[Clinical significance of IgM anti-HCV determination in chronic hepatitis C]. / Klinický význam stanovení IgM anti-HCV u chronické hepatitídy C.

BACKGROUND: In the majority of patients with acute viral hepatitis C the early antibody IgM anti-HCV in serum is positive. However, a substantial portion of the patients with chronic hepatitis C has also positive IgM anti-HCV as a sign of the continuing replication of the virus. The objective of the work was to assess the presence of IgM anti-HCV in patients with confirmed chronic hepatitis C, in subjects with HBsAg negative chronic hepatitis and in excluded blood donors. Moreover, the authors assessed the relationship between IgM anti-HCV positivity and the activity of serum transaminases and whether the presence of IgM anti-HCV has an impact on the histological finding in the liver. METHODS AND RESULTS: 88 patients were examined (44 women and 44 men), average age 48 years. In 47 subjects histological examinations of the liver were made. IgG anti-HCV were assessed by the Monolisa anti-HCV Sanofi Pasteur test and IgM anti-c22 by an Abbott kit IgM HCV EIA: With regard to the results of the serological examination the patients were divided into three groups which were mutually compared. Group 1 comprised 24 patients with a positive IgG and IgM anti-HCV, group 2 38 patients with a positive IgG anti-HCV only and group 3 26 patients with a negative IgG and IgM anti-HCV. Of 88 examined patients 62 had positive IgG anti-HCV (70%). Of 62 IgG anti-HCV positive subjects 24 (39%) had positive IgM anti-c22. A total of 24 patients had blood transfusions (39%) but only 9 of them had positive IgM anti-c22 (37.5%). The mean ALT serum activity was significantly higher in subjects with positive IgM than in those without IgM (p = 0.006), however, for AST the difference was not significant (p = 0.09). Comparison of patients with a confirmed histological finding in the liver revealed that two-thirds of patients with a positive IgM anti-c22 either suffered from cirrhosis or chronic active hepatitis, while anti-HCV positive patients without IgM anti-c22 had cirrhosis or chronic active hepatitis only in one third of the cases. CONCLUSIONS: The results suggest that in chronic hepatitis C some 40% of the patients have positive IgM anti-c22; these subjects have a significantly higher serum ALT activity and a more advanced histological finding in the liver than subjects without IgM anti-c22. Assessment of IgM anti-c22 is important not only for diagnosis but also for treatment of chronic HCV infection with antiviral drugs.

Clinical importance of assessment of anti-HCV IgM antibodies in chronic hepatitis C.

In the majority of patients with acute hepatitis C the anti-HCV IgM antibodies in serum were present, however, some patients with chronic hepatitis C were positive for anti-HCV IgM too. The aim of this study was to assess the presence of anti-c22 IgM in patients with chronic hepatitis C and to determine whether the positivity for anti-c22 IgM has an impact on the histological finding in the liver. A total of 88 patients were examined (44 women, 44 men), mean age 48 years. The first group comprised 24 patients positive for both anti-HCV IgG and anti-c22 IgM, the second group 38 patients positive for anti-HCV IgG only, and the third group 26 patients negative for both anti-HCV IgG and anti-c22 IgM. Of 62 anti-HCV-IgG-positive subjects 24 (39%) were positive also for anti-c22 IgM. Of 24 patients who received a blood transfusion 9 (37.5%) were positive for anti-c22 IgM. The mean serum alanine aminotransferase (ALT) activity was significantly higher in subjects with anti-c22 IgM than that in subjects without them (p = 0.006), however, the difference in aspartate aminotransferase (AST) was not significant (p = 0.09). Histological examination was performed in 46 patients. Two-thirds of the patients with anti-c22 IgM had either cirrhosis or chronic active hepatitis (CAH) while only one third of the anti-HCV-positive patients without anti-c22 IgM had CAH or cirrhosis. The results showed that approximately 40% of the patients with CAH and cirrhosis had anti-c22 IgM, a significantly higher serum ALT activity and more serious histological finding in the liver than anti-HCV-positive patients without anti-c22 IgM.

[A relapsing and protracted form of viral hepatitis A: comparison of adults and children]. / Relapsující a protrahovaná forma virové hepatitidy A: porovnání dospelých s detmi.

In recent years in children and adults with acute viral hepatitis A relapses and a protracted course of the disease were described. The authors followed up 37 patients with viral hepatitis A (20 children and 17 adults) and compared the clinical course of the disease, the period of hospitalization, persistence of IgM anti-HAV antibody in serum, the incidence of relapses and protracted forms of the disease. In adults the mean hospitalization period was longer (28 days as compared with 19), the average serum bilirubin value was higher (94 mumol/l as compared with 51 mumol/l), there were more cases with obvious jaundice (59% as compared with 30%) and the early serum antibody IgM anti-HAV persisted longer (19 weeks as compared with 14 weeks). Relapses of the disease were equally frequent (12% vs. 10%), however adults had more often a protracted course of hepatitis (23.5% vs. 10%). The observed differences were not statistically significant. Almost half the cases of hepatitis affected several members of the family. The results suggest that viral hepatitis A in adult age has a more severe course than in children. The authors recommend in cases with an elevated transaminase serum activity more frequent check-up examinations to avoid missing of a relapse, and to examine repeatedly IgM anti-HAV as in protracted forms of hepatitis IgM anti-HAV may persist even when the transaminase activity is normal.

Causes of acute exacerbations of chronic hepatitis B.

