Diagnóstico microbiológico de las hepatitis virales / Microbiological diagnosis of viral hepatitis

La inflamación hepática o hepatitis tiene causas diversas, tanto infecciosas como no infecciosas. Entre las primeras, cabe destacar la etiología viral que es la causa de, al menos, la mitad de todas las hepatitis en el mundo. Se han descrito distintos virus con tropismo primario por el tejido hepático. Estos microorganismos se han ido nombrando sucesivamente con las letras del abecedario: A, B, C, D, E y G. El objetivo de este artículo es revisar este grupo heterogéneo de virus en sus aspectos más básicos, sus implicaciones clínicas, su tratamiento, las principales medidas preventivas frente a estas infecciones y, con especial interés, las aproximaciones diagnósticas, tanto serológicas como moleculares, que se utilizan para su detección, cuantificación y caracterización

Liver inflammation or hepatitis has many different causes, both infectious and non-infectious. Among the former, viral infection is responsible for at least half of all hepatitis worldwide. Different viruses have been described with primary tropism for liver tissue. These microorganisms have been successively named with letters of the alphabet: A, B, C, D, E and G. The aim of this paper is to review this heterogeneous group of viruses in its most basic aspects, including clinical implications, treatment, main control, and prophylactic measures and, of special interest, diagnostic approaches, both serological and molecular, which are used for their detection, quantification and characterization

[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.

Una causa excepcional de hepatitis aguda en el adulto: parvovirus B19 / An exceptional cause of acute hepatitis in an adult: parvovirus B19

La hepatitis es un cuadro clínico que puede ser originado por múltiples causas. Las más frecuentes son de etiología viral, siendo las más comunes aquellas causadas por los virus de las hepatitis A, B y C. Sin embargo, otros virus no hepatotropos pueden estar implicados en esta enfermedad, entre los que se encuentra el parvovirus B19. Se presenta un caso de hepatitis aguda por parvovirus B19, así como una revisión de aspectos epidemiológicos, clínicos, diagnósticos y terapéuticos de dicha entidad (AU)

There are multiple causes of hepatitis. The most frequent etiologies are viral, usually hepatitis A, B and C viruses. However, other, non-hepatotropic viruses can cause this disease, including parvovirus B19. We present a case of acute hepatitis due to parvovirus B19, as well as a review of the epidemiological, clinical, diagnostic and therapeutic features of this entity (AU)

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.

Utilidad de la biología molecular en el diagnóstico microbiológico de las hepatitis virales / Utility of molecular biology in the microbiological diagnosis of viral hepatitides

Las hepatitis virales se diagnostican satisfactoriamente en el laboratorio mediante inmunoanálisis, para detectarantígenos y anticuerpos en suero. Sin embargo, ladetección temprana de infecciones agudas durante elperíodo de ventana, la investigación de las llamadasinfecciones “ocultas”, y la necesidad de cuantificar laviremia y de caracterizar en detalle las cepas de virus,como apoyo al tratamiento antiviral, han planteado nuevasnecesidades que sólo las técnicas moleculares puedensatisfacer. Además, en tiempos en los que las estrategiaspreventivas buscan reducir significativamente la incidencia de estas infecciones, o incluso llegar a la erradicación de algunas de ellas, la caracterización completa de los brotes epidémicos y de los casos que puedan indicar la emergencia de variantes virales de escape a vacuna son objetivos importantes para la salud pública, y sólo pueden alcanzarse con la asistencia de estas técnicas. La incorporación de estos métodos a la rutina de los centros de transfusión, en un esfuerzo más para mejorar la seguridad de la transfusión sanguínea, ha generado nuevas necesidades de apoyo por parte del laboratorio de microbiología, que obligan a éste a incorporarlos también a su trabajo diario. Después de más de una década, las circunstancias han permitido que los métodos automatizados para detectar, cuantificar, caracterizar y secuenciar los genomas de estos virus sean una realidad al alcance del microbiólogo asistencial, lo que no hace sino abundar en la necesidad de que los laboratorios hospitalarios sigan contando con especialistas capacitados para su correcto manejo

