Superinfection In Patients Research Articles

Concurrent hepatitis C virus and hepatitis delta virus superinfection in patients with chronic hepatitis B virus infection.

Since hepatitis C virus (HCV) and hepatitis delta virus (HDV) are transmitted by the same routes as hepatitis B virus (HBV), simultaneous or concurrent HCV and HDV infection in patients with chronic HBV infection may occur. To test this hypothesis and to examine the clinicohistological and immunopathological presentations of such multiple hepatitis virus infections, acute and/or convalescent serum specimens from 86 patients with acute HDV superinfection were tested by enzyme immunoassay for antibodies to HCV. Of the 86 patients, 18 (20.9%) were associated with HCV infection. Although patients with early mortality cannot be evaluated by the HCV markers used in this study, the results showed that the clinical and histologic features were similar except that patients with HCV infection were older than those without HCV infection (P less than 0.01). Immunopathological studies carried out within 2 months after the onset of acute HDV superinfection demonstrated that hepatitis B core antigen (HBcAg) was not detected in any patient and HDV antigen was detected in 18.2% of the patients with HCV infection whereas HBcAg and HDAg were found in 7% and 65.1%, respectively, of those without HCV coinfection (P less than 0.02). It is concluded that concurrent HCV and HDV superinfections can and do occur in patients with chronic HBV infection. In these triple viral infections, HCV may even transiently suppress HDV and HBV.

Acute hepatitis delta virus superinfection in patients with liver cirrhosis

A clinicopathologic study in a total of 164 patients with acute hepatitis delta virus (HDV) infection showed that nine male patients (5.5%) had evidence of liver cirrhosis prior to or during the episode of acute hepatitis. All nine patients had typical clinical presentations and laboratory findings of acute viral hepatitis. Four of them had prolonged prothrombin time, three developed ascites and one finally died of hepatic failure. Clinical ascites occurred more frequently in cirrhotic patients with severe but non-fulminant hepatitis than their non-cirrhotic counterparts ( p < 0.05). In addition, histologic studies in five patients with cirrhosis disclosed diffuse lobular necrotizing inflammatory activity, with four snowing bridging hepatic necrosis, which also occurs more frequently in cirrhotic than in non-cirrhotic patients ( p < 0.05). The data suggest that HBsAg positive patients with cirrhosis are susceptible to acute HDV infection which may lead to extensive necrosis or even decompensation and failure, simulating decompensation of the underlying liver disease. Therefore, careful clinicopathologic work-ups are required for accurate diagnosis and correct assessment of their outcomes.

Effect of blood product medium supplements on the activity of cefotaxime and other cephalosporins against Enterococcus faecalis

The activities of cefotaxime and other aminothiazoyl oxime cephalosporins against Enterococcus faecalis were enhanced by addition of 5% sheep blood to Mueller-Hinton agar. This effect was not seen with aztreonam (aminothiazoyl oxime monobactam), cefotiam (aminothiazoyl, nonoxime), or other cephalosporins, and it was specific to the syn-configuration of the oxime moiety. Enhancement of cefotaxime activity was demonstrable against approximately 50% of 86 clinical isolates and could only be shown at low bacterial inocula. Human serum, serum alpha 1-, beta- and gamma-globulin fractions and albumin often antagonized or did not affect significantly the antimicrobial activity of cefotaxime, while the alpha 2-globulin fraction usually enhanced drug activity. The in vivo activity of cefotaxime against E. faecalis was examined in a rat peritoneal abscess model. The test organism was resistant to cefotaxime by standard methods (MIC greater than 128 micrograms/ml) but was inhibited by 1.0 microgram/ml when rat serum was presented in the medium. Cefotaxime reduced titers of bacteria within abscesses after 5 days of therapy (5.77 +/- 0.68 log10 CFU/g) in comparison with those in control animals (7.38 +/- 0.28 log10 CFU/g, p less than 0.05). Moxalactam, the in vitro activity of which was not augmented by serum, proved ineffective in the animal model. While these observations do not have direct therapeutic relevance, they offer a possible explanation for the relatively infrequent occurrence of enterococcal superinfection in patients treated with cefotaxime.

Cefoperazone plus tobramycin versus ticarcillin plus tobramycin in febrile granulocytopenic cancer patients

Cefoperazone plus tobramycin was compared in a prospective, randomized trial with our standard regimen of ticarcillin plus tobramycin as empiric therapy of fever in granulocytopenic patients with cancer. Patients who received cefoperazone were also given vitamin K (5 mg orally twice a week). Of 39 microbiologically and clinically documented infections treated with ticarcillin plus tobramycin, 28 (72 percent) showed improvement. Of 27 microbiologically and clinically documented infections treated with cefoperazone plus tobramycin, 21 (78 percent) showed improvement. The overall response rates were similar (40 of 53, or 74 percent, for ticarcillin plus tobramycin versus 38 of 48, or 79 percent for cefoperazone plus tobramycin). There was no difference in response between groups according to site of infection. Serious side effects were minimal with both regimens. There were no enterococcal superinfections in patients receiving cefoperazone. These results suggest that the overall efficacy and toxicity of study regimens are similar.

