[Disorders of gut microflora in the pathogenesis of liver cirrhosis and complications of portal hypertension].

A total of 85 patients with alcoholic and viral cirrhosis were included in study to assess the prevalence of dysbiosis and its relationship with the severity of disease, and with development of dyspeptic disorders. Intestinal bacterial over-growth was measured by means of a lactulose breath test, fecal flora was cultured under aerobic and anaerobic conditions. Intestinal bacterial overgrowth and colon dysbiosis were determined in 82.4% of patients with equal prevalence in alcoholic and viral cirrhosis. Intestinal dysbiosis was found to be risk factor of increasing cirrhosis severity and liver dysfunction, as well as development of complications of portal hypertension. It was documented, that intestinal dyspepsia syndrome in cirrhotic patients is strongly associated with the presence of gut microflora disorders.

Bacteriological quality of water and water borne diseases in Bangalore: a longitudinal study.

In developing countries diarrhea diseases take a big toll which can be prevented by adequate supply of safe drinking water. Thus a longitudinal study was taken up to determine the morbidity due to water borne diseases and bacteriological quality of water. 150 houses in two different areas, one supplied by bore well and other by tap water was selected by modified cluster sampling. Weekly morbidity details collected. Monthly water samples were assessed for bacteriological quality from main supply, household storage and morbidity reported houses. The difference in proportion of potable and non potable water at storage points was statistically significant. The overall incidence rate of target diseases was 3.58%,majority were diaarrhoel diseases with increased incidence in children less than five years.

Syphilis-related hepatitis in a liver transplant patient.

We herein describe a case of secondary syphilis hepatitis in a liver transplant patient. This homosexual man presented 15 years after an orthotopic liver transplant with nonsquamous papillomacular rash, mild cytolysis, and anicteric cholestasis. Laboratory tests showed syphilis seroconversionwith a VDRL test titer of 1/256, a Treponema pallidum hemagglutination assay of 1/5120, and a positive immunoglobulin M fluorescent Treponemal antibody absorbance. A liver biopsy performed 13 months after the diagnosis showed low-grade hepatitis with a METAVIR score of A1F1; it also showed moderate, nonspecific portal inflammation consisting primarily of neutrophils, with no evidence of cholestasis. The patient was given benzathine-penicillin (2400000 IU) with a transient increase in prednisolone dosages. Cytolysis rapidly, and cholestasis progressively, disappeared. Results of an immunoglobulin M fluorescent Treponemal antibody absorbance test became negative, whereas the VDRL test and the Treponema pallidum hemagglutination assay titers decreased slightly over time.

[Microbiological diagnosis of viral hepatitis]. / Diagnóstico microbiológico de las hepatitis víricas.

Hepatitis of viral aetiology caused by hepatotropic virus (A, E, B, D and C) represents an important work load for the clinical virology laboratory. Most of the diagnostic is based upon detection in serum and plasma samples of different serological and virological markers, which correlates with different infection stages. In chronic infection by HBV and HCV is necessary to perform diagnostic by molecular methods as well as antigen detection in sequential samples along the course of the disease taking into account that a reliable storage must be provided for stability of structural components of the virus. Recent knowledge about mutations variants in some of the virus may alter the validity of particular markers.

[Necrotizing fasciitis in a patient during interferon-alpha treatment for hepatitis C virus infection: case report]. / Martwicze zapalenie powiezi u chorego z zakazeniem wirusowym watroby typu C leczonego interferonem alfa. 0pis przypadku.

Necrotizing fascitis (NF) is a rare disease with a mortality rate ranging from 24 to 60 percent. The infection may be mono- or polymicrobial and is characterized by extensive necrosis of the skin and muscle, as well as fascia and subcutaneous tissue. NF may develop at the site of injury, e.g. trauma, needle puncture, or surgical incision. The lower extremities, perineum, and abdominal wall are common sites of NF. The remaining 10 percent of cases occur in the upper extremities or neck, usually in patients with vascular disease or diabetes mellitus. The course is rapidly progressive and may be life-threatening if the diagnosis is not made promptly and appropriate surgical debridement is not carried out. We report on a 44-year-old man with necrotizing fascitis during interferon-alpha treatment for hepatitis C virus infection.

[The influence of hepatitis G virus infection on the course of chronic virus hepatitis B or C in children]. / Wplyw zakazenia wirusem zapalenia watroby typu G na przebieg przewleklego wirusowego zapalenia watroby typu B lub C u dzieci.

Hepatitis G virus (HGV) infection is often observed in patients with hepatitis B or C virus (HBV or HCV) infections. The aim of this study was an evaluation of the influence of HGV infection on the course of virus hepatitis B and C in children. 113 children aged 2-15 years old, with hepatitis B or C were enrolled to the study. In the study group children were examined for the presence of virus genetic material, e.g. HGV-RNA. The analysis of children records with respect to results of physical examination and additional tests (laboratory tests, abdomen ultrasonography) was carried out. On the basis of the analysis it was showed that HGV infection did not significantly change the course of basic liver disease.

Successful allogeneic bone marrow transplantation in a 2.5-year-old boy with ongoing cytomegalovirus viremia and severe aplastic anemia after orthotopic liver transplantation for non-A, non-B, non-C hepatitis.

