The

VOLUME - I
ISSUE - III
MAY / JUN 2004
Crux
B I M O N T H LY F O R U M F O R T H E L A B O R ATA R I A N S

Editorial
We would like to thank all our valued readers for appreciating the previous two efforts. They
highlighted two emerging diseases with serious outcomes if not diagnosed in time. This issue
highlights a disease that has brought about a hiatus in the living populations of many a nation. It
is gradually wiping the working and reproductive age groups. Being an STD, the disease affects
both parents and in the process has acquired the dubious distinction of having created the
CONTENTS largest number of orphans.

No single disease has evoked so much response and investment from the medical fraternity as
1 Editorial HIV/AIDS. Considered so devastating that for almost two decades even “CANCER” has been
relegated to the backbench. Labeled as a Bio-hazard 3 disease, HIV/AIDS has no known cure or
Disease vaccine available as on date. The “mantra” then is PREVENTION. How does one prevent?
2 Diagnosis Educate the population at large and prevent spread from the already infected individuals. Logic
dictates that all infected persons must first be diagnosed. For doing so, we must thoroughly
Trouble know about the disease process and must be well conversant with the diagnostic tools
5
Shooting available. The DISEASE DIAGNOSIS section of this issue discusses all aspects of HIV/AIDS
(though in brief) with special reference to internationally accepted diagnostic criteria. The
6 Bouquet thought of HIV/AIDS evokes suicidal tendencies and attracts the highest degree of social stigma;
a disease so horrifying must be reported with utmost caution. Flip this page to be transported to
the world of HIV/AIDS diagnosis.
7 Interpretation
Affliction with tuberculosis has been considered to be a social curse. With the arrival of HIV/AIDS
8 Tulip News and development of multi-drug-resistant strains, the problem has been compounded manifold.
No perfect or foolproof immunological diagnostic tool has been devised as yet, consequently,
the dictum “SEEING IS BELIEVING” still holds good. Diagnosis of tuberculosis can be established
by actually visualizing the acid-fast bacilli microscopically. Conversely, the disappearance of
AFBs heralds the institution of appropriate and effective treatment. The TROUBLE SHOOTING
section resolves the problems encountered during this exercise.

Glycosylated hemoglobin has assumed significant importance in the management of diabetes

mellitus. The investigation reveals all about previous 90-120 days history vis-à-vis diabetes
mellitus. The investigation schedule and interpretation of the GHb. values obtained is clarified in
the INTERPRETATION segment of this issue.

BOUQUET has all the shoots it has been coming with thus far. Just the hues and aromas are
different

Trust you shall enjoy and appreciate this issue too.

PUBLISHED FOR THE TULIP GROUP CUSTOMERS

1
F O R P R I V A T E C I R C U L A T I O N O N L Y
Group
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Macrophase Tropic HIV-I Strain T Cell Tropic HIV-I Strain

gp120
gp 41

HIV - I
co- receptor
(chemokine
receptor)
CCR3 CD4 receptor
CCR5
HIV - I co-receptor
CD4 (Fusin)
receptor CD4 CxCR4
receptor CD4 receptor
SDFI

gp - 120, SU

gp - 41, TM

HLA Class II DR

HLA Class I

P6
RNA
P24, CA
Lipid Bilayer
P17, MA Protease

Integrase
P7
P9,NC HIV Gene Protein Product Function in Life Cycle of HIV
gag Gag/core protein Viral core proteins
Reverse precursor p24: major capsid protein
Transcriptase p17: matrix protein
p9: binds to viral RNA
p7: binds to viral RNA
env Env./envelope proteins Viral envelope proteins:
gp 120: major envelope protein, mediates virion binding to
cell surface receptor ( CD4)
gp 41: mediates fusion of viral envelope and cell membrane
pol Reverse transcriptase Converts single-stranded viral RNA into viral DNA duplex

Integrase Integrates viral DNA duplex into host cell genome as provirus
DNA
Protease Cleaves core precursor polyprotein into functional core
proteins
tat Tat protein Essential regulatory protein, trans-activates expression of all
viral genes
rev Rev protein Regulatory protein, activates expression of HIV structural and
enzymatic genes
vif Vif protein Role in viral budding and infectivity of free virions
vpu Vpu protein Promotes release of budding virions from host cell
nef Nef protein Regulatory protein ( essential for pathogenicity of SIV)
vpr Vpr protein Regulatory protein, role uncertain