Delta superinfection in patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma in a Sahelian area. Study of 112 cases versus 46 controls

From October 1982 to June 1985 158 hospitalized patients in the National Hospital of Niamey, Republic of Niger, were selected whenever one of the following signs was found: hepatomegaly, jaundice, ascites, oesophageal varices, abdominal venous pattern, or splenomegaly. Investigations included hepatic echography ( 158 158 ), needle liver biopsy ( 68 158 ), radioimmunoassays for serum hepatitis B surface antigen (HBsAg; 158 158 ), anti-HBs ( 152 158 ), anti-HBc ( 129 158 ) and anti-delta antibody (anti-HD; 158 158 ). 112 patients with liver diseases comprised 28 with chronic hepatitis, 55 with non-alcoholic hepatic cirrhosis, and 29 with hepatocellular carcinoma (HCC). 46 patients with other diagnoses were used as controls. 71 112 liver disease patients were positive for HBsAg in serum compared with 1 46 controls ( P < 10 −9). Prevalences of delta superinfection in patients with serum HBsAg (+) and anti-HD (+) were 45 112 (40 · 2%) in liver disease patients versus 1 46 (2 · 2%) in controls ( P < 10 −9). Delta superinfection was very frequent in chronic hepatitis ( 8 28 ), non-alcoholic cirrhosis ( 24 55 ) and HCC ( 14 29 ). In chronic hepatitis, delta superinfection was more frequent in the chronic active form than in the chronic persistent type (not significant). Cirrhosis patients with delta superinfection were younger (10 years in males, 11 years in females) than those without ( P < 0 · 05).

Candida infections: an overview.

The range of human infections caused by the yeast Candida albicans and a handful of related species is considerable. They range from relatively trivial conditions such as oral and genital thrush to fatal, systemic superinfections in patients who are already seriously ill with other diseases. Interest in Candida infections, and in C. albicans in particular, has become huge in recent years as fatal infections have become more prevalent and new Candida-based pathologies have been recognized. There is now even a large pseudoscientific cult based on the notion that chronic allergy to Candida can cause all sorts of common illnesses. The medical importance of Candida infections and the scientific value of C. albicans as a model for fungal cellular development have stimulated enormous advances in our understanding of the epidemiology of candidosis, pathogenesis of the disease, and the genetics and biochemistry of C. albicans.

Natural course of delta superinfection in chronic hepatitis B virus-infected patients: histopathologic study with multiple liver biopsies.

We evaluated the natural course of delta superinfection in patients with chronic B viral hepatitis by examining serial liver biopsy specimens from 23 patients. The mean follow-up period was 2.5 years, and the average number of liver biopsies per patient was 2.8. The striking features were: (i) the prolonged acute hepatitis-like necroinflammatory activity (mean = 15 months) following acute delta hepatitis and (ii) rapid progression to severe forms of liver disease within a mean interval of 24 months from the onset of delta superinfection. Although there was a high frequency of stainable delta antigen (90%) in these liver biopsy specimens, there was no correlation between the degree of positivity and the histopathological changes.

Pleural thickening as a manifestation of aspergillus superinfection.

Pleural thickening is a very frequent manifestation of Aspergillus superinfection in patients with cavitary or cystic pulmonary disease. It was seen in all 33 cases in this series.The presence of pleural thickening in pulmonary disease not usually associated with it, or an increase in the amount in diseases in which pleural thickening is commonly seen, both suggest Aspergillus superinfection. When such pleural thickening is seen, diligent search should be made for this fungus.

CORRELATION OF VIROLOGICAL AND CLINICAL PROFILE OF PATIENTS WITH CHRONIC HEPATITIS B &amp; C CO-INFECTION

Background: Both HBV super-infection in patients with chronic hepatitis C and HCV super-infectionin patients with chronic hepatitis B have been reported. In case of co-infection, hepatitis B and C interactwith each other and affect immune responses resulting in active HCV with inactive HBV, active HBVwith inactive HCV, both active and both inactive. The objective of our study was to find out andcorrelate the virological and clinical profile in our patients with chronic hepatitis B and C co-infection.Material and Methods: This observational, descriptive and cross-sectional study was conducted atMedical ‘A’ Ward, PGMI, LRH Peshawar and Author’s Private Hepatology Clinic, from July 2010 toJune 2014. All patients with HBsAg and Anti-HCV Reactive by ELISA for more than six months wereincluded in the study. Following investigations were carried out in these patients: Serum ALT, HBeAg,anti-HBe, HBV DNA PCR, HCV RNA PCR, and abdominal ultrasound. Data was entered and analyzedusing SPSS version 16.0.Results: A total of 130 patients were included in the analysis, out of which 81 (62.3%) were males.Mean age of patients was 40.52±14.27 years. Majority of patients belonged to age-group of 21-30 years.Mean serum ALT of patients was 83.69±60.48 U/L. Majority of patients belonged to ALT-Group of 41-80 U/L. Hepatitis C Virus was the dominant virus in 53% of patients. Chronic Hepatitis was thedominant clinical profile in 73% of patients.Conclusion: Hepatitis C Virus is the dominant virus in our patients with BC co-infection. There is nostatistically significant association between virological and clinical profile of these patients.Key Words: Hepatitis B Virus, Hepatitis C Virus, BC Co-infection, Chronic Hepatitis, Cirrhosis,Hepatocellular Carcinoma