Serological Evidence Of Previous Infection Research Articles

P154 Male lupus characteristics from multi-ethnic cohort

Abstract Background/Aims Systemic lupus erythematous (SLE) is a chronic autoimmune (AI) disease of unknown etiology. It predominantly presents in women and only 1 in 10 of sufferers are men. We sought to examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London, UK. Methods Male lupus patients were identified through review of a pre-existing lupus patients database and clinic lists at Barts Trust. All patients’ electronic notes were reviewed prior to a telephone interview. All the participants fulfilled the ACR 1997 criteria for SLE. Descriptive data analysis was performed for all identified patients. Results Fifty-one patients were identified. Sample demographics showed that male lupus was more prevalent among Afro-Caribbeans (37%,n=19), followed by Asians (33%,n=17) and Caucasians (29%,n=15). The median age was 40.5 (IQR:32.5-52.7) years, with median age at SLE diagnosis 28 years (IQR:23-45).Family history of an AI condition was seen in 25%, whilst 14% had a family history specifically of SLE. Possible significant stressor prior to diagnosis reported in 45% (n = 23) patients. Serological evidence of previous infection with EBV, VZV or parvovirus was found in 76%. Although all patients were below the state pension age of 66, more than half were unemployed. The majority of males had multiorgan involvement including renal (67%,n=34), cutaneous (55%,n=28), hematological (45%,n=23), musculoskeletal (31%,n=16), cardiac (27%,n=14), pulmonary (20%,n=10), and neurologic (14%,n=7). Renal biopsy was done in 33/34 renal cases and the showed proliferative class-III/IV in 65%. Hypertension was a significant comorbidity in 39%, 47% had a concomitant AI condition. Juvenile-onset SLE was diagnosed in 6% of the patients with median age at disease onset 10 years (IQR:14-16,100% Caucasians). These males all had kidney nephropathy class-IV/V. Regarding serology, 94% were positive for antinuclear antibody, 40% speckled, 31% homogenous, and 8% for nucleolar and mixed pattern. Two patients ANA test was not recorded but they had confirmed renal/cutaneous biopsy findings.Three-quarters were positive for anti-double stranded DNA. Ro and La antigens were detected in 35% and 8%, while anti-Sm and anti-RNP antibodies were detected in 37% and 43%, respectively. Antiphospholipid antibodies were identified in less than a third, of which 40% presented with thrombotic events. Triple antiphospholipid antibodies was detected in 53%, 20% had LA, 15% had aCL, and 7% had either anti-B2GP1 or aCL/anti-B2GP. Conclusion Our dataset demonstrates a higher prevalence in Afro-Caribbean and Asians and a young age of onset (median 28 years) with presentation about 10 years earlier than most other reports. The majority were unemployed and reported significant life-stressors. Over three-quarters of patients had evidence of prior infection.Most of the lupus males had multiorgan involvement and over two-thirds had renal involvement, proliferative class-III/IV. There was a high prevalence of dsDNA, ENA (anti-Ro) and APL. Disclosure H. Aldeyarbi: None. S. George: None. G. Marchan: None. R. Rajakariar: None. A. Cove-Smith: None. A. Pakozdi: None. M. Cunningham: None. M. Lewis: None. B. Turner: None. D. Pyne: None.

Adipose Tissues from Human and Bat-Derived Cell Lines Support Ebola Virus Infection.

Ebola virus is a zoonotic pathogen with a geographic range covering diverse ecosystems that are home to many potential reservoir species. Although researchers have detected Ebola virus RNA and serological evidence of previous infection in different rodents and bats, the infectious virus has not been isolated. The field is missing critical knowledge about where the virus is maintained between outbreaks, either because the virus is rarely encountered, overlooked during sampling, and/or requires specific unknown conditions that regulate viral expression. This study assessed adipose tissue as a previously overlooked tissue capable of supporting Ebola virus infection. Adipose tissue is a dynamic endocrine organ helping to regulate and coordinate homeostasis, energy metabolism, and neuroendocrine and immune functions. Through in vitro infection of human and bat (Eptesicus fuscus) brown adipose tissue cultures using wild-type Ebola virus, this study showed high levels of viral replication for 28 days with no qualitative indicators of cytopathic effects. In addition, alterations in adipocyte metabolism following long-term infection were qualitatively observed through an increase in lipid droplet number while decreasing in size, a harbinger of lipolysis or adipocyte browning. The finding that bat and human adipocytes are susceptible to Ebola virus infection has important implications for potential tissue tropisms that have not yet been investigated. Additionally, the findings suggest how the metabolism of this tissue may play a role in pathogenesis, viral transmission, and/or zoonotic spillover events.

