HCV RNA in blood donors with isolated reactivities by third-generation RIBA.

BACKGROUND: The objective of this collaborative study was to learn the proportion of HCV RNA-positive samples obtained from a population of donors with isolated anti-HCV reactivities by third-generation RIBA (RIBA-3) (indeterminate results). STUDY DESIGN AND METHODS: During a 2-year period, 11 blood transfusion centers kept all samples with indeterminate RIBA-3 results to test them by PCR, using both local and commercial techniques. RESULTS: Of the 758 RIBA-3 indeterminate samples, 10 (1.3%) were positive for HCV RNA: 3. 3 percent (6/180) and 1.3 percent (4/317) of samples with anti-core or anti-NS3 reactivity, respectively, and none of the 52 and 209 samples with anti-NS4 or anti-NS5 reactivity, respectively. HCV RNA-positive donors with anti-core reactivity were infected with different subtypes (1 with HCV subtype 1b, 1 with 2, 1 with 2a/2c, 2 with 3a, and 1 with 5a), and a follow-up indicated a chronic-carrier state in two of the six donors. Acute hepatitis was diagnosed in three of the four donors with anti-NS3 reactivity alone. Two of these three were IV drug users and were infected with subtype 1a. CONCLUSION: HCV RNA-positive donors with indeterminate results in RIBA-3 are extremely rare, but they do exist. They were observed only when either anti-core or anti-NS3 was present. With such a RIBA-3 profile, PCR testing remains necessary to reveal an eventual acute or chronic HCV infection.

HTLV testing in blood transfusion.

To improve the safety of the blood supply, HTLV screening of blood donations became mandatory in different countries. In Japan and in Europe, the majority of HTLV-infected donors are HTLV-1 whereas in the USA more than half of them are HTLV-II-positive. The prevalence of HTLV-infected donors is low in European Countries as is the rate of seroconversion. Consequently, to test donors only once would have a high efficiency. This procedure is already in use in certain countries. Furthermore, if the use of leucodepleted cell concentrates is generalized, the policies of HTLV screening will still be further modified.

Contribution of polymerase chain reaction and radioimmunoprecipitation assay in the confirmation of human T-lymphotropic virus infection in French blood donors. Retrovirus Study Group of the French Society of Blood Transfusion.

BACKGROUND: To verify the criteria for human T-lymphotropic virus (HTLV) seropositivity in Western blot (WB) proposed by the Retrovirus Study Group of the French Society of Blood Transfusion, 186 blood donations that were repeatedly reactive in HTLV enzyme-linked immunosorbent assay, selected according to their WB pattern, were tested by polymerase chain reaction (PCR) and radioimmunoprecipitation assay (RIPA). STUDY DESIGN AND METHODS: In two commercially available WBs, 12 samples were confirmed as positive (rgp21+p19+p24) and 174 were interpreted as indeterminate (one or two reactivities to these proteins). The primer pairs used for the PCR allowed the amplification of type I (HTLV-I) or type II (HTLV-II) (or both) sequences. The RIPA was performed with two 35S-labeled cell lines: HTLV-I infected HUT 102/B2 and HTLV-II-infected MoT. RESULTS: Of the 12 positive samples, 11 were classified as HTLV-I-positive and one as HTLV-II-positive. Among the 174 indeterminate samples, three (WB pattern: rgp21+, p19+, p24-) were HTLV-I positive in PCR (one of them was positive in RIPA also); the other 171 were HTLV negative. CONCLUSION: In the study of a population in which 97 percent of HTLV infections are due to HTLV-I, these data support the three-protein criteria (rgp21, p19, and p24) for a positive blot reading. No HTLV infection was observed when rgp21 did not react. Consequently, p19 and/or p24 band patterns represent false reactivity and do not require PCR or RIPA confirmation. To discriminate between false- and true-positive results in the absence of MTA-1 or K55 reactivity, PCR and/or RIPA is required only when rgp21 reactivity is associated with one gag band (p19 or p24).

[Familial transmission of hepatitis C virus]. / Transmission familiale du virus de l'hépatite C.