BACKGROUND: A 2.5-year-old boy received a cadaveric orthotopic liver transplant for acute liver failure due to non-A, non-B, non-C hepatitis. After transplantation, he developed thrombocytopenia and neutropenia and subsequently severe aplastic anemia. The patient also suffered from recurrent cytomegalovirus (CMV) viremia, treated with foscarnet and ganciclovir. METHODS: For treatment of his aplastic anemia, the patient underwent an allogeneic bone marrow transplantation from his HLA-identical sister after conditioning with cyclophosphamide at 200 mg/kg and antithymocyte globulin at 3 mg/kg for 5 days. Prophylactic acyclovir was given because of ongoing CMV viremia at the time of bone marrow transplantation. RESULTS: The transplant course was uneventful, with rapid engraftment. There were no signs of liver dysfunction, graft-versus-host disease, or reactivation of CMV. The patient is in excellent health, with normal liver and bone marrow function 3 years after bone marrow transplantation. CONCLUSION: This case report shows that allogeneic bone marrow transplantation is feasible and well tolerated in a patient with severe aplastic anemia after liver transplantation for acute fulminant viral hepatitis.

Sequence characterization of the 5' noncoding region of GB virus C/hepatitis G virus.

The nucleotide sequences of the 5' noncoding region of the GB virus C/hepatitis G virus (GBV-C/HGV) were determined in 18 isolates from the United States. Two genotypes have been classified based on the sequence heterogeneity within the 5' noncoding region of GBV-C/HGV. The most distantly related isolates between the two genotypes were 84.6% identical. Sequence identity of the isolates within a genotype was 95-99%. The 5' noncoding region of this virus contains four highly conserved domains. These conserved elements would facilitate the selection of optimal primers for the sensitive detection of GBV-C/HGV RNA by PCR. In addition, they suggest a crucial role for this region in viral replication and/or gene expression. Detection of genotypic variation among GBV-C/HGV infected individuals may provide further insight into the possible pathogenicity and into the transmission of the virus.

[Interferon therapy in chronic active viral hepatitis]. / Interferon kezelés vírus okozta krónikus aktív hepatitisben.

The authors give a short review of the recent data about the types of interferons and their biological activity. The role of interferons in the therapy of B, C and D chronic viral hepatitis is discussed. Interferon treatment means a substantial progress in the therapy of chronic viral hepatitis, however it represents a final recovery from chronic B or C hepatitis only in 25-40 percent or 40-45 percent of the cases, respectively. The authors refer to the combination therapy which seems to be promising in the future.

Variants of hepatitis B, C and D viruses: molecular biology and clinical significance.

Variants of hepatitis B virus (HBV), hepatitis C virus (HCV) and of the hepatitis Delta virus (HDV) have been identified in patients both with acute and chronic infections. In the HBV DNA genome, naturally occurring mutations have been found in all viral genes, most notably in the genes coding for the structural envelope and nucleocapsid proteins. In the HCV RNA genome, the regions coding for the structural envelope proteins 1 and 2 as well as the 3'-contiguous nonstructural region 1 were found to be hypervariable. Viral variants may be associated with a specific clinical course of the infection, e.g. acute-fulminant or chronic hepatitis. Specific mutations may reduce viral clearance by immune mechanisms ('immune escape') or response to antiviral therapy ('therapy escape'). Furthermore, mutations of envelope epitopes can lead to viral variants which are not recognized or neutralized by antibodies to wild-type virus, resulting in 'diagnosis escape' or 'vaccine escape'. The exact contribution, however, of specific mutations to the pathogenesis and natural course of HBV, HCV or HDV infection, including the development of hepatocellular carcinoma, remains to be established.

Viral hepatitis: a 1994 interim report.

A variety of viruses cause many of the disorders that are recognized as acute and chronic liver diseases. Remarkable scientific advances achieved during the past two decades have lead to readily available accurate diagnostic tests for hepatitis viruses designated A through E. Effective vaccines have been developed to prevent hepatitis B and, more recently, hepatitis A. Heightened understanding of the pathogenesis of chronic hepatitis caused by hepatitis B and C suggests several promising therapeutic approaches. Interferon is the sole drug yet proven to be effective in the treatment of some patients with chronic hepatitis B and C. Newer antiviral agents that will be used alone or in combination are under development.

Envelope and precore/core variants of hepatitis B virus.

The appearance of replication-competent variants of HBV with mutations in the envelope and precore/core and X proteins emphasizes that these proteins are the focus of immune selection pressures in the human host. The presence of an antibody response in the absence of a CTL response may create the ideal selection environment. This occurs in the early phase of passive/active immunization against HBV envelope proteins in neonates born to HBV-infected mothers and also during the emergence of HBeAg-negative variants during and after HBe antigen/antibody seroconversion in chronic HBV carriers with defective CTL responses. The sequence and speed of application of the multiple selection pressures (humoral and possibly cellular) determine the virologic and clinical outcome. When these variant viruses are passed to a new host, in the absence of the immune selection pressures or modified immune pressures that resulted in their selection, a picture clinically different from that seen in the original host may emerge.