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Constitutional
Signs Death
Primary
Infection ARC/AIDS
107
1200
Seroconversion

Plasma RNA Titer / mL

Minor or No Symptoms
Clinical Latency, Sequestration of HIV 106
1000
Acute HIV Syndrome Opportunistic
Wide Dissemination of Virus Diseases
Seeding of Lymphoid Organ 5
10
3
CD4 T Cells / mm

800 Antibodies
HIV Specific CTL To HIV env.

10 4
600
Viremia

10 3
400
+
CD4 PBL 102
200

0 3 4 6 7 9 10 11 12 1 2 3
1 2 5 8
3 - 12 Weeks 1-3 YEARS
UP TO 12 Years

L is t o f c o n d itio n s in th e 1 9 9 3 A ID S S u rve illa n c e C a s e D e fin itio n is s u e d

b y th e C e n te rs fo r D is e a s e C o n tro l a n d P re ve n tio n
1 C D 4 T -c e ll c o u n t < 2 0 0 /c u b ic m m
2 O p p o rtu n is tic in fe c tio n s
· C a n d id ia s is o f b ro n c h i, tra c h e a o r lu n g s
· C a n d id ia s is , e s o p h a ge a l
· C o c cid io d o m yc o sis , d is se m in a te d o r e xtra p u lm o n a ry
· C yp to c o cc o sis , e xtra p u lm o n a ry
· C ryp to s p o rid io s is d is e a se ( o th e r th a n live r, s p le e n o r n o d e s )
· C yto m e g a lo viru s re tin itis ( w ith lo s s o f vis io n )
· H e rp e s sim p le x : c h ro n ic u lc e r (s ) ( > 1 m o n th d u ra tio n ) ; o r b ro n c h itis ,
p n e u m o n itis o r e s o p h a gitis
· H is to p la s m o s is , d is se m in a te d o r e xtra p u lm o n a ry
· Is o p so ra s is , c h ro n ic in te s tin a l ( > 1 m o n th d u ra tio n )
· M yc o b a cte riu m a viu m c o m p le x o r M . k a n sa s ii, d is se m in a te d o r
e xtra p u lm o n a ry
· M yc o b a cte riu m tu b e rc u lo s is , a n y s ite
· M yc o b a cte riu m , o th e r s p e cie s o r u n id e n tifie d s p e cie s , d is se m in a te d o r
e xtra p u lm o n a ry
· P n e u m o c ys tis ca rin ii p n e u m o n ia
· P n e u m o n ia , re c u rre n t
· S a lm o n e lla s e p tic e m ia , re c u rre n t
· T o xo p la s m o s is o f b ra in
3 N e o p la s tic d is e a s e
· C e rvic a l c a rc in o m a , in va s ive
· K a p o s i’s sa rc o m a
· L ym p h o m a , B u rk itt’s ( o r e q u iva le n t te rm )
· L ym p h o m a , im m u n o b la s tic ( o r e q u iva le n t te rm )
· L ym p h o m a , p rim a ry in b ra in
4 H IV e n c e p h a lo p a th y (A ID S d e m e n tia c o m p le x )
5 W a stin g s yn d ro m e d u e to H IV
6 P ro g re s s ive m u ltifo c a l le u k o e n c e p h a lo p a th y ( P M L )