Incidence of Hepatitis E Infection in American Patients With Suspected Drug-Induced Liver Injury Is Low and Declining: The DILIN Prospective Study.

Hepatitis E virus (HEV) infection rarely causes icteric hepatitis, yet 10%-40% of adult Americans have serological evidence of previous infection. The aim of this study was to investigate the incidence, presentation, and outcome of acute and previous HEV infection in a large cohort of patients with suspected drug-induced liver injury (DILI). Serum samples from 2012 patients enrolled in the DILI Network were tested for anti-HEV immunoglobulin G (IgG). Those with detectable anti-HEV IgG underwent testing for anti-HEV IgM; those with detectable anti-HEV immunoglobulin m (IgM) were tested for HEV RNA. Anti-HEV IgG was detected in 407 (20%) patients and associated with increasing subject age and earlier year of enrollment. The median age of seropositive subjects was more than a decade higher than seronegative subjects (59.8 vs 48.7 years). The overall prevalence of anti-HEV declined from 22% (2004-2011) to 18% (2012-2019), suggestive of a cohort effect. The frequency of acute hepatitis E (median ALT = 1231 IU/L) also decreased from 3% (2004-2008) to 1.2% (2009-2013) to 0.6% (2014-2019). These results suggest that acute HEV infection is usually subclinical and was much more frequent in this cohort before 2004. Acute HEV infection accounts for less than 1% of suspected American DILI cases and is more frequent in older men. Previous HEV infection is also most commonly seen in older individuals. Clinicians should consider testing for unsuspected acute HEV infection in older adult patients with acute hepatocellular DILI and jaundice.

High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening.

Strategies to minimize the risk of transmission and acquisition of COVID-19 infection in patients with ESKD receiving in-center hemodialysis have been rapidly implemented across the globe. Despite these interventions, confirmed COVID-19 infection rates have been high in the United Kingdom. Prevalence of asymptomatic disease in an adult hemodialysis population has not been reported. Also, to our knowledge, the development of humoral response to SARS-CoV-2 has not been previously reported in this population. Although serologic testing does not provide information on the infectivity of patients, seroprevalence studies may enable investigation of exposure within dialysis units and hence, assessment of current screening strategies. To investigate the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population, we used the Abbott IgG assay with the Architect system to test serum samples from 356 patients receiving in-center hemodialysis for SARS-CoV-2 antibodies. Of 356 patients, 121 had been symptomatic when screened before a dialysis session and received an RT-PCR test; 79 (22.2% of the total study population) tested positive for COVID-19. Serologic testing of all 356 patients found 129 (36.2%) who tested positive for SARS-CoV-2 antibodies. Only two patients with PCR-confirmed infection did not seroconvert. Of the 129 patients with SARS-CoV-2 antibodies, 52 (40.3%) had asymptomatic disease or undetected disease by PCR testing alone. We found a high seroprevalence of SARS-CoV-2 antibodies in patients receiving in-center hemodialysis. Serologic evidence of previous infection in asymptomatic or PCR-negative patients suggests that current diagnostic screening strategies may be limited in their ability to detect acute infection.

Conjunctival transcriptome profiling of Solomon Islanders with active trachoma in the absence of Chlamydia trachomatis infection