Viral hepatitides are satisfactorily diagnosed in thelaboratory by immunoassays for either antigen or antibodydetection in serum samples. However, the early detectionof acute infections during the window period,investigation of “occult” infections, and issues related to the establishment and follow-up of antiviral therapy in chronic infections pose new challenges that onlymolecular methods can meet. In addition, fullcharacterization of epidemic outbreaks and surveillance of the emergence of viral variants able to escape fromvaccine protection are major public health objectives that can only be achieved through the use of these techniques. As a further attempt to improve the viral safety of blood transfusions, the incorporation of molecular biology techniques into the routine work of transfusion centers has generated new technical and scientific demands on microbiology laboratories, which must in turn incorporate these methods to respond to the challenge. After more than a decade, automatic methods for the detection, quantification, characterization and sequencing of the genomes of these viruses have become a reality for the clinical laboratory, reaffirming the essential role of the microbiologist in the hospital setting

Utilidad de la biología molecular en el diagnóstico microbiológico de las hepatitis virales / Utility of molecular biology in the microbiological diagnosis of viral hepatitides

Las hepatitis virales se diagnostican satisfactoriamente en el laboratorio mediante inmunoanálisis, para detectar antígenos y anticuerpos en suero. Sin embargo, la detección temprana de infecciones agudas durante el período de ventana, la investigación de las llamadas infecciones ¿ocultas¿, y la necesidad de cuantificar la viremia y de caracterizar en detalle las cepas de virus, como apoyo al tratamiento antiviral, han planteado nuevas necesidades que sólo las técnicas moleculares pueden satisfacer. Además, en tiempos en los que las estrategias preventivas buscan reducir significativamente la incidencia de estas infecciones, o incluso llegar a la erradicación de algunas de ellas, la caracterización completa de los brotes epidémicos y de los casos que puedan indicar la emergencia de variantes virales de escape a vacuna son objetivos importantes para la salud pública, y sólo pueden alcanzarse con la asistencia de estas técnicas. La incorporación de estos métodos a la rutina de los centros de transfusión, en un esfuerzo más para mejorar la seguridad de la transfusión sanguínea, ha generado nuevas necesidades de apoyo por parte del laboratorio de microbiología, que obligan a éste a incorporarlos también a su trabajo diario. Después de más de una década, las circunstancias han permitido que los métodos automatizados para detectar, cuantificar, caracterizar y secuenciar los genomas de estos virus sean una realidad al alcance del microbiólogo asistencial, lo que no hace sino abundar en la necesidad de que los laboratorios hospitalarios sigan contando con especialistas capacitados para su correcto manejo(AU)

Viral hepatitides are satisfactorily diagnosed in the laboratory by immunoassays for either antigen or antibody detection in serum samples. However, the early detection of acute infections during the window period, investigation of ¿occult¿ infections, and issues related to the establishment and follow-up of antiviral therapy in chronic infections pose new challenges that only molecular methods can meet. In addition, full characterization of epidemic outbreaks and surveillance of the emergence of viral variants able to escape from vaccine protection are major public health objectives that can only be achieved through the use of these techniques. As a further attempt to improve the viral safety of blood transfusions, the incorporation of molecular biology techniques into the routine work of transfusion centers has generated new technical and scientific demands on microbiology laboratories, which must in turn incorporate these methods to respond to the challenge. After more than a decade, automatic methods for the detection, quantification, characterization and sequencing of the genomes of these viruses have become a reality for the clinical laboratory, reaffirming the essential role of the microbiologist in the hospital setting(AU)

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.

Diagnóstico microbiológico de las hepatitis víricas / Microbiological diagnosis of viral hepatitis

Las hepatitis de etiología vírica por virus hepatotropos (A, E, B, D y C) representan una importante carga de trabajo para el laboratorio de virología clínica. La mayoría del diagnóstico se basa en la determinación, a partir de muestras de suero y plasma, de distintos marcadores serológicos y virológicos que correlacionan con las infecciones en sus diferentes estadios. Por el riesgo de evolución crónica que presentan VHB y VHC es necesario recurrir a métodos moleculares y a detección de antígenos en muestras seriadas a lo largo de la enfermedad con una adecuada conservación que preserve sus componentes estructurales. Por otra parte los conocimientos recientes sobre variantes con mutaciones en algunos de los virus pueden alterar la validez de determinados marcadores (AU)

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 (AU)

[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.

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.