Autoimmune reactions in HBV and HCV.

BACKGROUND: Hepatotropic viruses HBV and HCV are capable of triggering autoimmune reactions (AIH). The aim of the study was the assessment of clinical course of AIH in patients with HBV and HCV, and the revision of treatment methods employed in these cases. MATERIAL AND METHODS: Among 120 patients with AIH and those qualified for antiviral therapy, 21 (17.5%) subjects were selected, including 16 with HCV (7 men and 9 women) and 5 with HBV (including 2 men and 3 women). AIH diagnosis was based on international criteria taking into account biochemical tests, autoantibodies and morphological picture of the liver. HBV infection was confirmed with the determination of HBV markers and HCV--with the presence of antiHCV and HCV RNA. RESULTS: The duration of infection at AIH diagnosis was difficult to assess in patients with HCV. AIH was diagnosed when patients were qualified for antiviral treatment. Three patients displayed high anti-LKM1, 8--ANA and SMA, two pts--ANA, two pts--SMA, one pt--ANA + pANCA and one--SMA + pANCA. Nine patients did not show hyperproteinaemia, and hypergammaglobulinaemia was not observed in 2 patients. Six patients suffered from other immunity disorders--thrombocytopenia, vasculitis, arthritis, visceral lupus erythematosus. The diagnosis of chronic hepatitis was confirmed by morphological examinations in 15 patients. Ten subjects received adrenocortical hormones, 3 patients were treated with adrenocortical hormones and azathioprine, 4 received interferon and 3 received no treatment. All patients with HBV proved HBeAg(-). In these patients, AIH symptoms developed 5-18 years after the diagnosis of HBV infection. Liver biopsy confirmed the diagnosis in 4 patients. SMA was observed in 2 subjects, ANA and SMA--in the remaining patients. All the subjects manifested typical biochemical changes as well as high IgG values. Extrahepatic exponents of immune process were observed in 3 patients. Three subjects were treated with Encorton (Prednisone), while 2 patients received Encorton and Azathioprine. CONCLUSIONS: Patients with HBV and HCV infections may manifest the features of AIH in the course of the disease, which requires careful attention while selecting treatment.

A pharmacokinetic study of amphotericin B lipid complex injection (Abelcet) in patients with definite or probable systemic fungal infections.

This study describes a pharmacokinetic evaluation of amphotericin B (AMB) lipid complex injection (ABLC or Abelcet) in 17 patients with systemic fungal infection administered 5 mg/kg of body weight/day by infusion for 10 to 17 days. The results showed that AMB exhibited multiexponential disposition with high clearance, large volume of distribution at steady state, and long apparent elimination half-life but no evidence of accumulation in the blood after multiple daily doses. The results confirm previous observations and further reinforce the suggestion that ABLC may exist as a depot in the tissues from which free AMB is slowly released to limit exposure.

[Wegener's granulomatosis]. / Ziarniak Wegenera.

The authors present a case of Wegener's granulomatosis in a 22 year-old female patient. They observed multi-organic changes concerning upper and lower respiratory tracts, skin, oral cavity, joints, kidneys. The diagnosis was confirmed in the Department for Infectious Diseases after two years of the beginning of the disease. The diagnosis was based on a course of the disease, histopathological changes of the skin, an increase of cANCA levels. CTX, prednisolon, cyclosporin and immunoglobulins i.v. for 5 days were used in the therapy. Apart from this symptomatic treatment was also introduced. The 14-month remission of the disease was obtained.

[Borreliosis--Lyme disease--a growing clinical problem]. / Borelioza--choroba z Lyme--narastajacy problem kliniczny.

Clinical and epidemiological analysis of Lyme disease cases treated at the Infectious Diseases Clinic of the Medical University of Gdansk and the District Hospital of Infectious Diseases in the years 1993-1995 was done. The results were compared to data presented in the literature. The material consisted of 184 patients, 169 in I stage of the disease and 15 in the II stage. Out of 15 in the II stage, 2 patients presented with lymphocytoma benigna cutis, 7 with arthritis and 6 with neuroboreliosis. The Lyme disease diagnosis was confirmed with positive serological tests in 45% of patients in the I stage and in 100% of patients in the II stage. Over the analysed time interval, 1993-1995, the incidence of Lyme disease has increased markedly; 1993-38 cases, 1994-50 cases and 96 cases in 1995.

[Case of Wegener granuloma]. / Przypadek ziarniniaka Wegenera.

A case is presented of Wegener granuloma with lesion in the maxillary sinus, orbit, eye, lungs, kidneys and on the skin, observed in the Department of Infectious Diseases. The diagnosis was made after seven months of the disease, on the basis of clinical picture and histological examination. The applied treatment with cyclophosphamide and steroids led to regression of most symptoms. The permanent consequence was left eye amblyopia of significant degree. During 3.5 years of follow-up three recurrencies of the disease were observed which were associated with attempts at dose reduction of the drugs used. Presently, the patient is in a remission lasting 22 months. Five months passed as yet from the completion of the treatment. In view of the possibility of disease recurrence, the patient remains in further follow-up of the department.

[Detection of asymptomatic HBV infection among pregnant women based on personal studies]. / Bezobjawowe zakazenie HBV w populacji kobiet ciezarnych na podstawie wlasnych badan.

The total seroprevalence of HBsAg among pregnant women in Gdansk region is 1.3%. Our examination was based on observation of 226 HBsAg chronic carrier pregnant women. The risk of infection on the way of inoculation in childhood took place in 68%, in 10.8% it was connected with occupation. The presence of HBsAg and HBeAg was revealed in 8.8%. During period of observation none of the women eliminated HBsAg. The clinical course of infection in our group was stable. Liver biopsy was performed in 47 cases. Hepatitis minimalis was found in 35 cases, fibrosis portalis in 2, hepatitis chronica persistens in 5 and normal histological liver structure in 2 cases. Asymptomatic carrier state didn't influence on the course of pregnancy and delivery.