[Evaluation of serum IgG, IgA and IgM levels as indicators of hepatic fibrosis in patients with chronic hepatitis C infection]. / Kronik Hepatit C Enfeksiyonu Olan Hastalarda Karaciger Fibrozu Göstergesi Olarak Serum IgG, IgA ve IgM Düzeylerinin Degerlendirilmesi.

The prediction of development of hepatic fibrosis is of crucial importance in terms of disease monitorization and treatment follow-up of patients with chronic hepatitis C virus (HCV) infections. Liver biopsy which is an invasive and complicated method, still remains as the gold standard method for the diagnosis of liver fibrosis. Recently, non-invasive diagnostic tests to determine the biological markers of liver fibrosis have been developed as a possible alternative to liver biopsy. The aim of this study was to evaluate the levels of serum IgG, IgA and IgM antibodies as possible indicators for hepatic fibrosis among patients with chronic HCV infection. A total of 57 patients (35 female, 22 male; mean age: 51 ± 8.9 years) who were followed-up between January 2007-November 2008, were enrolled in the study. All of the patients were positive for serum anti-HCV and HCV-RNA, while none of them were under antiviral therapy for the last six months. The patients were hospitalized for liver biopsy and biopsy samples were evaluated according to Modified Knodell Histological Activity Index. Forty-nine patients with no liver fibrosis or low to moderate fibrosis were classified as Group 1 (stage 0, 1, 2, 3) and eight patients with high to severe fibrosis were classified as Group 2 (stage 4, 5, 6). Serum IgG, IgA and IgM levels of the patients were determined by a commercial immunonephelometric method (Dade Behring, Germany). Increased antibody levels were detected in a total of 61.4% (35/57) of patients, of which 28 (49.1%) yielded high IgG, 5 (8.8%) yielded high IgM and 2 (3.5%) yielded high IgA levels. The mean IgG levels of patients in Group 1 and 2 were 16.3 ± 4.6 and 21.8 ± 5.2 g/L; mean IgM levels were 1.3 ± 0.6 and 1.6 ± 0.8, and median IgA levels were 2.0 (0.5-5.3) and 3.3 (1.3- 4.3) g/L, respectively. IgG and IgA levels of patients from Group 2 were found significantly higher than those patients from Group 1 (p= 0.003, p= 0.03, respectively), however there was no significant difference between the groups with respect to serum IgM levels (p= 0.311). When the patient groups were also evaluated in terms of other parameters, no statistically significant differences were detected for ALT, AST, HCV-RNA levels and mean ages (p= 0.95, p= 0.21, p= 0.73, p= 0.10, respectively), however, anti-HCV levels were found significantly higher in Group 2 (p= 0.043). The data of this study indicated a significant relationship between the levels of serum IgG, IgA and the severity of hepatic fibrosis among patients with chronic HCV infection. It was concluded that high serum IgG and IgA levels may be helpful indicators together with the other non-invasive markers for the prediction of liver fibrosis in case when liver biopsy could not be performed.

Measles, rubella, mumps, and varicella seroprevalence among health care workers in Turkey: is prevaccination screening cost-effective?

BACKGROUND: To investigate the immune status of health care workers (HCWs) against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to define an appropriate vaccination program among HCWs. METHODS: Voluntary HCWs from a children's hospital and a general hospital were included in the study between March and May 2005. The specific IgG antibodies against MMRV viruses were screened by ELISA. RESULTS: Three hundred sixty-three HCWs participated in the study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and varicella, 98%. No association was found between the susceptibility to at least 1 of MMRV virus infections and gender, age, duration of work, profession, and department of work in analysis either among the whole study group, or each hospital. The positive predictive value for the history of varicella was 100%, whereas it was 92% for MMR. The cost of vaccination for varicella was significantly expensive without screening before vaccination. However, there was not much difference for MMR infections. CONCLUSION: A policy based on obtaining the history of varicella infection from the staff and then screening the ones with negative history and vaccination of only seronegative HCWs was found to be appropriate.

[The value of the immunoglobulin G avidity test for the serologic diagnosis of brucellosis]. / Brusellozisin serolojik tanisinda immünoglobulin G avidite testinin degeri.

In order to investigate the value of immunoglobulin G (IgG) avidity test for the serological diagnosis of Brucella infections, a total of 118 patients (74 male, 44 female; mean age: 43 +/- 18.7 years) were included into the present study. The patients have been diagnosed with the characteristic clinical findings, > or = 1/160 antibody titers in standard tube agglutination (STA) test and/or blood culture positivities. Brucella spp. have been grown in blood cultures of 78 patients, and STA test results were found positive (> or = 1/160 titers) in 117 patients. The diagnosis of a patient with 1/80 STA titer was based on the blood culture positivity. By enzyme immunoassay (ELISA), 3 patients (2.5%) were found positive for IgM, 14 (11.9%) were positive for IgG, and 101 (85.6%) were positive for both IgM and IgG. The patients who were found IgG positive have been grouped according to their duration of complaints. Group 1 included 99 patients with the history of brucellosis < or = 6 months, and group 2 included 16 patients with the history of brucellosis > 6 months. IgG avidity test was performed by ELISA in 115 IgG positive serum samples, with the denaturation substance (8 M urea). The cut-off value for IgG avidity index (AI) was accepted as 40%, and the avidity maturation period was defined as 6 months. As a result, the rates of patients who had low IgG AI in group 1 and 2 were found as 91.9% and 43.7%, respectively, while these rates were 8.1% and 56.3% for the presence of high IgG AI, respectively. The rate of low AI in group 1 was an expected result, while the rate was more than expected in group 2, indicating that Brucella antibodies with low avidity indices would not be helpful for the diagnosis of a recent infection, while Brucella antibodies with high avidity indices would be useful for the elimination of a recent infection.