OBJECTIVES: The intrafamilial transmission of hepatitis C virus infection was assessed in the family members of patients with chronic hepatitis C. METHODS: The presence of serum anti-hepatitis C virus (HCV) antibodies and epidemiological features were studied in 193 relatives (104 heterosexual partners, 89 children) of 113 patients with chronic hepatitis C. The presence of serum anti-HCV antibodies was detected by an ELISA 2 test and confirmed by a RIBA 2 test. In all patients, liver injury was ascertained by biopsy (31 cirrhosis, 82 chronic active hepatitis). RESULTS: Eleven of 104 (10.6%) regular heterosexual partners were positive for anti-HCV antibodies. In 8 of these, risk factors were detected (drug addiction: n = 6, blood transfusion: n = 1, occupational exposure: n = 1). Only 3 of 96 (3.2%) regular heterosexual partners without percutaneous risk factors were positive for HCV. Among couples with heterosexual partners negative for anti-HCV antibodies, the mean duration of the sexual relationship was 12 years. Serum anti-HCV antibodies were present in 1 of 89 (1.1%) children without history of blood transfusion or drug addiction. None of the 35 children born after supposed maternal contamination were positive for serum anti-HCV antibodies. CONCLUSIONS: We conclude that the prevalence of serum anti-HCV antibodies, assessed with second generation tests, in sexual partners of patients with chronic hepatitis C, is lower than previously reported with first generation anti-HCV tests but higher than in the general population (3.2% vs approximately equal to 1%). Serum anti-HCV antibodies were very rarely detected in children from patients with chronic hepatitis C.

Percutaneous coil embolization of iatrogenic femoral arteriovenous fistula or pseudo-aneurysm.

Five male patients aged 43-67 years (mean, 60) with four iatrogenic femoral arteriovenous fistula and two pseudo-aneurysms (1 and 4 cm in diameter) were treated by percutaneous embolization, with coils. One coil migrated during placement to the pulmonary artery without clinical symptoms. All lesions remained obliterated after a mean follow-up of 10 months on Duplex-Doppler control. External manual compression under color-coded-Doppler was tried in three patients and failed.

Serological diagnosis of HTLV-I/II infections in France.

During the last years, important improvements have been made in the field of HTLV-I/II serodiagnosis. The screening tests, which combine higher performances of the sensitivity towards HTLV-I and HTLV-II samples, and better specificity, are manifold. The criteria of positivity by western-blots have been reinforced. As for HIV, some western-blot profiles with no evolution on two successive samples, correspond to non specific HTLV reactions. HTLV-I/II serotyping is easier than before. More effective tools will certainly be available in the coming years for the Blood Transfusion Services and the physicians.

Families and epileptic fits--fit for a family.

The author gives a clinical description of an epileptic young girl who consults a psychiatrist in order to assess her troubles of social and school adaptation. Meeting the family makes it possible to single out several critical phenomena. These crises overlap, confusing the questions and the answers medical and psychological competence can suggest. Intergrating the family's resources, the neurologist's skills and the family psychotherapist's proficiency will supply adequate answers as soon as the questions are organized into a coherent system, in which the unknown will nevertheless have its place.

Pyogenic liver abscess. Diagnostic and therapeutic approach: a case report.

We report a case of liver abscess secondary to an asymptomatic, subacute appendicitis in a 51-year-old man. The general condition of the patient was altered but there were no gastrointestinal signs. Treatment consisted in broad-spectrum antibiotics, followed by surgical drainage of the abscess and appendicectomy.

Seroepidemiology of HTLV-I/II in universal screening of blood donations in France.

OBJECTIVE: To evaluate the serological and epidemiological characteristics of HTLV-I/II-positive blood donors in continental France during the first 6 months of universal screening of blood donations (n = 1,816,927). METHOD: A collaborative investigation of all confirmed anti-HTLV-I/II-positive samples reported by blood transfusion centres was performed. Seventy-three out of 77 reported samples were retested at two reference laboratories. Epidemiological data on risk factors were compiled. RESULTS: Of the 73 retested samples, 66 were confirmed to be HTLV-I-positive and one to be HTLV-II-positive; six samples were designated false-positive, mainly because of non-specific reactivity to recombinant gp21 in Western blot. The overall prevalence of HTLV-I/II in continental France is 0.039 per thousand. The main risk factor identified for HTLV-I infection was directly (origin) or indirectly (heterosexual contact) linked to endemicity in the Caribbean. The cost per case of avoided contamination in the 6-month period of this study was 1.36 million French francs. CONCLUSIONS: Sixty-two per cent of HTLV-I/II-infected blood donations would not have been discarded through the previous targeted HTLV screening or through other mandatory tests, including anti-hepatitis B core. To avoid false-positive results, we propose a new algorithm of diagnosis.

