and rs8099917TT versus rs12979860non-CC and rs8099917TT. Disclosure of Interest None Declared.