Assessment of immunological changes in Epstein-Barr virus co-infection in Egyptian chronic HCV patients

Epstein-Barr virus (EBV) plays a major role in liver pathology. Similar to other members of the herpesvirus family, EBV establishes a persistent infection in more than 90% of adults. The aim of this study was to evaluate the impact of EBV and chronic hepatitis C co-infection (HCV) on biochemical and immunological responses in patients. The study was conducted in 62 patients and 33 apparently healthy controls. Patients were divided into three groups: group I, consisting of 31 patients with chronic hepatitis C infection (CHC), group II, consisting of eight patients with EBV infection and without HCV infection and group III, consisting of 23 patients with EBV and chronic HCV. The percentage of CD3+ cells, helper CD4+ cells and CD19+ B-cells was measured by flow cytometry. Human interferon-γ (IFN-γ) and interleukin (IL)-15 levels were measured by an ELISA. The levels of liver alanine aminotransferase and aspartate aminotransferase enzymes were higher in EBV/HCV patients compared to that in EBV and HCV mono-infected patients. EBV/HCV patients had significantly reduced percentages of CD3+ and CD4+ cells compared to EBV patients. Serum IFN-γ levels were significantly reduced in EBV/HCV patients (3.86 pg/mL) compared to CHC patients (6.76 pg/mL) and normal controls (4.69 pg/mL). A significant increase in serum IL-15 levels was observed in EBV/HCV patients (67.7 pg/mL) compared to EBV patients (29.3 pg/mL). Taken together, these observations suggest that HCV and EBV co-infection can potentiate immune response dampening in patients.

Fatores de risco para necessidade de ventilação mecânica em crianças com Influenza A(H1N1)pdm09 / Risk factors for need of mechanical ventilation in children with Influenza A(H1N1)pdm09

OBJETIVO: A pandemia causada pelo vírus Influenza A(H1N1)pdm09 teve seu pico nos meses de julho e agosto de 2009, no Sul do Brasil, sendo a incidência mais alta em crianças e adultos jovens. No período pós-pandêmico, no Brasil, houve aumento de casos nos meses de inverno dos anos de 2011 e 2012, de forma semelhante ao vírus influenza sazonal. Como ainda estão ocorrendo infecções devido ao influenza pandêmico, nosso objetivo foi investigar fatores de risco para pior desfecho em crianças. MÉTODOS: Foi realizado um estudo de coorte retrospectivo analisando as fichas de pacientes menores de 14 anos hospitalizados e com RT-PCR positiva para Influenza A(H1N1)pdm09 durante a primeira onda , em seis centros terciários brasileiros. Definimos a necessidade de ventilação mecânica como desfecho com gravidade e, como possíveis preditores, os fatores idade, doenças crônicas, codetecção bacteriana e viral, achados da radiografia do tórax e uso de oseltamivir. RESULTADOS: No presente estudo, foram incluídos120 pacientes. Em uma análise multivariada, doenças crônicas (razão de prevalência: 2,613; intervalo de confiança de 95%: 1,267 a 5,386) e codetecção viral (razão de prevalência: 2,43; intervalo de confiança de 95%: 1,203 a 4,905) se associaram estatisticamente a um pior desfecho (p < 0,05). CONCLUSÕES: A presença de doenças crônicas como preditores reforça evidências prévias. Além disso, verificamos que a codetecção viral é fator de risco. São necessários outros estudos para confirmar essa associação.

OBJECTIVE: The pandemic caused by influenza A(H1N1)pdm09 virus peaked between July and August of 2009 in southern Brazil, with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases during the winter months of 2011 and 2012 in Brazil, similar to seasonal influenza virus. Since infections due to pandemic influenza are still occurring, the present study aimed to investigate the risk factors for worse outcome in children. METHODS: A retrospective cohort study was performed by reviewing the charts of hospitalized patients younger than 14 years with reverse transcription-polymerase chain reaction (RT-PCR) positive for influenza A(H1N1)pdm09 during the first pandemic wave in six Brazilian tertiary centers. Need for mechanical ventilation was defined as the severity of outcome; age, chronic diseases, bacterial and viral co-detection, chest radiograph findings, and use of oseltamivir were possible predictors. RESULTS: In the present study, 120 patients were included. In a multivariate analysis, chronic diseases (prevalence ratio: 2.613, 95% CI: 1.267-5.386) and viral co-detection (prevalence ratio: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p < 0.05). CONCLUSIONS: The presence of chronic diseases as predictors reinforces previous finding. Furthermore, viral co-detection was found to be a risk factor. Further studies are necessary to confirm this association.

