Serological Patterns Research Articles

Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: The Angolan experience

The Republic of Angola is a priority country for onchocerciasis and lymphatic filariasis (LF) elimination, however, the co-distribution of the filarial parasite Loa loa (loiasis) is a significant impediment, due to the risk of severe adverse events (SAEs) associated with ivermectin used in mass drug administration (MDA) campaigns. Angola has a high risk loiasis zone identified in Bengo Province where alternative interventions may need to be implemented; however, the presence and geographical overlap of the three filarial infections/diseases are not well defined. Therefore, this study conducted a rapid integrated filarial mapping survey based on readily identifiable clinical conditions of each disease in this risk zone to help determine prevalence and co-distribution patterns in a timely manner with limited resources. In total, 2007 individuals from 29 communities in five provincial municipalities were surveyed. Community prevalence estimates were determined by the rapid assessment procedure for loiasis (RAPLOA) and rapid epidemiological mapping of onchocerciasis (REMO) together with two questions on LF clinical manifestations (presence of lymphoedema, hydrocoele). Overall low levels of endemicity, with different overlapping distributions were found. Loiasis was found in 18 communities with a prevalence of 2.0% (31/1571), which contrasted to previous results defining the area as a high risk zone. Onchocerciasis prevalence was 5.3% (49/922) in eight communities, and LF prevalence was 0.4% for lymphoedema (8/2007) and 2.6% for hydrocoeles (20/761 males) in seven and 12 communities respectively. The clinical mapping survey method helped to highlight that all three filarial infections are present in this zone of Bengo Province. However, the significant difference in loiasis prevalence found between the past and this current survey suggests that further studies including serological and parasitological confirmation are required. This will help determine levels of infection and risk, understand the associations between clinical, serological and parasitological prevalence patterns, and better determine the most appropriate treatment strategies to reach onchocerciasis and LF elimination targets in the loiasis co-endemic areas. Our results also suggest that the utility of the earlier RAPLOA derived maps, based on surveys undertaken over a decade ago, are likely to be invalid given the extent of population movement and environmental change, particularly deforestation, and that fine scale micro-mapping is required to more precisely delineate the interventions required defined by these complex co-endemicities.

Juvenile lupus: Different clinical and serological presentations compared to adult lupus in Egypt

Aim of the work: We aimed to evaluate the differences in clinical presentation, serological pattern and disease activity between juvenile and adult-onset of Egyptian systemic lupus erythematosus (SLE) patients. Patients and methods: 160 Egyptian SLE patients (80 Adult-onset and 80 juveniles) were included. Patients records were reviewed for clinical and laboratory evaluation on presentation. Disease activity at onset was assessed using SLE Disease Activity Index (SLEDAI). Results: The mean age of the adult patients was 29.9±7.2years and of the juvenile cases (12.8±2.1years). The female:male ratio of the adults was 10:1 while it was 39:1 in the SLE children. The most common clinical presentation among adult SLE was malar rash (75%) followed by articular manifestations (62.5%), while in juveniles, nephritis (78.8%) followed by articular manifestations (71.2%) were the most common. Juvenile patients had more frequent neuropsychiatric (p=0.015) and hematologic abnormalities (p<0.001) at onset; and lupus nephritis (72.5%) compared to adults (36.2%) (p<0.001) during the first year of presentation. Juvenile SLE showed higher frequency of proteinuria (p<0.001), hematuria (p=0.02) and active urinary sediments (p=0.016). Proliferative nephritis was the most common form among both juveniles and adults. Positivity and titres of both anticardiolipin antibodies and lupus anticoagulant were significantly higher in juvenile SLE. Juvenile SLE patients had significantly higher SLEDAI [median (IQR): 12 (10–22)] compared to adults [median (IQR): 8 (4–12)], p<0.001. Conclusion: Juvenile SLE patients differ from adult SLE with more frequent major organs affection and significantly higher serological activity. Earlier and more careful assessment with strict management plan and follow-up are needed in juvenile SLE patients.

Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin.

