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Some viral infections, such as rubella, cytomegalovirus and parvovirus B 19 infections or varicella, are particularly feared in pregnant women in view of the risk of foetal infection. Laboratory tests play an important role since there is no other way of diagnosing the infection and determining whether it is primary or secondary, a distinction which to a great extent conditions the severity of the foetal disease. However, no virological diagnosis can be made unless the examinations needed are prescribed correctly and at the right moment. The diagnosis of rubella is now well codified, but that of CMV infection still suffers from interpretation problems and that of parvovirus B 19 infection can only be obtained from specialized laboratories. The application of rapid diagnostic methods and molecular biology to foetal specimen collected under ultrasonography should provide a more accurate prenatal diagnosis of congenital viral infections.

7 cases of multifocal choroiditis and panuveitis are reported here (6 females, 1 male). All clinical data were carefully considered. In all cases an aqueous sampling was made for the detection of anti-herpes virus antibodies in aqueous and serum. 3 specificities were tested: herpes simplex (HSV), herpes zoster (HVZ) and cytomegalovirus (CMV). An intraocular synthesis of specific antibodies was found against VZV in 2 cases and against HSV in 1 case. There was another presumptive case for HSV.

Clinical data and histopathologic report of the association of a retinal malignant lymphoma and acute retinal necrosis. Demonstration of virus particle and vitreous herpetic antibodies.

Hemagglutination inhibition (HI), single radial hemolysis (SRH) and enzyme-linked immuno sorbent assay (ELISA), performed with commercial antigen and reagents are described and were compared in the three distinct situations that require rubella antibody detection. Determination of immunity status was carried out on 156 sera. A degree of correlation greater than 0.9 was found when comparing the three methods. Analysis of a further 74 sera, from 31 primary infections and three congenital syndromes, was performed to compare the occurrence of the various classes of antibodies in the three tests: HI test and IgM-ELISA become positive the day after the rash, whereas SRH test is not positive before the sixth day. From our limited study bearing on a total of 230 sera, each test has a precise assignment. For the determination of immunity status, SRH is simpler, faster, and inexpensive; absence or evidence of past infection can be unequivocally obtained especially in cases of low (1:10, 1:20) residual immunity. In the serodiagnosis of a rubella rash, SRH alone, due to the delayed rise in antibody titers, will demonstrate a complete seroconversion with a first serum collected up to the fifth day of the eruption. In case of absence of an early serum, of primary infection in a pregnant woman, of a newborn with suspicion of congenital syndrome, the measurement of rubella specific IgM is best obtained with ELISA, a procedure less time-consuming than HI following centrifugal, chromatographic, or electrophoretic separation, and "light" (8 S) RF with SRH test is discussed. Interference of IgM Rheumatoid Factor (RF) with IgM ELISA and IgG RF with SRH test is discussed.

A case of meningoencephalitis is reported in a 14 year old boy. After an acute onset with fever and coma, the outcome was rapidly favorable. Antibody titers in acute and convalescent sera demonstrated recent infection with EBV. EBV encephalitis appears to be a post-infectious encephalitis with no direct viral invasion of the CNS and no acute viral replication.

From November 1985 to August 1987, 22 children underwent orthotopic liver transplantation (OLT). Primary cytomegalovirus (CMV) infection was observed in 3 of 10 seronegative recipients (30%). It was severe in 2 cases, which were treated successfully by a combination of DHPG and CMV hyperimmune globulin. From September 1987 to August 1988, a virologic survey was undertaken. It enabled us to take prophylactic measures and to make an early diagnosis of CMV infection, permitting early antiviral treatment. During this period, 26 children received liver grafts. Nine of 13 seronegative recipients (69, 2%) developed primary CMV infection. Seven had received immunoprophylaxis and 8 were treated by DHPG. None had severe disease and all improved rapidly.

On the occasion of 2 case reports, the authors emphasize the present possibility of evoking cytomegalovirus infection during pregnancy from virologic and serologic data. Such data may lead to change the evolution of such pathologic pregnancies.

