Hepatitis B virus infection in Aseer Region, south-western Saudi Arabia: a call for an immediate action against a preventable disease.

OBJECTIVES: The present study was designed as a large-scale cross-sectional study to cast some light on the magnitude of hepatitis B virus (HBV) infection in Aseer Region, south-western Saudi Arabia, a region reported to be of the highest endemicity. METHODS: During the WHO hepatitis day of 2013, an aggressive health education campaign was launched in all the hospitals and primary health care centres in Aseer Region. Posters were distributed to encourage the local population to visit the health facilities to be tested for HBV. They were interviewed using a structured questionnaire. Detection of hepatitis B surface antigen (HBsAg) was done using a fourth-generation ELISA kits. RESULTS: The present study included 10,234 persons. The study revealed an overall seroprevalence of 5.9% (95% confidence interval [CI] = 5.5-6.4%). A seroprevalence of 0.8% (95% CI = 0.2-2.1%) was found among persons aged less than 15 years, and a seroprevalence of 1.3% (95% CI = 0.4-2.9%) was found among persons aged 15-24 years. On the other hand, among persons aged 25 years and over (who were born before the expanded programme on immunization [EPI]), a seroprevalence of 6.3% (95% CI = 5.8-6.8%) was found. Pockets of unvaccinated individuals were identified. CONCLUSION: The present study has documented the efficacy of vaccination in protecting against HBV infection. It also identified the presence of pockets of unvaccinated persons requiring further investigations. Aggressive health education programmes and 'catch-up' mass vaccination of those aged over 25 years is mandatory.

The role of hepatitis E virus infection among patients with acute viral hepatitis in southern Saudi Arabia.

We investigated the etiology of acute sporadic viral hepatitis in southern Saudi Arabia in a series of 132 patients admitted with acute viral hepatitis. Of these cases, 108 (81.8%) were due to acute hepatitis A virus infection, of which 11 (8.3%) patients had been previously exposed to hepatitis E virus, and another 10 (7.6%) were chronic carriers of hepatitis B virus. Three cases (2.3%) were acute hepatitis B virus infection. The overall prevalence of hepatitis E IgG antibodies was found to be 9.1%. The remaining 21 (15.9%) patients were tested for hepatitis E IgM, EBV-VCA IgM and hepatitis C IgG antibodies by sensitive enzyme immunoassays. In none of them could hepatitis E IgM, EBV-VCA IgM or hepatitis C IgG antibodies be demonstrated, and these patients were thus considered as acute non-A, non-B hepatitis. Acute hepatitis C virus infection, however, could not be ruled out from this group. We therefore concluded that the majority of clinically apparent viral hepatitis cases were due to HAV, while HBV accounted for a small proportion of the cases. Clinically apparent HEV infection does not appear to be common in the population studied, since even those with serologic evidence of previous exposure to HEV did not recall a history suggestive of acute viral hepatitis.

Etiology and clinical features of acute epididymo-orchitis.

Seventy-nine patients presenting with acute epididymo-orchitis (AEO) were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, serological, biochemical, imaging, and endoscopic studies were undertaken to look for urinary tract infection (UTI), brucellosis, gonorrhea, diabetes mellitus (DM), bladder outflow obstruction (BOO), and other urinary tract pathology (UP). Thirty-nine patients also underwent, on their urethral scrapings, the direct immunofluorescence test with monoclonal antibodies (DIF) for Chlamydia trachomatis. The mean age was 44 +/- 20.4 years (median = 40 years) and 43% of the patients were married. Only one patient had urethritis, which nongonococcal. Thirty-five percent presented with pyrexia and only one had brucellosis. Fifty-three percent had significant pyuria but only 22 patients (285) had bacteriuria and E. coli was the etiological agent in 19/22 patients (86%). Eleven out of 39 patients (28%) were positive for Chlamydia trachomatis. BOO, UP, and DM were encountered in 25%, 12.5% and 10%, respectively, but no obvious cause was detected in 26 (33%) patients. Recurrent AEO, abscess formation and bacteremia occurred in 21.5%, 4%, and 1%, respectively. Recurrent AEO was significantly more common in married patients than in single patients (P<0.05) and BOO was significantly more common in patients above the age of 50 years. It is concluded that an underlying cause of AEO could be identified in only two-thirds of the patients. In the remaining one-third, the etiology continues to be obscure and investigations for viral and fastidious infections may be of help in future studies. Endoscopy and urodynamic studies for BOO can be restricted to the elderly patients to cut down the cost of management of this fairly common emergency.

Characterization of a synthetic peptide mimicking trypsin-cleavage site of rotavirus VP4.