BackgroundClinical signs of active (inflammatory) trachoma are found in many children in the Solomon Islands, but the majority of these individuals have no serological evidence of previous infection with Chlamydia trachomatis. In Temotu and Rennell and Bellona provinces, ocular infections with C. trachomatis were seldom detected among children with active trachoma; a similar lack of association was seen between active trachoma and other common bacterial and viral causes of follicular conjunctivitis. Here, we set out to characterise patterns of gene expression at the conjunctivae of children in these provinces with and without clinical signs of trachomatous inflammation-follicular (TF) and C. trachomatis infection.MethodsPurified RNA from children with and without active trachoma was run on Affymetrix GeneChip Human Transcriptome Array 2.0 microarrays. Profiles were compared between individuals with ocular C. trachomatis infection and TF (group DI; n = 6), individuals with TF but no C. trachomatis infection (group D; n = 7), and individuals without TF or C. trachomatis infection (group N; n = 7). Differential gene expression and gene set enrichment for pathway membership were assessed.ResultsConjunctival gene expression profiles were more similar within-group than between-group. Principal components analysis indicated that the first and second principal components combined explained almost 50% of the variance in the dataset. When comparing the DI group to the N group, genes involved in T-cell proliferation, B-cell signalling and CD8+ T cell signalling pathways were differentially regulated. When comparing the DI group to the D group, CD8+ T-cell regulation, interferon-gamma and IL17 production pathways were enriched. Genes involved in RNA transcription and translation pathways were upregulated when comparing the D group to the N group.ConclusionsGene expression profiles in children in the Solomon Islands indicate immune responses consistent with bacterial infection when TF and C. trachomatis infection are concurrent. The transcriptomes of children with TF but without identified infection were not consistent with allergic or viral conjunctivitis.

Fc Gamma Receptor 3A Polymorphism and Risk for HIV-Associated Cryptococcal Disease

ABSTRACTCryptococcus neoformans is one of the most common causes of fungal disease in HIV-infected persons, but not all of those who are infected develop cryptococcal disease (CD). Although CD4+ T cell deficiency is a risk factor for HIV-associated CD, polymorphisms of phagocytic Fc gamma receptors (FCGRs) have been linked to CD risk in HIV-uninfected persons. To investigate associations between FCGR2A 131 H/R and FCGR3A 158 F/V polymorphisms and CD risk in HIV-infected persons, we performed PCR-based genotyping on banked samples from 164 men enrolled in the Multicenter AIDS Cohort Study (MACS): 55 who were HIV infected and developed CD and a matched control group of 54 who were HIV infected and 55 who were HIV uninfected. Using additive and allelic statistical models for analysis, the high-affinity FCGR3A 158V allele was significantly associated with CD status after adjusting for race/ethnicity (odds ratio [OR], 2.1; P = 0.005), as was the FCGR3A 158 VV homozygous genotype after adjusting for race/ethnicity, rate of CD4+ T cell decline, and nadir CD4+ T cell count (OR, 21; P = 0.005). No associations between CD and FCGR2A 131 H/R polymorphism were identified. In binding studies, human IgG (hIgG)-C. neoformans complexes exhibited more binding to CHO-K1 cells expressing FCGR3A 158V than to those expressing FCGR3A 158F, and in cytotoxicity assays, natural killer (NK) cells expressing FCGR3A 158V induced more C. neoformans-infected monocyte cytotoxicity than those expressing FCGR3A 158F. Together, these results show an association between the FCGR3A 158V allele and risk for HIV-associated CD and suggest that this polymorphism could promote C. neoformans pathogenesis via increased binding of C. neoformans immune complexes, resulting in increased phagocyte cargo and/or immune activation.

Serological evidence for avian H9N2 influenza virus infections among Romanian agriculture workers

In recent years, wild birds have introduced multiple highly pathogenic avian influenza (HPAI) H5N1 virus infections in Romanian poultry. In 2005 HPAI infections were widespread among domestic poultry and anecdotal reports suggested domestic pigs may also have been exposed. We sought to examine evidence for zoonotic influenza infections among Romanian agriculture workers. Between 2009 and 2010, 363 adult participants were enrolled in a cross-sectional, seroepidemiological study. Confined animal feeding operation (CAFO) swine workers in Tulcea and small, traditional backyard farmers in Cluj-Napoca were enrolled, as well as a non-animal exposed control group from Cluj-Napoca. Enrollment sera were examined for serological evidence of previous infection with 9 avian and 3 human influenza virus strains. Serologic assays showed no evidence of previous infection with 7 low pathogenic avian influenza viruses or with HPAI H5N1. However, 33 participants (9.1%) had elevated microneutralization antibody titers against avian-like A/Hong Kong/1073/1999(H9N2), 5 with titers ≥ 1:80 whom all reported exposure to poultry. Moderate poultry exposure was significantly associated with elevated titers after controlling for the subjects' age (adjusted OR = 3.6; 95% CI, 1.1-12.1). There was no evidence that previous infection with human H3N2 or H2N2 viruses were confounding the H9N2 seroreactivity. These data suggest that H9N2 virus may have circulated in Romanian poultry and occasionally infected man.

