RESUMO
We identified demographic, clinical and biological determinants of herpes simplex virus type 2 (HSV-2) shedding among HIV-infected participants in the Women's HIV Interagency Study (WIHS). Cervicovaginal lavage (CVL) specimens from 369 HIV-infected HSV seropositive women were tested with TaqMan polymerase chain reaction (PRC) for detection HSV-2 DNA. Seven percent of women tested positive for HSV-2 DNA in CVL. Significant correlates of the presence of HSV-2 DNA in CVL were being younger, African American or Hispanic race/ethnicity and injecting drugs in the past six months (P < 0.05). A borderline significant trend for reduced viral shedding with higher CD4+ T cell counts was observed (P = 0.08). All women who were never observed with any genital lesions and had consistently negative self-reported history of genital sores throughout the follow-up (n = 29, 8%) were negative for CVL HSV-2 DNA. HSV-2 DNA quantity was significantly associated with having frequent subsequent lesion recurrences (Spearman rho = 0.48, P = 0.016; adjusted prevalence ratio [APR] = 2.5, P = 0.012). Increasing the age of the host was inversely correlated with decreased viral shedding over time. However, a subset of older women continued to shed significant amounts of virus despite passage of time. This study provides genital HSV-2 DNA titre as a quantitative and symptom- and sign-based measures as qualitative predictors of HSV-2 shedding from the lower genital tract among HIV-infected women.
Assuntos
Infecções por HIV/complicações , Herpes Genital/diagnóstico , Herpes Genital/virologia , Herpesvirus Humano 2/isolamento & purificação , Eliminação de Partículas Virais , Adulto , Anticorpos Antivirais/sangue , DNA Viral/sangue , Feminino , Herpes Genital/patologia , Herpesvirus Humano 2/genética , Humanos , Reação em Cadeia da Polimerase , Fatores de Risco , Ducha VaginalAssuntos
Atresia Biliar/virologia , Hepatite C/complicações , Adolescente , Adulto , Atresia Biliar/etiologia , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Humanos , Lactente , Reação em Cadeia da Polimerase , Testes SorológicosAssuntos
Infecção Hospitalar/epidemiologia , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Adolescente , Adulto , Sequência de Bases , Criança , Pré-Escolar , Primers do DNA , Ensaio de Imunoadsorção Enzimática , Feminino , Hepacivirus/genética , Anticorpos Anti-Hepatite/sangue , Hepatite C/transmissão , Anticorpos Anti-Hepatite C , Humanos , Lactente , Deficiência Intelectual , Assistência de Longa Duração , Masculino , Dados de Sequência Molecular , Reação em Cadeia da Polimerase/métodos , PrevalênciaAssuntos
Doadores de Sangue , Hepatite C/virologia , Reação em Cadeia da Polimerase/métodos , Regiões 5' não Traduzidas , Hepacivirus/genética , Hepacivirus/imunologia , Hepacivirus/isolamento & purificação , Hepatite C/sangue , Hepatite C/imunologia , Hepatite C/transmissão , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas não Estruturais Virais/genética , Proteínas não Estruturais Virais/imunologiaAssuntos
Anemia Ferropriva/microbiologia , Duodenite/complicações , Gastrite/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori , Anemia Ferropriva/sangue , Criança , Duodenite/epidemiologia , Gastrite/epidemiologia , Gastroenteropatias/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Ferro/metabolismo , MasculinoAssuntos
Refluxo Gastroesofágico/complicações , Adolescente , Antiulcerosos/uso terapêutico , Antieméticos/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Cifose/complicações , Cifose/diagnóstico por imagem , Cifose/cirurgia , Masculino , Metoclopramida/uso terapêutico , Radiografia , Ranitidina/uso terapêutico , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , SíndromeAssuntos
Doenças do Ânus/patologia , Dedos/patologia , Dermatopatias Bacterianas/patologia , Infecções Estreptocócicas/patologia , Doenças do Ânus/tratamento farmacológico , Criança , Humanos , Masculino , Penicilinas/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológicoAssuntos
Constipação Intestinal/etiologia , Doença de Hirschsprung/diagnóstico , Sulfato de Bário , Criança , Pré-Escolar , Constipação Intestinal/complicações , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Diagnóstico Diferencial , Encoprese/etiologia , Enema , Feminino , Doença de Hirschsprung/etiologia , Doença de Hirschsprung/terapia , Humanos , Lactente , MasculinoAssuntos
Constipação Intestinal/etiologia , Defecação/fisiologia , Criança , Constipação Intestinal/fisiopatologia , Constipação Intestinal/psicologia , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/psicologia , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/psicologia , Doenças da Medula Espinal/complicaçõesAssuntos
Endometriose/cirurgia , Erosão do Colo do Útero/cirurgia , Eletrocoagulação , Feminino , HumanosRESUMO
The presence of jaundice in the neonate, infant or young child presents a broad differential diagnosis. The 'disease' may be benign, as in breast-milk jaundice, or potentially fatal, as in hereditary fructose intolerance. The cause of the jaundice may be a primary hepatic disorder, such as extrahepatic biliary atresia, or secondary to a non-hepatic cause, such as haemolysis or sepsis. There may be significant hepatic injury and dysfunction, as in fulminant viral hepatitis, or simply elevation of plasma bilirubin, as in Gilbert's syndrome. In this chapter we will discuss the familial hyperbilirubinaemia syndromes. This diverse group of disorders is characterized by hepatic dysfunction in the absence of hepatocellular injury. The first section of the chapter will discuss the unconjugated hyperbilirubinaemias: Crigler-Najjar syndrome I, Crigler-Najjar syndrome II and Gilbert's syndrome. The discovery of the gene for bilirubin uridine diphosphate glucuronosyltransferase has increased our understanding of the genetic heterogeneity and clinical presentation of the Crigler-Najjar syndromes. The remainder of the chapter will discuss the conjugated hyper-bilirubinemias: Rotor syndrome and Dubin-Johnson syndrome. These rare diseases share many clinical features; however, they can be readily distinguished by biochemical markers in the urine and bile.
Assuntos
Hiperbilirrubinemia Hereditária , HumanosRESUMO
In this chapter, an abbreviated account is presented on the subject of hereditary diseases and the liver. However, it is incomplete because Alagille syndrome, storage disorders, alpha-1-antitrypsin deficiency and Wilson disease are not included as they appear in other chapters of this volume. Biliary atresia is omitted because all available evidence does not support any significant genetic association. Molecular biological techniques have enabled linkage of several liver cholestatic disorders to chromosomal loci, and further characterization of the canalicular bile salt transporter (cBST) will advance our understanding of pathogenetic mechanisms involved in benign and progressive cholestatic syndromes. Disorders that have been treated as separate entities may have common 'roots', exemplified by the concept of the ductal plate malformation in fibropolycystic disease. Whereas the majority of disorders referred to in this chapter present early in life, there are several that are associated with liver failure in the neonatal period, which makes early recognition particularly important. Liver transplantation offers a cure for many hereditary disorders affecting the liver but it is not applicable to all.
Assuntos
Hepatopatias/congênito , Fígado/metabolismo , Erros Inatos do Metabolismo/metabolismo , Humanos , LactenteRESUMO
The phenotypic characteristics of peripheral blood lymphocytes (PBLs) from responders and nonresponders to hepatitis B (HB) vaccine and their response to pokeweed mitogen (PWM) stimulation in vitro were compared. The nonresponders had significantly higher absolute numbers and percentages of T11+, HNK-1+, and T8+ lymphocytes. Also, after PWM stimulation, PBLs from HB-vaccine nonresponders had impaired IgG and IgM production and failed to produce antibodies to HB surface antigen in vitro. These findings suggest that healthy individuals who fail to produce such antibodies have a higher population of suppressor lymphocytes that alters their normal immune response to HB vaccination.