A synthetic peptide corresponding to the trypsin cleavage site on the 84 k protein of bovine rotavirus was synthesized (VP4-peptide). This synthetic peptide could be cleaved by trypsin and therefore possessed the enzyme binding site present on the authentic protein. Further proof that this peptide mimicks the authentic trypsin cleavage site was the specific reaction of anti-peptide serum with the 84 k protein. The reaction of anti-peptide serum with infectious virus neutralized infectivity thereby supporting the biological importance of this site. Another interesting characteristic of this peptide was its ability to bind to the nucleocapsid protein resulting in a laddering effect on the nucleocapsid monomer (45 k), dimer (90 k) and trimer (135 k) [Gorzilia et al., J. Gen. Virol. 66, 1889-1900 (1985); Sabara et al., J. Virol. 53, 58-66 (1985); Sabara et al., J. Gen. Virol. 67, 201-212 (1986)]. Definitive proof of binding was provided by the fact that the increments in the ladder corresponded to the molecular weight of the synthetic peptide and that anti-peptide serum specifically reacted with the ladder formations. The laddering of the nucleocapsid could be eliminated by incubation with trypsin thus further supporting the formation of a synthetic peptide-nucleocapsid complex. Due to the ability of the peptide to bind to trypsin and to the nucleocapsid protein its biological activity was investigated. It appeared that increasing concentrations of the peptide reduced the rate of virus plaque formation, thereby suggesting that virus replication was inhibited. These results illustrate two features of this synthetic peptide which warrant further investigation; (1) its capacity to mimic an enzyme cleavage site and, (2) its ability to complex tightly to another protein. In protection-challenge experiments performed using a murine model, animals immunized with VP4-peptide provided protection passively, to neonates suckling on the immune dams, against a virulent rotavirus. The potential applications of this peptide in rotavirus diagnosis, therapy and synthetic peptides based vaccine is discussed.

Rhinosporidium seeberi and papovavirus infection of the conjunctiva: a clinical and ultrastructural study.

The present study describes, for the first time, the clinical and the ultrastructural findings of a rare case presented with concurrent conjunctival infection of Rhinosporidium seeberi and a papovavirus. In contradistinction to previous reports, the present case lacked the characteristic granulomatous inflammatory reaction of rhinosporidiosis. This finding, together with the frequent recurrence of the lesion, led us to postulate the presence of a Local Acquired Immune Deficiency State (LAIDS). This Local AIDS may be caused by an immunosuppression mechanism which is probably mediated by papovavirus.

A comparison of indirect immunofluorescence and electron microscopy for the diagnosis of some haemorrhagic viruses in cell cultures.

Yellow fever, dengue (types 1, 2 and 4), Chikungunya, Rift Valley fever, Ebola, Marburg, and Lassa viruses were inoculated into susceptible cell cultures and daily investigated by indirect immunofluorescence (IFA) and electron microscopy (EM) with a view to achieve an early detection-identification of these agents. Compared to the other cell lines tested (Vero, BHK-21 and Aedes albopictus), CV-1 cells were found to be more sensitive. Viral antigens were detected by IFA from a few hours post inoculation (CHIK and RVF) to a maximum of 3 days (YF and EBO). For most of the viruses studied, the cytopathic effect (CPE) commenced 2-3 days after the detection of viral antigens. Virus particles were detected by EM only in the case of EBO, MBG and LAS, before any CPE was observed in cell cultures.

Characterization of some ungrouped viruses.

Bangui, Bobaya, Kowanyama, Upolu and Zinga are enveloped spherical RNA viruses sensitive to ether and acid pH; morphologically resembling Bunyaviridae, their diameters range from 90 to 100 nm and their bouyant density is 1.17 to 1.18 g/ml in sucrose. St. Floris, a bunya-like virus, serologically related to Rift Valley Fever, has a diameter ranging from 90 to 110 nm. Triniti, Zingilamo, IPYM 120 and virus strain AnB4268 are enveloped spherical RNA viruses sensitive to ether and acid pH, have diameters of 65, 55, 55 and 60 nm and bouyant densities of 1.18, 1.24, 1.20 and 1.18 g/ml in sucrose, respectively; morphologically they resemble Togaviridae. Salanga is a poxvirus measuring 190 X 225 nm. Virus strain AnY1444 is a spherical, non-enveloped RNA virus measuring 85 nm, morphologically resembling Reoviridiae; it is restraint to both ether and acid pH and shows two-peak densities of 1.32 and 1.36 g/ml in caesium chloride. Bangoran, Keuraliba and Yata resemble Rhabdoviridae measuring 60 X 175, 65 X 195 and 60 X 185 nm, respectively.