Evidence for avian H9N2 influenza virus infections among rural villagers in Cambodia

Southeast Asia remains a critical region for the emergence of novel and/or zoonotic influenza, underscoring the importance of extensive sampling in rural areas where early transmission is most likely to occur. In 2008, 800 adult participants from eight sites were enrolled in a prospective population-based study of avian influenza (AI) virus transmission where highly pathogenic avian influenza (HPAI) H5N1 virus had been reported in humans and poultry from 2006 to 2008. From their enrollment sera and questionnaires, we report risk factor findings for serologic evidence of previous infection with 18 AI virus strains. Serologic assays revealed no evidence of previous infection with 13 different low-pathogenic AI viruses or with HPAI avian-like A/Cambodia/R0404050/2007(H5N1). However, 21 participants had elevated antibodies against avian-like A/Hong Kong/1073/1999(H9N2), validated with a monoclonal antibody blocking ELISA assay specific for avian H9. Although cross-reaction from antibodies against human influenza viruses cannot be completely excluded, the study data suggest that a number of participants were previously infected with the avian-like A/Hong Kong/1073/1999(H9N2) virus, likely due to as yet unidentified environmental exposures. Prospective data from this cohort will help us better understand the serology of zoonotic influenza infection in a rural cohort in SE Asia.

XMRV Infection in Patients With Prostate Cancer: Novel Serologic Assay and Correlation With PCR and FISH

To develop a serum-based assay to detect neutralizing antibodies to the xenotropic murine leukemia virus-related virus (XMRV) retrovirus and to use this assay with polymerase chain reaction and fluorescence in situ hybridization to identify patients with prostate cancer previously exposed to XMRV infection and those who carry XMRV viral sequences in their prostate. Patients who had undergone radical prostatectomy were enrolled, and biologic specimens were obtained at surgery. The patients were genotyped for the R462Q RNASEL variant using a TaqMan genotyping assay on DNA from the peripheral blood. A serum assay that detects XMRV neutralizing antibodies was developed and used to determine which patients had serologic evidence of previous infection with XMRV virus. Some of these patients were also tested for the presence of XMRV nucleotide sequences in their prostate using polymerase chain reaction and fluorescence in situ hybridization analysis. At a serum dilution of 1:150, our assay detected 11 (27.5%) of 40 patients with XMRV neutralizing antibodies, including 8 (40%) of 20 with the RNASEL genotype QQ and 3 (15%) of 20 with either the RQ or RR genotype. These results were in complete concordance with 2 other assays (polymerase chain reaction and fluorescence in situ hybridization), which were designed to detect XMRV infection. XMRV infects some patients with prostate cancer. Neutralizing antibodies against XMRV correlated with 2 independent methods of detecting the virus in the prostate. The antibody response suggests that with clinical serologic assay development, it might be possible to screen patients for XMRV infection. The cases presented in the present report provided biologic samples that can be used for the development of a clinically relevant assay.

Evidence of Previous Avian Influenza Infection among US Turkey Workers

The threat of an influenza pandemic is looming, with new cases of sporadic avian influenza infections in man frequently reported. Exposure to diseased poultry is a leading risk factor for these infections. In this study, we used logistic regression to investigate serological evidence of previous infection with avian influenza subtypes H4, H5, H6, H7, H8, H9, H10, and H11 among 95 adults occupationally exposed to turkeys in the US Midwest and 82 unexposed controls. Our results indicate that farmers practising backyard, organic or free-ranging turkey production methods are at an increased risk of infection with avian influenza. Among these farmers, the adjusted odds ratios (ORs) for elevated microneutralization assay titres against avian H4, H5, H6, H9, and H10 influenza strains ranged between 3.9 (95% CI 1.2-12.8) and 15.3 (95% CI 2.0-115.2) when compared to non-exposed controls. The measured ORs were adjusted for antibody titres against human influenza viruses and other exposure variables. These data suggest that sometime in their lives, the workers had been exposed to low pathogenicity avian influenza viruses. These findings support calls for inclusion of agricultural workers in priority groups in pandemic influenza preparedness efforts. These data further support increasing surveillance and other preparedness efforts to include not only confinement poultry facilities, but more importantly, also small scale farms.