In a prospective 2 year study of 59 cases of childhood meningitis, mumps was the most common etiological virus (39%), followed by enterovirus (27%). The analysis of the cases suggested that a diagnosis of the infectious agent may be arrived at using clinical data such as the degree of nuchal rigidity, the age of the patients, and the presence of associated parotiditis or macular rash. Pleiocytosis in the CSF was higher and included a larger percentage of lymphocytes during mumps meningitis than during enterovirus meningitis. Mumps or enterovirus were isolated in the CSF of 23% (mumps) and 27% (enterovirus) of the patients. Alpha interferon which was acid labile was detected in the CSF of 89% and 63% respectively of patients with mumps and enterovirus meningitis.

Heart failure with myocardial infarction occurred in the course of a neonatal infection with aseptic meningitis. Coxsackie B4 infection was found in the child and its mother. The unusual myocardial action of the virus, coronary embolus, intermediate role of a pancreatitis. By age 8 months, under digitalis glycosides treatment, growth and psychomotor development were normal.

Paralytic poliomyelitis were observed in two healthy children who both had previously received four doses of standard inactivated poliovaccine (IPV). These children, whose immune defenses were normal, failed to respond to IPV. This absence of antibody response might be related to an insufficient antigenicity of inactivated vaccines, justifying the extensive use of the more potent IPV, now produced on continuous cell lines.

The authors present the results of fractionation by ultracentrifugation in the identification of rubella antibodies in 20 vaccinated children and 389 pregnant women suspected of having rubella. Testing for specific IgM was constantly positive when an exanthematous disease was seen in association with a significant increase an antibody level as measured by standard techniques, making questionable the reed of fractionation under such circumstances. By contrast, however, the shortest delay in collection of the first sample of serum renders fractionation essential. Alone, it made possible the diagnostic of rubella in patients in whom the first serum, although collected within 3 to 5 days after the rash, had the same antibody level as a second serum collected later. Whilst fractionisation requested for contact only without rash did not reveal specific IgM, positive results were obtained rarely in sera with a high antibody level on routine examination. The very uncertain significance of these last results, the frequency of cases of recent rubella with very modest antibody levels and the occasional finding of duodtful results, render the authors highly sceptical as to the value of fractionisation in the presence of a high serum level on routine examination in a pregnant woman.

CSF and sera from 238 newborns and children with various neurological diseases were assayed on bovine cells for the presence of alpha-interferon (IFN). An intrathecal synthesis of pH 2-resistant alpha-IFN was recovered in all newborns and in more than 90% of children with herpes encephalitis. It was also observed in one case of mumps encephalitis and in one case of encephalitis associated with Influenza A infection. An acid-labile alpha-IFN production was detected in CSF from more than one half of patients with viral meningitis or active congenital rubella and in those with neurological complications of systemic lupus erythematosus. This alpha-IFN subtype was also detected in CSF from only 2/37 children with measles encephalitis. In contrast, no alpha-IFN (less than 2 IU) in CSF was found among patients with subacute sclerosing panencephalitis, Guillain-Barré syndrome, Reye's syndrome, acute cerebellar ataxia, infantile spasms or facial paralysis of unknown origin.

The hemolysis in gel test (HIG) was compared with the hemagglutination inhibition test (HI). This new test is simple and time-sparing since it does not require dilution or serum pre-treatment, and can be measured directly in mm. It is not more expensive than the HI method. It has proved sensitive and is not affected by non specific serum hemagglutination inhibitors and is conclusive whenever HI titers are looked upon with suspicion (titers of less than 1/20). It is therefore well adapted to mass screening of immunity against rubella but in the field of recent infections HI method still has its role to play. Using the HIG test as a reference, we measured the loss of Ig to rubella following the three most commonly employed methods for removal of inhibitors: the mean values of 16 sera were 25% of antibodies lost after kaolin pre-treatment, 62% lost after heparine-Mn-Cl2 procedure 75% lost after dextran-CaCl2 treatment.

The acute and convalescent sera of 328 children with acute enteritis were checked with the bovine diarrhea virus as antigen in complement fixation test. 13% had a seroconversion. Some cases were associated with skin rashes or signs of respiratory infection.

A case of brachial plexus neuropathy is described in an 18 month-old boy. Specific Epstein-Barr virus (EBV) serology suggests that EBV was the causative agent.