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which may be misdiagnosed as pancreatic carcinoma. This study aims to verify new biomarkers for AIP and propose a serological pattern to differentiate AIP from pancreatic adenocarcinoma with routinely performed tests. In this study, data of serum samples were collected and compared between 25 patients with AIP and 100 patients with pancreatic carcinoma. Receiver operating characteristic analysis and logistic regression was performed to evaluate the diagnostic effect of serum parameters in differentiating AIP from pancreatic carcinoma alone or in combination. Among several serum markers observed in the two groups, carbohydrate antigen 19–9 (Ca19-9), globulin, eosinophils and hemoglobin were selected as the independent markers. Serum levels of Globulin, Eosinophil percentage in AIP group were significantly higher than in pancreatic cancer group (P<0.05), while hemoglobin and tumor marker CA19-9 levels were lower (P <0.05). The combination of these markers identified patients with AIP with 92% sensitivity and 79% specificity, which indicated relatively high diagnostic value. Elevated serum eosinophils, globulin, together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to initiate diagnosis of AIP in time.

Serological Investigation against Recombinant Hepatitis B Virus Surface Mutants in Vaccinated Healthcare Workers and HBV Chronic Carriers with Anti-HBs

Aims: Hepatitis B virus (HBV) infection is still a worldwide public health problem despite regular vaccination programs around the world. This study was performed to investigate the serological pattern of vaccinated subjects against recombinant repeatedly isolates of hepatitis B virus surface mutants, and evaluate the characteristics of HBsAg positive patients having HBs antibodies concurrently. Methods: Fifty vaccinated health care staffs participated in this study accompanied with five patients simultaneously carry HBsAg and anti-HBs antibody. For all the samples, the anti-HBs Enzyme-linked immunosorbent assay was performed for detecting antibody against thirteen recombinant mutants. Findings: The results showed that all vaccinated individuals had clinically sufficient protective antibody values (greater than 10 MIU/ml) with the mean value of 165 mIU/ml ± 29 mIU/ml. whereas, only 30% of individuals showed the complete protective neutralizing immune response to all specific HBsAg recombinant mutants. The lack of responsiveness mainly observed in three of HBV mutants; D144A (70%), Q129R (48.5%) and G145R (ad) (30%) respectively. The HBV chronic carriers with anti-HBs showed having the Q129R, G145R (ay), D144A, T126 N, T126s and G145 (ad) escaped mutants. Conclusion: The lack of responsiveness to some specific HBV mutants in vaccinated subjects, point out the potential risk of exposure to hepatitis B virus mutants.

Serological survey of hepatitis B immunity in healthcare workers in Catalonia (Spain)

ABSTRACTHealthcare workers (HCW) are exposed to preventable infectious diseases, notably hepatitis B (HB). The aim of this study was to determine the immunity of HCW against hepatitis B. We made a seroprevalence study using a self-administered survey and obtained blood samples. Antibodies against the HB surface antigen (anti-HBs) and against the HB core antigen (anti-HBc) were studied. The odds ratio (OR) and 95% confidence intervals (CI) were calculated. The adjusted OR were calculated using logistic regression.Of the 644 HCW who participated (29.7% physicians, 38.7% nurses, 13.4% other clinical workers and 18.3% non-clinical workers), 46.4% were primary care workers and 53.6% hospital workers. The overall prevalence of anti-HBs was 64.4%. HCW aged <25 y had a significantly higher prevalence (86.7%) than those aged 35–44 y (adjusted OR 3.40; 95% CI 1.06–10.90). The prevalence of anti-HBc was 4.1%, and increased with age. Significant differences were found for HCW aged >44 y with respect to those aged 25–34 y. 75.6% of HCW stated they were vaccinated, but only 39.3% had a vaccination card. In HCW who stated they were unvaccinated, 10.8% had a vaccinated serological pattern (anti-HBc-negative and anti-HBs -positive). Written, updated vaccination records are essential to reliably determine the vaccination status.

Risk factors related to the failure of prevention of hepatitis B virus Mother-to-Child transmission in Yunnan, China

ObjectiveTo investigate the relationship between the failure of prevention of hepatitis B virus Mother-to-Child transmission and HBV serological pattern, viral load as well as HBV genotypes. Methods2765 pairs of mother-infant matched samples were collected. These pregnant women were HBsAg positive and delivered at hospital from January 1st, 2011 to June 30th, 2011. Of these samples, 26 pairs of sera samples were randomly selected from 114 pairs of samples which failed in the prevention of hepatitis B virus Mother-to-Child transmission. Serological tests, viral load and genotype detection were performed for further analysis. Additionally, the selected subjects were followed and tested again in 2014. ResultsHBeAg positive rates were 76.92% and 69.23% in mother group and infant group respectively, showed no statistical difference. The average HBV DNA levels were >2×105IU/ml in both mother group and infant group. Genotype analysis revealed that 11 pairs of mother-infant matched samples belonged to C gene type and another 11 pairs were B gene type. Different genotypes were observed in 4 pairs of mother-infant matched samples. ConclusionHbeAg positive and high HBV DNA level were two major risk factors of HBV mother to child transmission. Additionally, nosocomial infection was another potential way of HBV vertical transmission, especially in remote area of Yunnan province.