Viral Infections and Prolonged Fever after Liver Transplantation in Young Children with Inborn Errors of Metabolism

Liver transplantation could be a useful treatment for selected inborn errors of metabolism. This study evaluated the outcome and viral infections after liver transplantation in young children and infants with these diseases. The outcome of liver transplantation and clinical characteristics of the following 4 patients were assessed: 1 infant with ornithine transcarbamylase deficiency (OTCD) who received liver transplant aged 3 years and 4 months; 1 infant with carbamyl phosphate synthetase I deficiency (CPSID) who received liver transplant at 14 months of age; and 2 infants with methylmalonic acidemia (MMA) who received liver transplant at 8 months and 11 months of age, respectively. All donors, except the 8-month-old infant with MMA, showed serologic evidence of previous cytomegalovirus (CMV) infection before transplantation. All 4 of these donors showed serologic evidence of previous infection of Epstein-Barr virus (EBV). None of the recipients had previous CMV infection. Both the infant with OTCD and the 8-month-old infant with MMA had previous EBV infection, while the other 2 patients did not. Preoperative hemodialysis was performed in both infants with MMA. Postoperative follow-up included metabolic stability, disability degree, and viral infections. None of the patients developed severe metabolic decompensation after transplantation and all increased protein intake postoperatively. Symptomatic viral infections, however, were present in all patients postoperatively, including CMV infection in the infant with OTCD and the 11-month-old infant with MMA, reactivation of EBV infection in the infant with OTCD and the 8-month-old infant with MMA, and primary EBV infection in the infant with CPSID. Liver transplantation was an effective treatment for all 4 of these patients with inborn errors of metabolism. The risk of symptomatic viral infections for these patients was high. This was likely associated with conditions including immunosuppression, young age, endemic nature of CMV and EBV infections, and lack of CMV prophylaxis.

Perinatal Parvovirus B19 Infection

After completing this article, readers should be able to: 1. Understand the epidemiology of parvovirus B19 infection. 2. Describe the clinical and hematologic features of B19 infection. 3. List the virologic and serologic tests used to diagnose B19 infection. 4. Describe the fetal consequences of maternal B19 infection. Parvovirus B19 infection in pregnancy may result in fetal infection with complications that include nonimmune hydrops and fetal death. Early case reports beginning in 1984 highlighted fetal adverse outcomes; subsequent prospective studies indicate a risk of adverse pregnancy outcomes considerably lower than initially appreciated. Nonetheless, the occurrence of severe nonimmune hydrops or stillbirths in even a small percentage of parvovirus B19-infected pregnant women is a concern. Human parvovirus was discovered in 1975. These small, single-stranded DNA viruses are distributed widely among mammals. B19 is the only human parvovirus identified to date. The virus is structurally simple; the genome consists of approximately 5,600 base pairs and three viral-coded proteins. Two proteins, designated VP1 and VP2, form the viral capsid; the third known protein is nonstructural (NS1) and is associated with viral replication and cytotoxicity. Viral replication occurs only in rapidly dividing cells, which partially explains the proclivity of the virus for fetal tissues and rapidly dividing erythrocyte precursors. B19 infection is common in childhood, with serologic evidence of previous infection seen in approximately 50% of adults. Following an incubation of about 10 days, symptoms, including fever and a flulike illness, may occur. This first phase of infection is accompanied by viremia. In 7 to 10 days, a second phase is characterized by immune-mediated symptoms such as rash and arthralgia. Viremia has ceased by the time the second phase of illness occurs, and virus no longer can be detected in respiratory secretions. The previous description of illness characterizes erythema infectiosum (fifth disease). The spectrum of symptoms includes asymptomatic …