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Specimen type. Specimen requirements.
Abscess contents, As much as possible in
aspirated fluid. syringe with Luer tip cap.
Blood. 10 ml SPS (yellow top) blood
collection tube or 10 ml
Isolator tube.
Body fluids (pleural, As much as possible (10-15 ml Disinfect site with alcohol
pericardial, min.) in sterile container or if collecting by needle
peritoneal). syringe with Luer tip cap.
Collect bloody specimens into
SPS blood collection tubes.
Bone. Bone in sterile container
without fixative or preservative.
Bone marrow. As much as possible in SPS
blood collection tube or 1.5 ml tube contents immediately
in pediatric Isolator tube.
Bronchoalveolar
lavage or > 5 ml in sterile container. bronchoscope with tap water.
bronchial washings.
Bronchial brushings. Sterile container or
Middlebrook 7H9 broth,
or Kirchner medium.
CSF > 2 ml in sterile container. Use maximum volume
Gastric lavage fluid. > 5-10 ml in sterile container.
Collect in the morning soon
after the patient awakens
in order to obtain sputum
swallowed during sleep.
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Specimen type. Specimen requirements. Special instructions.
Lymph node. Node or portion on sterile container Collect aseptically, and
without fixative or preservative. avoid indigenous
microbiota. Select caseous
portion if available.
Do not immerse in saline or
other fluid or wrap in gauze.
Skin lesion. Submit biopsy specimen in sterile Swabs in transport
container without fixative or medium (Amies or Stuarts)
preservative. Submit aspirate in are acceptable only if
syringe with Luer tip cap. biopsy sample or aspirate
is not obtainable. For
cutaneous ulcer,collect
biopsy sample from
periphery of lesion, or
aspirate material from
under margin or lesion.
Smear on slides. Smear specimen over 1.5 by Heat fix smears.
1.5 cm area of clear slide. Transport in slide container
taped closed and
labeled BIOHAZARD.
Sputum. 5-10 ml in sterile, wax-free For expectorated sputum,
disposable container. Collect an instruct patient on how to
early morning specimen from deep, produce sputum specimen
Special instructions. productive cough on at least three as distinct from saliva or
consecutive days. Do not pool nasopharyngeal discharge.
Cleanse skin with alcohol specimens. For follow-up of Have patient rinse mouth
before aspirating sample. patients on therapy, collect at with water before collecting
Laboratory may provide weekly intervals beginning three sputum to avoid
7H9 broth / Kirchner medium weeks after initiation of therapy. contaminating specimen
for transport of small with food particles,
volumes of aspirates. mouthwash, or oral drugs,
Disinfect site as for routine which may inhibit the
blood culture. Mix tube growth of mycobacteria.
contents immediately after For induced sputum, use
collection. SPS is preferred sterile hypertonic saline.
anticoagulant. Heparinized Indicate on request if
blood is also acceptable. specimen is induced
sputum.
Stool. >1 g in sterile, wax-free, Collect specimen directly
and syringe. disposable container. into container, or transfer
from bedpan or plastic
wrap stretched over toilet
---- bowl. Wax from container may
produce false positive smear.
Collect aseptically. Mix SPS
following collection.
Avoid contaminating
Saprophytic mycobacteria
may produce false-positive
culture or smear results.
----
attainable.
Collect fasting early morning
specimen on three consecutive
days. Use sterile saline. Adjust
to neutral pH with 100 mg of
sodium carbonate immediately
following collection.
Laboratory should provide
collection tube containing
sodium carbonate.
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TULIP NEWS

Tulip Group has showcased Rapid Immunoconcentration Test for HIV 1 and HIV 2 Antibodies
Indian manufacturing and R&D
capability internationally.
New Generation
Tulip Group has a totall
manufacturing space of Intelligence
approximately 15,000 sq.
meters duly approved by the
DFDA, Goa.

A total number of 75 chemists,

B.Sc.'s, M.Scs, PhD's. Man the
research, quality control,
manufacturing and compliance
to GMP, GLP in force.

Out of the approximate 900

employees in the group,
approximately 700 are
dedicated to the manufacturing
plants.

All Tulip Group companies are

ISO 9001: 2000 accredited.

Tulip Group manufactures over

150 products currently. Rapid Immunochromatographic Test for HIV 1 / 2 Antibodies
Tulip Group markets the
products in India through a
sales team of 200 strong
3rd Generation
professional sales team. Speed and Power
Internationally the Group's
products are exported to over
50 countries globally through
distribution and manufacturing
arrangements.

Groups ever increasing

business presence has already
encompassed
Immunohaematology,
Immunology, Clinical
Biochemistry, Manufactured by
Parasitology,Microbiology,
Haemostasis, Rheumatology
and Virology through rapid
tests in various formats as well QUALPRO DIAGNOSTICS
as quantitative assays. Plot Nos. 88/89, Phase IIC, Verna Industrial Estate, Verna, Goa 403 722, India.

Printed and published by D.G. Tripathi, Edited by Dr. R.J. Sood M.D. (path.) for and on behalf of Tulip Diagnostics Private Ltd, Gitanjali, Tulip Block, Dr. Antonio Do Rego Bagh Alto Santacruz, Bambolim Complex Post Office, Goa - 403202, INDIA. Fax: (0832) 2458544,
E-mail: tulip@sancharnet.in. Website: www.tulipgroup.com

Microxpress Coral Clinical Systems

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