Prevalence of HBV DNA among 20 million seronegative blood donations in China from 2010 to 2015.

The prevalence of HBV DNA among seronegative blood donations in China has not been studied extensively on a nationwide scale. The aim of this study was to analyse the prevalence, trend, distributions, and serological characteristics of HBV DNA positive/seronegative blood donations. We collected HBV test data from all blood banks of China from 2010 to 2015 and performed supplemental serological tests and quantitative detection of HBV DNA of the seronegative/HBV DNA positive blood donations. We analysed the prevalence of HBV DNA among seronegative blood donations screened by varying nucleotide acid test (NAT) reagents. The analysis results showed that a total of 20,084,187 seronegative blood donations were screened by NAT from 2010 to 2015 in China. The average frequency of HBV DNA among seronegative blood donations was 1/1482, but there has been a steady increase from 1/1861 in 2011 to 1/1269 in 2015. The geographical distribution of seronegative and HBV DNA positive blood donations was roughly consistent with that of HBsAg. The most common serological pattern was HBeAb and HBcAb positive. In conclusion, our study offeres fundamental data of seronegative and HBV DNA positive blood donations throughout China.

Hepatitis B serologic patterns in children of HBV carriers or infected mothers

Background Vertical transmission is usually the cause of increas-ing carrier rates for hepatitis B infection, especially in highly en-demic areas.Objective To determine the serologic patterns of hepatitis B inchildren of HBV carrier/infected mothers.Methods This was a cross sectional study on children of HBVcarrier/infected mothers. Subjects were recruited consecutively andexamined at the Department of Child Health, Cipto MangunkusumoHospital during January–July 2003. Children were included if theywere generally healthy and their parents gave permission. Chil-dren with chronic illness, previous blood transfusions, or drug abusewere excluded.Results Fifty-nine children of 32 HBV carrier/infected mothers wererecruited. HBsAg was positive in 8 children, anti-HBs in 37, andanti-HBc in 4 children. Seventy-three percent of children had beenvaccinated against HBV but only 81% had positive anti-HBs. Ofeighteen children who received hepatitis B vaccine and HBIg atbirth, none was infected. Six out of 25 children who received onlyhepatitis B vaccine were infected.Conclusion HBsAg, anti-HBs, and anti-HBc were positive in 14%,36%, and 7% of children of HBV carrier/infected mothers, respec-tively

Serological Patterns of Hepstitis B Virus Among HBsAg Negative Blood Donors in Baghdad, Iraq by Using Architect System

Background: About 10-15% of population HBV infection becomes chronic, and 85-90% are resolved. In Iraq, HBs-Ag assay by ELISA is only mandatory test for detection of HBV infection in blood donors. Anti- HBc and anti-HBs were not detectable in their sera.Objective: To investigate the distribution of serological patterns for HBV who were HBsAg negative.Material and method: Between July 18, 2011 to December 25, 2011, 10ml of blood samples were collected from National blood Transfusion Center donors, Baghdad, for 25782 individuals (25294 male, 488 female), mean age (20-65)years. HbsAg positive sera excluded (185), and final number of donors included in thestudy was 25597 HbsAg negative.Result: The data showed a previous exposure for HBV(p&gt;0.05) through anti-HBc and anti-HBs 3.8% by Architect system. The anti-HBs combine with anti-HBc was 68.5%, while anti-HBc alone was 31.5%. Independent risk factors were association with married, history of blood transfusion and residence.Conclusion: The prevalence of the HBV in Iraq is 4.6% as intermediate region at first time.

الانماط المصلية لالتهاب الكبد الفيروسي B بين الواهبين للدم السلبيين للمستضد السطحي لالتهاب الكبد الفايروسيB في بغداد –العراق بنظام الفحص المناعي.