Aplastic anemia successfully treated with rituximab

An otherwise healthy 73-year-old female was admitted to our department in 1997 because of easy bruising and a platelet count of 12 x 10(9)/L. The patient was taking no medications. Bone marrow examination revealed erythroid hyperplasia, megakaryocytic hypoplasia, and no sign of malignancy. Chromosome analysis showed a normal karyotype. There was serological evidence of previous infection with parvovirus B19. No antibodies to HBV, HCV, CMV, or EBV were found. ANA and cardiolipin antibodies were not detected. Treatment with prednisolone was without effect, but 3 weeks after i.v. gamma-globulin therapy, the platelet count was normal, 233 x 10(9)/L. Two years later, the patient was readmitted with a platelet count of 11 x 10(9)/L. At this time, treatment with corticosteroids, azathioprine, and gamma-globulin had only a temporary effect, and further therapy was stopped because of side effects. During the next 3 years, the patient developed transfusion-dependent anemia, and her white blood cell count decreased to 1.8 x 10(9)/L. A new bone marrow examination showed aplastic anemia with bone marrow cellularity about 10%. After an intracerebral hemorrhage, the patient accepted treatment with rituximab and received 4 weekly doses of 375 mg/m2. This therapy was followed by an increase in the platelet count to 232 x 10(9)/L, white blood cell count to 6.8 x 10(9)/L, and no more need for blood transfusions. A bone marrow examination 5 months after treatment with rituximab showed hyperplastic myelopoiesis, normoblastic erythropoiesis, and slightly reduced megakaryopoiesis. The use of anti-CD20 monoclonal antibody in aplastic anemia warrants further investigation.

Development of an ELISA procedure to detect swine carriers of pathogenic Yersinia enterocolitica

An enzyme immunoassay (ELISA) was developed to detect antibodies in pigs against the lipopolysaccharidic antigen of the three serotypes of Yersinia enterocolitica mostly associated with human infections. Recent epidemiological evidence has demonstrated that pigs and pork are important sources of yersiniosis in humans. The purpose of this study was to clarify the use of an ELISA to detect swine carriers of this enteroinvasive bacteria by examining seroconversion and tissue distribution of Y. enterocolitica following experimental infection and then screening pigs at a slaughterhouse by bacterial culture and ELISA. It was observed that seroconversion occurred in animals experimentally inoculated with Y. enterocolitica but not with other enterobacteria. It was also found that 27% of swine at a slaughterhouse carried the bacterium in their tonsils and/or intestinal tract, whereas 66% showed serological evidence of previous infection. About 6% of swine at slaughter were culture-positive, but seronegative. Although, similar numbers of swine showed serological evidence of previous infection by each of the three Y. enterocolitica serotypes tested, virtually all culture isolates belonged to serotype O:3. This ELISA appears as a valuable control tool that can be used, in conjunction with culture, to identify pigs or herds infected by strains of Y. enterocolitica associated with human infections.

Cytomegalovirus infection and coronary heart disease: results of a german case-control study.

This case-control study investigated whether previous infection with cytomegalovirus (CMV) was associated with coronary heart disease (CHD). In total, 312 patients of German nationality aged 40-68 years who had a coronary stenosis of >50% of the luminal diameter were recruited for study. Controls (n=479) were voluntary blood donors. CMV serology was performed to determine presence of specific CMV antibodies (IgG, IgM, IgA ELA test; Medac, Hamburg, Germany). Rheologic and inflammatory markers were determined. The prevalence of specific IgG antibodies against CMV was 54.5% in cases and 49.9% in controls (P=.116). The odds ratio for CHD was 1.21 (95% confidence interval, 0.84-1.75) given a positive serostatus of specific IgG antibodies after adjustment for covariates. With the exception of C-reactive protein in controls, none of the rheologic or inflammatory markers was associated with CMV serostatus. Thus, serologic evidence of previous infection with CMV was not a major risk factor for CHD in this population.

Helicobacter pylori infection status in relation to antibiotic and non-steroidal prescribing in patients on maintenance treatment for chronic duodenal ulcer.

