viduals. By the serologic assays used by Visser et al.,I it is hard to distinguish primary CMV infection from a reactivated one. Latent C M V infections may be reactivated with the association of original infection or GBS.Although most CMV infections are subclinical, the infection is occasionally characterized by a mononucleosis-like syndrome in normal immunocompetent individuals. Visser et al. * reported the possibility of a strong relation between CMV infection and development of severe sensory loss in GBS patients. The etiologic role of CMV in more severe demyelination associated with GBS is unknown.Polymerase chain reaction and other molecular biological assays for CMV provided a rapid, sensitive, and specific method to diagnose active CMV infection as viral DNA is present in the clinical specimens such as serum or CSF of patients infected with CMV. The diagnosis of active CMV infection can also be established by isolating the virus from clinical specimens. Although the presence of serum anti-CMV IgM antibodies in patients is diagnostic evidence of acute CMV infection, the methods often used to detect CMV IgM antibodies are variable in their sensitivity (30-89%) when compared with isolation of the virus.3 The lack of sensitivity of the enzyme immunoassay for detection of serum IgM antibodies against CMV was also reported. The role of commercially available CMV IgM assays in the diagnosis of acute infection with CMV needed further study using larger populations of affected patients. More sensitive and specific methods of diagnosis for active CMV infection, particularly of isolation of the virus, have allowed prospective longitudinal study. ' We studied the relationship between primary CMV infection and serum levels of cytokine~.~.~ Also likely is that specific cellular interactions as well as production of several cytokines are necessary for the primary or reactivated CMV infection. General immunologic evaluation of the patients with GBS was also necessary to analyze CMV infection. Reply from the Authors:Our primary aim of the study was not to confirm the association of a recent cytomegalovirus (CMV) infection with the Guillain-Barre syndrome (GBS), which has already been established? ' I and confirmed by us using age, sex, and seasonal matched neurologic controls. Virus-specific antibodies against CMV were found in 20 (154) of 134 GBS patients and in only three (<1%) of the 154 controls. Does this presence of elevated IgM antibodies against CMV indicate a primary infection or a reactivation? As this depends on the IgG titers, we reanalyzed the (available) sera. In six patients, IgG antibodies against CMV were low, indicating a primary infection; in eight, it was high, which could indicate a possible reactivation. In one patient, reactivation was proven, since serum samples before onset of GBS were available.The diagnosis of active CMV infection can be confirmed by detection of the Pp65 antigen.'" At the time of our study, this test was not available. Polymerase chain reaction assay is not yet well standardi...

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A case of child abuse occurring in a family in which the mother had Huntington's disease is presented. Families affected by Huntington's disease are at high risk in this regard. The literature and family dynamics are reviewed.

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