الخلفية: ( (10-15% من المصابين بالتهاب الكبد الفايروسي B يصبحون حاملين و(85-90)% منهم يشفون. فحصت المستضدات السطحية لالتهاب الكبد الفايروسي B للواهبين للدم بوساطة الاليزا هي الاختبار التقليدي الوحيد في العراق .بينما لايكشف عن اضداد اللب واضداد المستضد السطحي في مصولهم. الهدف: التعرف على توزيع الانماط المصلية&nbsp; لانتشارالتهاب الكبد الفايروسي B بين المتبرعين بالدم الذين يبدون اصحاء، ويكون لديهم المستضد السطحي لالتهاب الكبد الفايروسيB &nbsp;سلبياً. الطريقة: جمعت العينات&nbsp; خلال الفترة من &nbsp;الثامن عشر من تموز 2011 الى الخامس والعشرين من كانون الاول &nbsp;2011 من المركز الوطني لنقل الدم في بغداد على25782 &nbsp;(25294 &nbsp;ذكر و 488انثى), معدل العمر-20)- 65) سنة.&nbsp; استثنيت العينات التي اظهرت نتيجة موجبة للمستضد من الدراسة (185)،&nbsp; وكان العدد النهائي للواهبين ضمن الدراسة هو 25597 من الذين يكون لديهم المستضد السطحي لالتهاب الكبد الفايروسيB &nbsp;سلبياً. &nbsp;النتائج: اتضح وجود بيانات معنوية عن تعرض سابق لفيروس التهاب الكبد الفايروسي B,&nbsp; خلال فحص اضداد اللب واضداد المستضد السطحي للعينات سالبة المستضد السطحي باستعمال تقنية Architect system &nbsp;&nbsp;بنسبة &nbsp;3.8%&nbsp; لاضداد اللب (1000&nbsp; عينة من اصل(25597 . وجد المضاد السطحي&nbsp; مشتركا مع المضاد اللبي بنسبة (68.5%)، بينما وجد المضاد اللبي منفردا بنسبة (31.5%)، اما عوامل الخطر الاخرى فقد اشتملت على حالات الزواج والسكن وسوابق نقل الدم.

The treatment of nonunions with application of BMP-7 increases the expression pattern for angiogenic and inflammable cytokines: a matched pair analysis.

The local application of bone morphogenetic protein-7 (BMP-7) in combination with the transplantation of autologous bone graft improves the outcome in nonunion treatment; however, the specific reasons remain unclear. In this study, we sought to determine if the local application of BMP-7 contributes to improved bone regeneration in nonunion therapy by modulation of the angiogenic and inflammable cytokine expression patterns of the early inflammation response. Therefore, we utilized the analysis of serological cytokine expression patterns. As a matched pair analysis, best-fitting patients who were treated with transplantation of autologous bone graft (G1, n=10) were compared with patients who were treated with additional application of BMP-7 (G2, n=10). The changes in the cytokine expression patterns were monitored and correlated to clinical data of bone healing. Significant differences in angiogenesis potential (vascular endothelial growth factor [VEGF] serum levels) could be found in the first days after surgery (P<0.05). Furthermore, the increase and absolute amount of VEGF levels in the BMP-7 group were considerably higher than in the control group during the first 2 weeks after surgery. The expression pattern of inflammable cytokines showed noticeable differences in the time point of significant elevated levels, in particular, inflammable cytokines showed an earlier peak in G2. Furthermore, interleukin-6 was significantly elevated within the first week only, comparing G2 to G1 (P<0.05). Our findings indicate that BMP-7 induces an early and more intense expression of VEGF via a direct and postulated indirect pathway, thereby providing a favorable environment for bone healing. Moreover, application of BMP-7 leads to an earlier expression of known proinflammatory cytokines. The results of this study show that application of BMP-7 leads to costimulatory effect on both angiogenic and inflammable cytokine expression patterns that may serve as a possible stimulus for bone regeneration.

Clinical and Serologic Patterns in a Large Canadian Paediatric Cohort with Celiac Disease, At Presentation and Follow-Up