Progression of iiver fibrosis in monoinfected ptients by hepatitis c virus andd coinfected by hcv and human immunodeficiency virus

Context The progression of liver fibrosis in patients coinfected by hepatitis C virus and human immunodeficiency virus (HCV/HIV) has been increasingly studied in the past decade. Studies made before the highly active antiretroviral therapy suggest that HIV can change the natural history of the HCV infection, leading to a faster progression of the liver fibrosis. Objective To evaluate and compare the fibrosis progression in two groups of patients (HCV/HIV coinfected and HCV monoinfected) Methods Seventy patients HCV monoinfected and 26 patients HCV/HIV coinfected who had not undertaken HCV treatment and were submitted to serial percutaneous liver biopsies were retrospectively evaluated. There was no difference in the fibrosis progression between the two groups. Conclusion The fibrosis grade evolution was not worse in the coinfected patients. The immunosuppression absence and the shortest time period between the biopsies in the coinfected group are possible explanations. .

Contexto A progressão da fibrose hepática em pacientes coinfectados pelos vírus da hepatite C (VHC) e da imunodeficiência humana (VHC/HIV) tem sido mais estudada na última década. Estudos realizados antes da terapia antiretroviral de alta potência (HAART) sugerem que o HIV pode mudar a história natural da infecção pelo VHC, levando a uma progressão mais rápida da fibrose hepática. Objetivo Avaliar e comparar a progressão de fibrose em duas populações de pacientes (coinfectados VHC/HIV e monoinfectados VHC). Métodos Foram avaliados retrospectivamente 70 pacientes monoinfectados VHC e 26 coinfectados VHC/HIV nunca tratados para o VHC e que haviam realizado duas biopsias hepáticas seriadas. Não houve diferença na progressão de fibrose entre os dois grupos. Conclusão A evolução do grau de fibrose não foi pior nos pacientes coinfectados. A ausência de imunodepressão e o menor intervalo de tempo entre as biopsias no grupo de coinfectados são possíveis justificativas. .

Gravidade das coinfecções virais em lactentes hospitalizados com infecção por vírus sincicial respiratório / Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection

OBJETIVO: Comparar a gravidade de infecções causadas por um único vírus (VSR) com a gravidade de coinfecções. MÉTODOS: Este estudo avaliou uma coorte histórica de lactentes com infecção aguda por VSR. Secreção de nasofaringe foi coletada de todos os pacientes rotineiramente para pesquisa viral usando técnicas de biologia molecular. Os seguintes desfechos foram analisados: tempo total de internação, duração da oxigenioterapia, admissão em unidade de terapia intensiva e uso de ventilação mecânica. Os resultados foram ajustados para os fatores confundidores (prematuridade, idade e aleitamento materno). RESULTADOS: Foram incluídos no estudo 176 lactentes com idade média de 4,5 meses e diagnósticos de bronquiolite e/ou pneumonia. Cento e vinte e um tinham infecção única por VSR, e 55 tinham coinfecções (24 VSR + adenovírus, 16 VSR + metapneumovírus humano e 15 outras associações menos frequentes). Os quatro desfechos de gravidade avaliados foram semelhantes entre o grupo com infecção única por VSR e os grupos com coinfecções, independente do tipo de vírus associado com o VSR. CONCLUSÃO: As coinfecções virais não parecem alterar o prognóstico de lactentes hospitalizados com infecção aguda por VSR.

OBJECTIVE: To compare the severity of single respiratory syncytial virus (RSV) infections with that of coinfections. METHODS: A historical cohort was studied, including hospitalized infants with acute RSV infection. Nasopharyngeal aspirate samples were collected from all patients to detect eight respiratory viruses using molecular biology techniques. The following outcomes were analyzed: duration of hospitalization and of oxygen therapy, intensive care unit admission and need of mechanical ventilation. Results were adjusted for confounding factors (prematurity, age and breastfeeding). RESULTS: A hundred and seventy six infants with bronchiolitis and/or pneumonia were included in the study. Their median age was 4.5 months. A hundred and twenty one had single RSV infection and 55 had coinfections (24 RSV + adenovirus, 16 RSV + human metapneumovirus and 15 other less frequent viral associations). The four severity outcomes under study were similar in the group with single RSV infection and in the coinfection groups, independently of what virus was associated with RSV. CONCLUSION: Virus coinfections do not seem to affect the prognosis of hospitalized infants with acute RSV infection.