Progression from acute to chronic hepatitis B is more common in older adults.

PURPOSE: The rate of progression of acute Hepatitis B (HBV) to chronic disease is quoted as <10%. The purpose of this study was to determine the rate of progression from acute to chronic HBV in Northern Ireland (NI), assessing the influence of age, gender and biochemical parameters. METHODS: All "acute" HBV cases diagnosed in NI between 2011 and 2015 were reviewed. Inclusion criteria: 1). positive HBsAg and positive HBV core IgM; 2). in the absence of positive HBV core IgM, positive HBsAg with a recent negative HBsAg. Patient age, HBsAg, HBV core IgM, peak bilirubin and peak ALT were recorded, along with date and result of repeat HbsAg testing. Mann-Whitney U test was used to compare mean age, peak ALT and bilirubin between clearing and non-clearing groups. Fisher's exact test was used to compare progression to chronicity according to gender and age less than or greater than 50yrs. RESULTS: Of 80 identified cases, 4 incorrectly categorised cases were excluded. Of the remaining 76, (15 female (mean age 37.27yr), 61 male (mean age 47.39yr)) follow-up data was available for 71 patients (15 female (mean age 37.27yr), 56 male (48.59yr)). All female patients cleared HBV. 42 of 61 males cleared HBV (p=0.0313).Overall the chronicity rate was 18.42% The mean age of those clearing the virus was 43.88 years, versus 55.64 years for those going on to develop chronic HBV (Mann-Whitney U test, z= -2.68, p=0.0037). Clearance rate was 83.72% in patients aged <50yrs and 63.64% in patients 50yrs (p=0.0068).Mean peak ALT (U/L) and peak bilirubin (µmol/L) for the clearing group were 2130 and 174 respectively compared to 656 and 100 for the non-clearing group (z= -3.51, p=0.0002, z= -2.35, p=0.009). CONCLUSION: Our results suggest a higher than expected rate of progression from acute to chronic HBV with a significantly higher risk for those over 50yrs. This suggests a need to revise information provided to older patients with acute HBV regarding the likelihood of progression.

Diagnostic accuracy of fungal PCR and ß-d-glucan for detection of candidaemia: a preliminary evaluation.

AIMS: Although treatment for candidaemia is time critical, culture-based tests prolong turnaround times and may promote underdiagnosis. Non-culture-based tests have the potential to overcome these difficulties but are in limited clinical use. The aim of this work was to undertake an initial evaluation of two non-culture-based tests for diagnosis of candidaemia. METHODS: Patients with candidaemia were identified prospectively over a 4-month period. Sera drawn from case (candidaemic) and control (non-candidaemic) patients on the same day as the positive blood culture were tested with both the Renishaw RenDx Fungiplex test and a commercial ß-d-glucan (BDG) assay (Fungitell, Associates of Cape Cod). Sensitivity and specificity were calculated independently and in combination, using paired blood culture as the reference standard. RESULTS: There were 10 eligible case patients and 39 negative controls. PCR sensitivity and specificity were found to be 44.4% (95% CI 18.9% to 73.3%) and 87.2% (72.8% to 94.8%), respectively. BDG sensitivity and specificity were 80% (47.9% to 95.4%) and 89.7% (75.9% to 96.5%), respectively. When combining PCR and BDG, sensitivity was 90% (95% CI 57.4% to 100%) and specificity was 79.5% (64.2% to 89.5%). When two sequential specimens were tested, PCR sensitivity increased to 60% (95% CI 31.2% to 83.3%) and BDG sensitivity to 90% (54.7% to 100%). CONCLUSION: A combination of tests, or a single test at multiple time points, may be preferable to relying on one test at a single time point. This should be accounted for in design of future diagnostic accuracy studies of tests for invasive candidosis.