Abstract BACKGROUND: Celiac Disease (CD) is a chronic illness involving an autoimmune response to gluten, leading to small intestinal inflammation in genetically susceptible individuals. A weakness in the North American pediatric CD literature exists around serologic outcomes after initiation of a gluten free diet (GFD). Only one published North American pediatric study looks at normalization of TTG after initiation of a GFD and only assessed TTG normalization at 6 months post diagnosis. Data is also limited on other clinical patters such as levels of anemia and BMI over the course of treatment of CD. OBJECTIVES: We sought to characterize serologic and clinical patterns in CD over an extended course using one of the largest databases of pediatric CD in North America. DESIGN/METHODS: A retrospective review of all patients diagnosed with CD at our institution from 1996-2014 was completed. Patients required biopsy-proven CD according to the Marsh criteria. Data abstracted included age at diagnosis, gender, reason for referral, comorbidities, family history of CD and autoimmune conditions, BMI, hemoglobin, MVC, fer-ritin, IgA and anti-TTG levels. A Cochran-Armitage trend test was used to trend anti-TTG and hemoglobin normalization over time RESULTS: 227 patients were identified who met study criteria. Visits with associated anti-TTG or hemoglobin analysis were categorized by time since diagnosis. At 6-12 months, 12-17 months, 18-23 months, 24-29 months, 30-35 months and 36-41 months from diagnosis 66.7% (n=144), 75% (n=40), 85.6% (n= 76), 86.9 (n= 23), 93.5 (n=62) and 95% (n= 20) of patients had normalized their anti-TTG levels respectively from a baseline of 100% abnormal TTG and 5.7% (n=140), 7.3% (n=41), 5.1% (n=77), 5.0% (n=20), 1.6% (n=60) and 5.0% (n=20) had anemia versus 18% at presentation. CONCLUSION: The small p-value (p=&amp;lt;0.0001) for the Cochran-Armitage test for anti-TTG normalization indicates the increased probability of a normalized anti-TTG as time from diagnosis increases. Knowledge of the slope of this trend could assist clinicians with better understanding the effectiveness of treatment for their patients. In this cohort, anti-TTG levels normalized over a broad time span, with increasing numbers of patients normalizing their anti-TTG through to the end of the study period. Further research goals aim to determine predictors of early anti-TTG normalization. In this cohort, the proportion of patient with anemia quickly decreased from a baseline of 18%, to general pediatric population levels between 6-12 months after treatment initiation and remained stable in this range through to the end of the study period with a non-significant p value (p=0.06) for trend over time.

Evolution of equine infectious anaemia in naturally infected mules with different serological reactivity patterns prior and after immune suppression

Information on equine infectious anaemia (EIA) in mules, including those with an equivocal reaction in agar gel immunodiffusion test (AGIDT), is scarce. For this, a study was conducted to evaluate the clinical, viral loads and pathological findings of two groups of naturally infected asymptomatic mules, respectively with a negative/equivocal and positive AGIDT reactivity, which were subjected to pharmacological immune suppression (IS). A non-infected control was included in the study that remained negative during the observation period. Throughout the whole study, even repeated episodes of recrudescence of EIA were observed in 9 infected mules, independently from their AGIDT reactivity. These events were generally characterised by mild, transient alterations, typical of the EIA acute form represented by hyperthermia and thrombocytopenia, in concomitance with viral RNA (vRNA) peaks that were higher in the Post-IS period, reaching values similar to those of horses during the clinical acute phase of EIA. Total tissue viral nucleic acid loads were greatest in animals with the major vRNA activity and in particular in those with negative/equivocal AGIDT reactivity. vRNA replication levels were around 10–1000 times lower than those reported in horses, with the animals still presenting typical alterations of EIA reactivation. Macroscopic lesions were absent in all the infected animals while histological alterations were characterised by lymphomonocyte infiltrates and moderate hemosiderosis in the cytoplasm of macrophages. On the basis of the above results, even mules with an equivocal/negative AGIDT reaction may act as EIAV reservoirs. Moreover, such animals could escape detection due to the low AGIDT sensitivity and therefore contribute to the maintenance and spread of the infection.

Re-recognizing serological change patterns and antiviral therapy opportunity of patients with acute hepatitis B through highly sensitive detection technology

This study was conducted to re-recognize serological change patterns of patients with acute hepatitis B (AHB) by a highly sensitive detection technology, as well as to explore methods to select the optimal treatment opportunity. The biochemical and virological parameters of 558 AHB patients were analyzed retrospectively. The serological markers of hepatitis B virus and HBV DNA were detected by electrochemiluminescence immunoassay and automatic real-time fluorescent quantitative PCR, respectively. At baseline, the positive rate of hepatitis B surface antigen (HBsAg) (86.2%) was significantly higher than the positive rate of HBV DNA (51.9%). Among the 58 patients with HBsAg-negative AHB, 16 were detected with trace amounts of HBV DNA at baseline. At 12 weeks, the HBsAg of 43 cases remained positive, and the mean level of HBsAg was 587.5IU/mL±313.4IU/mL. A total of 18 patients with HBsAg levels greater than 1500IU/mL at 12 weeks received interferon α-1b treatment and achieved HBsAg clearance within 24 weeks. Unlike traditional changing patterns, the clearance of HBV DNA in peripheral circulation for a few patients with AHB occurred later than HBsAg clearance. Detection of HBV DNA in peripheral circulation by highly sensitive detection technology could provide a diagnostic basis for those AHB patients who rapidly achieved HBsAg clearance before achieving HBV DNA clearance in their peripheral circulation and prevent misdiagnosis. Dynamic monitoring of the changes in HBsAg levels through highly sensitive detection technology could be used as a guide for the timely adoption of antiviral treatment with interferon and then AHB chronicity would be prevented.