[Hepatitis C virus and transfusion: policy regarding the donation and the donor. Groupe "Hépatites Virales" de la Société Nationale de Transfusion Sanguine]. / Virus de l'hépatite C et transfusion: attitude vis-à-vis du don et du donneur. Groupe "Hépatites Virales" de la Société Nationale de Transfusion Sanguine.

Hepatitis C virus (HCV) discovery and introduction of anti-HCV antibodies screening in blood transfusion imply the necessity of a good blood donations and blood donors policy. Detection of a seropositivity during the screening must be completed with a confirmatory test. The results are directly used to inform donors and define the blood products policy. Donors with positive results on confirmatory test are discarded and have physical and biological examinations in hepatology. Individuals with indeterminate or negative results must be retested for the HCV serology. Furthermore, because of a rapid improvement in the fields of technology, diagnosis and therapy of HCV, an adaptation of the policy is necessary.

[Analytical study of the Abbott and Ortho tests for screening and confirmation of anti-HCV antibodies. Le groupe de Travail "Hépatites virales" de la Société Française de Transfusion Sanguine]. / Etude analytique des trousses de dépistage et de confirmation des anticorps anti-VHC Abbott et Ortho.Le groupe de Travail "Hépatites Virales" de la Société Française de Transfusion Sanguine.

Anti-HCV systematic screening on blood donation was mandatory in France since first of March 1991. Two laboratories (Ortho-Chiron and Abbott) have introduced in Europe successively two kinds of hepatitis C positive diagnosis with 1st and 2nd generation ELISA screening and confirmatory assays. The aim of this multicentric study was to evaluated the sensibility and specificity of these tests. For that, they used 10,090 blood sera. As a result we have seen that the new "second generation" screening assays have a higher sensitivity without less of specificity for the confirmatory tests.

[IgG autoantibodies against cellular p72 antigen crossing with (MLV) p15-gag antigen: presence in early HIV 1 infection, in HBV infection and in primary Gougerot-Sjögren]. / Autoanticorps IgG contre un antigène cellulaire p72 croisant avec l'antigène (MLV) p15-gag: présence dans l'infection HIV 1 précoce, dans l'infection HBV et le Gougerot-Sjögren primitif.

IgG antibodies of autoimmune SLE (Systemic Lupus Erythematosus) serum S detected a HeLa hnRNP 72 kDa protein, cross-reacting with the retroviral (MLV) p15-gag polypeptide. Since serum S disclosed a ubiquitous 72 kDa antigen in HeLa cell fractions, was prepared the so-called cytoplasmic "X fraction", enriched for the 72 kDa protein, defined here as p72. This autoantigen was detected by antibodies of HIV 1+ patients, recently of seroconverted (RSC) asymptomatic subjects, of HBV+ sera, and of primary Gougerot-Sjögren (prGS) sera. The presence of these autoantibodies in different autoimmune and infectious pathologies raises the question of the involvement of p72 in the immune processes and in the early HIV1 infection.

[Serum antibodies to hepatitis C virus: analysis of risk factors of seropositivity in a population of blood donors in metropolitan France]. / Anticorps sériques contre le virus de l'hépatite C: analyse des facteurs de risque de séropositivité dans une population de donneurs de sang de France métropolitaine. Le Groupe "Hepatites Virales" de la Société Nationale de Transfusion Sanguine.

Risk factors were analyzed in a group of 117 blood donors seropositive for hepatitis C virus antibody. One risk factor, at least, was found in 63 (53.8%) subjects. Frequently encountered risk factors were 1) travels in developing countries (31/117); 2) blood transfusions (20/117); 3) health care works (10/117); 4) intravenous drug addiction (8/117); 5) homosexual or multiple heterosexual contacts (3/67). Our study emphasizes the high percutaneous transmission of hepatitis C in contrast with the low sexual transmission. No risk factor could be found in 54 (46.2%) of the 117 seropositive subjects: the route of transmission in these cases is an intriguing issue which certainly deserves further epidemiological investigations.