The authors analyzed acute exacerbations of chronic hepatitis B in 24 chronic HBsAg carriers (20 with positive HBeAg, 4 with anti-HBe), more than half of whom were treated with glucocorticoids, by examining specific antigens and antibodies of the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis delta virus (HDV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Of 38 observed exacerbations of the disease they found in 7 (18%) deterioration after discontinuation of glucocorticoids, in 7 (18%) seroconversion of HBeAg to anti-HBe, in 9 (24%) spontaneous exacerbation of chronic hepatitis B, in 11 (29%) chronic activation, reactivation of EBV superinfection, in 3 (8%) CMV reactivation or superinfection and in one (3%) HDV superinfection. In no instance HAV superinfection was observed. Exacerbations were found five times more frequently in subjects in the stage of active viral replication (in HBeAg+ subjects) than in subjects with anti-HBe. In eight patients EBV reactivation was found after glucocorticoids withdrawal: in five patients after an average period of 5 months (range 3-7) and in three patients after an average period of 33 months (range 22-48). The results provide evidence that in addition to already known causes of acute exacerbations of chronic hepatitis B in our geographical area probably an important cause of deterioration of hepatitis is reactivation or superinfection with EBV and CMV in some patients in conjunction with previous glucocorticoid treatment.

[The first hyperimmune immunoglobulin against cytomegaloviruses made in the Czech Republic]. / První ceský hyperimunní imunoglobulin proti cytomegaloviru.

The Czech immunoglobulin CMV was administered to 16 subjects with active CMV infection--mostly women with repeated miscarriages, CMV primoinfection during pregnancy, to children with congenital CMV infection and to patients with other clinical forms. The immunoglobulin was administered in a single dose or repeatedly by the intramuscular route. The decline of activity of the CMV infection was demonstrated by a decline of specific IgM CMV antibodies, disappearance of previously assessed viriuria and isolation of CMV in smears from the uterine cervix.

A comparison of developmental dynamics of Dermacentor reticulatus (Fabr.) of different geographic origins and their affection by different microclimate.

Developmental dynamics of D. reticulatus ticks of different geographic origins (NE Poland and SW Slovakia) were investigated and compared. A long-term field experiment was conducted in South Moravia in the zone of thermophilic oak forest. Ticks were studied in two different biotopes: in an open grassy area and in deciduous forest. Differences between the tick populations collected in Poland and Slovakia were observed in the duration of developmental cycle and in the outcome of metamorphosis, depending on biotope. The tick development in the open grassy area was more rapid, but with greater losses. The total production of adults was higher in the population originating from Slovakia.

Development of the tick Ixodes laguri Ol. in the nests of the European suslik Citellus citellus (L.).

In field and laboratory conditions new data were obtained concerning the life cycle of the nidicolous tick Ixodes laguri. The development of this tick was studied in experimental nests of the European suslik and a two-year cycle of I. laguri was demonstrated. However, the materials obtained indicate that a longer cycle may be anticipated.

Feeding of Dermacentor reticulatus (Fabr.) females depending on their age, origins and biotope of survival.

In Dermacentor reticulatus (Fabr., 1794) females originating from Slovakia and Poland the duration of feeding on host and its successful outcome depending on the age, origins of ticks and biotope of their survival was studied. In specimens older than a half year no influence of these factors on the duration of feeding was demonstrated. With increasing age the ability of full engorgement did no diminish. The data obtained indicate the possibility that a higher percentage of females of equal age engorge from the forest biotope than from the meadow biotope.

Possibilities of persistence in new biotopes of ticks imported by birds.

Survival and development of 6 tick species (Hyalomma anatolicum, Rhipicephalus sanguineus, Haemaphysalis punctata, Dermacentor marginatus, D. reticulatus and Ixodes ricinus) were studied in 3 groups differing in the range of distribution with respect to the place of importation, as a model for the knowledge of their possible inclusion in the new local biocenosis during transportation by natural hosts.

Development and survival of the tick Hyalomma dromedarii Koch under laboratory conditions.

Developmental cycle of the tick Hyalomma dromedarii as influenced by changes of temperature and humidity was studied under laboratory conditions. Feeding and metamorphosis of developmental stages were observed under standard laboratory conditions, the metamorphosis was traced at exposure to temperature of 28 degrees C, 80% RH to alternating diurnal climate 40 degrees C, 25% RH and 20 degrees C, 80% RH and alternating humidity of 40/100% and 60/100% RH at a constant temperature 30 degrees C.

Influence of microclimate on the life cycle of the common tick Ixodes ricinus (L.) in an open area in comparison with forest habitats.

Under conditions of the South-Moravian region of Pannonian climate (Valtice near Breclav), the life cycle of the common tick Ixodes ricinus (L.) was studied and a continous recording of main elements of microclimate (temperature and humidity) was carried out in an open grassy area. Simultaneously the process of hibernation was studied in four soil layers (surface, depths of 10, 20 and 30 cm). Observations were assessed by mathematiccal-statistical tests and compared with the results obtained by the same methods in the forest biotope (tipe of thermophilic oak forest)and in the ecotone of forest margin (Daniel et al. 1976). The ticks are able to complete the developmental cycle also in the open grassy areas, where during the vegetation period the development proceeds more quickly than in the forest but with considerably higher losses. In the discussion the conclusions are compared with literary data from other parts of Czechoslovakia.

Influence of microclimate on the life cycle of the common tick Ixodes ricinus (L.) in thermophilic oak forest.

Under conditions of the South Moravian thermophilic oak forest (Valtice near Breclav), the life cycle of the common tick Ixodes ricinus was studied by continuous recording of main elements of microclimate (temperature and humidity) in three different biotopes: forest, margin of the forest and meadow. Simultaneously conditions and the process of tick hibernation were studied in four soil layers (surface, depths of 10, 20 and 30 cm). Observations made in the winter and vegetation periods were assessed by mathematical-statistical tests. Results obtained in the forest biotope and at its margin are presented in this paper; results from the meadow biotope will be published separately.