36 Clinical and Serologic Patterns in a Large Canadian Pediatric Cohort With Celiac Disease at Presentation and Follow-Up

36 Clinical and Serologic Patterns in a Large Canadian Pediatric Cohort With Celiac Disease at Presentation and Follow-Up

Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis

IntroductionHepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentationHere, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. ConclusionsIsolated HBsAg positivity may result from multiple causes, one of which is cross-reactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications.

To chew or not to chew: that's the question

A 25-year-old Somalian man was referred to the department of internal medicine because of nausea, vomiting and jaundice of recent onset. On physical examination, he was frankly icteric without clinical signs of chronic liver disease. Laboratory data showed evidence of acute hepatitis. Viral serologic tests for hepatitis A, B, C and E were negative. Antinuclear antibodies (ANA) were positive (titre 1 : 1280; speckled pattern, NV < 1 : 40) as well anti-actin antibodies (titre 75 UA, NV < 20). A liver biopsy was performed and showed a feature compatible with toxic hepatitis. On further questioning, the patient admitted to daily chew Khat when he was living in Somalia. We concluded to Khat-induced toxic hepatitis together with high-titre anti-nuclear antibody mimicking serologic patterns of auto-immune hepatitis.

Occult hepatitis B virus infection: a new challenge for hepatitis B vaccine to block mother-to-child transmission

Occult hepatitis B virus infection (OBI) could occur in infants born to HBsAg-positive mothers after active and passive immunization, even though their serological patterns suggested successful protection from HBV mother-to-infant transmission according to the current criteria of being HBsAg-negative and anti-HBs positive. We should take into account its potential clinical impact and reconsider the effectiveness of the present immunoprophylaxis against HBV in this population. This review will focus on topics including the prevalence, serological features and probable risk factors underlying the phenomenon of OBI in infants with HBsAg carrier mothers after immunization.

Prevention and management of hepatitis B virus reactivation in cancer patients.

Hepatitis B virus (HBV) reactivation during immunosuppressive therapy is common in patients with solid tumor or hematological malignancies. It is associated with significant morbidity and mortality due to hepatitis flare and/or hepatic decompensation. These consequences arising from HBV reactivation are, however, largely preventable. Routine screening for HBV serologic status is recommended for all cancer patients undergoing chemotherapy or biologics. By recognizing different serological patterns (which represent either overt or occult HBV infection) and the types of immunosuppressive therapies prescribed, a risk-adapted approach can be established. Prophylactic therapy with nucleos(t)ide analogues (prior to or concomitantly with the commencement of immunosuppressive therapies) is more effective than pre-emptive therapy (starting antiviral when HBV DNA level is rising) in high-risk individuals. Entecavir has been proven to be more effective than lamivudine according to recent studies. Close monitoring of serum HBV level is the preferred strategy in low-risk patients. However, the optimal interval of DNA monitoring and the duration of therapy remain unknown.

Efforts in blood safety: Integrated approach for serological diagnosis of syphilis.

Recent efforts in transfusion medicine are focused on improving blood safety as well as establishing effective and efficient diagnostic algorithms for donor screening. To date, syphilis is a transfusion-transmitted infection re-emerged in many countries as a public health threat especially among populations at specific risk. This task requires new diagnostic tools and hemovigilance programs. The current diagnostic methodologies are debated, since presenting limitations and unresolved issues with special regard to the clinical interpretation of serological patterns, especially in asymptomatic patients and in blood donors. Furthermore, the switch from the traditional to alternative diagnostic algorithms underlines the lack of a gold standard, which has not been supported by shared guidelines. Besides, a lot of ongoing clinical trials on the performance of diagnostic assays, on the serological response associated with different pharmacological treatments, as well as on the prevention programs are currently under investigation. Here, we review the recent literature about the diagnosis of syphilis especially for low-risk populations proposing the adoption of an algorithm for blood donor screening that should satisfy the need of increasing safety for transfusion-transmitted infections in the modern blood transfusion centers.