It has been suggested that establishing Helicobacter pylori infection status is irrelevant prior to H. pylori eradication treatment in chronic duodenal ulcer, as virtually all may benefit from therapy. The aim of the present study was (i) to determine the prevalence of active H. pylori infection in patients with proven chronic duodenal ulcer on long-term H2-antagonist prophylactic treatment and whether knowledge of this would influence the use of eradication therapy and (ii) to assess other factors which might influence the clinical diagnosis or H. pylori status, such as non-steroidal and antibiotic use. One hundred and forty-five patients receiving long-term H2-antagonists for chronic duodenal ulcer were recruited. Their case records and a prescribing database were reviewed. Patients underwent endoscopy with biopsies for rapid urease test, histology and H. pylori culture. Serum was immunoblotted and an enzyme-linked immunosorbent assay for H. pylori was performed. Of the 145 patients, 128 (88%) were H. pylori biopsy positive. Twelve of the 17 H. pylori biopsy-negative patients had anti-H. pylori immunoglobulin G (IgG) antibodies and 10 of the 17 H. pylori-negative patients had previously received antibiotics for other indications. Nine patients were exposed to non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) and one had additional aspirin exposure. Only 11.7% of patients on maintenance treatment for chronic duodenal ulcer had no current infection with H. pylori, although more than 70% of these had serological evidence of previous infection. Confirmation of active infection may be indicated where there is a history of NSAID or antibiotic exposure and may result in more precise targeting of eradication therapy, thus avoiding unnecessary and potentially hazardous treatment.

Viral hepatitis.

Preview The incidence of viral hepatitis in the United States has remained fairly constant for several decades, despite the availability of vaccines and prophylactic measures and improved sanitation nationwide. However, epidemiologic findings, including risk factors for acquisition, are changing, probably because of changes in human ecology and behavior. Dr Becherer discusses this evolution in viral hepatitis and its effect on serologic screening.

Carcinoma nasofaríngeo en la infancia

A 1 3 yeat old girl was seen because of persistent upper respiratory symptoms and bilateral cervical lymph nodeenlargement Needle aspiration of a right pharyngeal tumor, biosy, computed axial tomography, thorax and bone X rayfilms were compatible with a stage IV nasopharrygeal carcinoma, Serological evidence of previous infection by EpsteinBair virus was also found. Some lymph node enlargement persisted after appropriate radiation therapy, but goodsubsequent response to chemotheraphy was observed. This malignancy has low incidence in pediatric patients.Diagnosis is based on computed axia! tomography of the nasopharyngeal region and biopsy of tumoral mass or involvedlymph nodes. There is a frequent association with previous Epslein Barr virus infection. Prognosis depends on clinicalstage of the disease and current treatment consist in irradiation and chemotherapy.(Key words: Nasopharingeal neoplasm, carcinoma, Ebstein Barr virus.]

Relationships between maternal immunity to herpes simplex virus and the risk of neonatal herpesvirus infection.

Current seroepidemiologic studies performed with assays that measure type-specific antibodies to herpes simplex virus (HSV) type 2 have demonstrated that infection due to the virus is common among women of child-bearing age. With regard to perinatal transmission of HSV, the virus infects nearly 50% of infants whose mothers have primary genital herpes, whereas less than 5% of infants exposed to recurrent maternal infection at the time of delivery become infected. Maternal immunity may also influence the clinical manifestations of neonatal herpes, with primary maternal infection more likely to be associated with disseminated disease in the infant. An effective HSV vaccine could alter the prevalence of neonatal herpes by (1) reducing women's risk of acquiring primary genital herpes during pregnancy and (2) boosting immunity in mothers for whom serologic evidence of previous infection due to HSV type 2 has been noted, which will enhance the transplacental transfer of virus-specific antibodies.

Occupational Risk Factors for Infection with Parvovirus B19 Among Pregnant Women

To identify exposures associated with parvovirus B19 infection during pregnancy, two groups of pregnant women were studied during an outbreak of erythema infectiosum (EI). Of 796 pregnant women from Connecticut who were tested serologically because of perceived exposure to B19, 53% (419/796) had serologic evidence of previous B19 infection, and 6% (23/376) of the rest had evidence of recent infection. Of 121 pregnant women who had not requested testing but who lived in a community where a large outbreak of EI had occurred among schoolchildren, 36% (43/121) had serologic evidence of previous infection, and only 3% (2/78) of the rest had had a recent infection. In the exposed group, 479 women returned a supplemental exposure questionnaire. The highest infection rates among susceptible women were for schoolteachers (16%, 10/64), followed by day care workers (9%, 2/22) and homemakers (9%, 4/46). Women working outside the home but not in school or day care settings had the lowest risk (4%, 3/80). This study suggests that there is risk for B19 infection in selected occupational settings and in households.