Occult Talaromyces marneffei Infection Unveiled by the Novel Mp1p Antigen Detection Assay.

Talaromyces marneffei causes fatal invasive mycosis in Southeast Asia. Diagnosis by culture has limited sensitivity and can result in treatment delay. We describe the use of a novel Mp1p enzyme immunoassay (EIA) to identify blood culture-negative talaromycosis, subsequently confirmed by bone marrow cultures. This EIA has the potential to speed diagnosis, enabling early therapy initiation.

Randomized controlled study investigating viral suppression and serological response following pre-S1/pre-S2/S vaccine therapy combined with lamivudine treatment in HBeAg-positive patients with chronic hepatitis B.

The aim of the current study was to evaluate viral suppression following combined treatment with an S/pre-S1/pre-S2 vaccine and lamivudine in patients with chronic hepatitis B. We established a randomized, controlled clinical trial to compare the responses of three different treatment groups: those receiving vaccine monotherapy, lamivudine monotherapy, or combination treatment. Viral response was evaluated via hepatitis B virus (HBV) DNA suppression using different levels of classification. Seroconversion was evaluated via HBeAg loss, HBeAg seroconversion, HBsAg loss, and anti-HBs response. We found that the group receiving combination treatment demonstrated a significant increase in viral suppression over that for the lamivudine or vaccine monotherapy group, although the HBeAg seroconversion rate was not different. This enhanced suppression effect in the combination group was reversed after the discontinuation of vaccine treatment, suggesting that booster doses are required for a sustained viral response. Anti-HBs was detected in 55/120 vaccine recipients, but only 3 patients demonstrated HBsAg loss, indicating that the vaccine-induced anti-HBs was unable to completely neutralize HBsAg in the serum. At the study end point, anti-HBs responders showed significantly higher HBeAg seroconversion rates, greater suppression of HBV DNA levels, and a lower median reduction in HBV DNA levels than those of anti-HBs nonresponders. Our results suggest that combined treatment with the vaccine and lamivudine was significantly more effective than lamivudine monotherapy in the short term and was especially successful in producing viral suppression and an enhanced anti-HBs antibody response.

Clinical and virological features of acute HBV-related hepatitis in southern Vietnam.

BACKGROUND: Despite the availability of effective vaccines, hepatitis B virus (HBV) infection is still frequent worldwide, and accounts for significant morbidity and mortality. However, data of acute HBeAg negative hepatitis still remain limited. AIMS AND METHODS: To understand clinical pictures of acute HBV hepatitis and its natural evolution, a prospective study was conducted in adult patients. RESULTS: Ninety patients were enrolled between March 2004 and April 2005 at Hospital for Tropical Diseases in Ho Chi Minh city. The prevalence of HBeAg negative was 53%. No significant difference was found in clinical characteristics and laboratory findings between HBeAg positive and negative patients. HBV-DNA was detected in 75% and 88% HBe negative and positive patients, respectively, where the frequency of ALT below 400 U/L was significantly higher in HBeAg negative cases (p= 0.01). Six month follow-up was available in 47 patients. HBsAg positivity was found in 16% of HBeAg negative subjects but only in 4.5% of HBeAg positive cases. Thirty two patients had neither HBsAg nor anti-HBs. CONCLUSIONS: The clinical laboratory feature and the outcome at 6 months of HBV acute hepatitis in Vietnam is similar in HBeAg positive and negative patients.