[Immunologic evaluations during prolonged and chronic hepatitis. Significance for diagnosis and prognosis. 100 cases]

This retrospective study illustrates the valuable contribution of immunological studies carried out during the third month of hepatitis. The persistence of HBs antigen at this stage of the disease considerably increases the risk of chronic hepatitis though not necessarily implying progression to cirrhosis. The latter should be feared if there is a marked increase in gamma globulins and in the presence of a high level of anti-smooth muscle and antinuclear antibodies. Amongst the other immunological features, an increase in IgA and IgM also indicates the possibility of progression from chronic hepatitis to cirrhosis. Comparative study in chronic active hepatitis of HBs antigen and various antibodies indicates essentially three types: - CAH with Ag HBs without auto-antibodies - Auto-immune CAH without Ag HBs - CAH without auto-antibodies nor Ag HBs. Progression to cirrhosis appears to be less frequent in the first group than in the second.

Nosocomial viral hepatitis B. A cluster among staff with subsequent transmission to patients

In a 2-month period four cases of hepatitis B occurred in hospital staff. Three months later two patients, hospitalized for open-heart surgery when the staff members had been infected, developed acute hepatitis B. Sera from all six ill individuals were subtype ayw and e-determinant positive. Epidemiologic investigation showed that the four staff had been exposed 3 months earlier to an asymptomatic hepatitis B surface antigen-positive (HBsAg) patient who was also e positive. To determine transmission from staff to patients study of 17 open-heart surgery patients was undertaken. Four of 17 were either HBsAg or anti-HBs positive. No correlation between infection and contact with three of four ill staff members or receipt of blood products was noted; however, 22 (46%) of 48 arterial blood gas specimens had been obtained from infected patients by one staff member, an inhalation therapist; this compared with seven (4%) of 157 specimens she obtained from control subjects (P less than 0.001). Furthermore, she handled indwelling arterial cannulae 25 (76%) of 33 times in infected patients compared with three (3%) of 95 times in control subjects (P less than 0.001). Transmission may have occurred via the arterial cannulae from a severe exudative dermatitis on the therapist's hands.

Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure

To determine the relation between the presence of donor DNA polymerase and e antigen, and recipient hepatitis, we tested, under code, serums from a controlled trial of hepatitis B immune globulin used to treat individuals accidentally inoculated with HBs Ag-positive blood. All recipients lacked antibody to HBs Ag. In 29 of 31 donors, both polymerase and e were in perfect agreement; both demonstrated a highly significant correlation with recipient hepatitis (P less than 0.001). DNA polymerase/e-negative blood did not cause hepatitis. Blood containing polymerase or e antigen did not cause hepatitis in six of 31 and four of 18 recipients, respectively. Hepatitis did not correlate with transaminase or duration of antigenemia in the donor. Polymerase and e appear to be indicators of the relative infectivity of HBs Ag-positive serum, particularly after small-volume exposure. They may be important determinants in assessing infectivity of chronic carriers of HBs Ag and in evaluating efficacy of hepatitis B immune globulin and hepatitis B vaccines.

Studies of smooth-muscle antibodies in acute hepatitis

Smooth-muscle antibodies (SMA) of the IgG and IgM class in titres of 10 to 80 were demonstrated in 19 of 38 patients with acute hepatitis (50 per cent). No IgA-SMA were detected. IgM-SMA occurred in the beginning of the disease, while IgG-SMA were found both early and late in the course of disease. There was no correlation between the occurrence of SMA and the biochemical liver parameters or the mode of exposure to infection, but IgM-SMA were found more often in the first serum sample obtained from patients without hepatitis-B-associated antigen (HBAg) than in HBAg-positive patients (P1 + P2 = 0.04) and it is suggested that hepatitis virus A more readily than hepatitis virus B can elicit the formation of SMA. The mean PHA-induced lymphocyte-transformation response was significantly lower in hepatitis patients than in the controls (0.02 greater than p greater than 0.01). The lymphocyte-transformation response to a low PHA dose (1 mug per ml) was lower in hepatitis patients without SMA than in those with SMA (0.10 greater than p greater than 0.05). SMA were not found in 28 control persons, and the incidence of tissue antibodies other than SMA did not differ in hepatitis patients and controls.

Viral infections in renal transplant recipients

Cytomegalovirus (CMV) infections are common in renal transplant recipients. We studied 23 recipients prospectively to determine whether infections by other herpes-group and non-herpes-group viruses were also present. Sera, obtained at the time of surgery and periodically thereafter, were tested for antibody to CMV, herpes simplex virus (HSV), Epstein-Barr virus (EBV), parainfluenza viruses types 1, 2, and 3, and the viruses of measles and rubella. We found no evidence of an unusual incidence of primary or secondary infection by the non-herpesviruses tested. Rises to CMV, HSV, and EBV antibody titers occurred in 43, 38, and 32% of patients, respectively. All serological rises to herpes-group viruses occurred in patients seropositive at the time of transplantation, with the exception of three patients who experienced primary CMV infections. We conclude that reactivation of all herpes-group viruses tested may occur in transplant recipients. Morbidity was associated only with primarly CMV infection.

Effect of human leukocyte interferon on hepatitis B virus infection in patients with chronic active hepatitis

Four patients with chronic hepatitis B infection and chronic active hepatitis were treated with human leukocyte interferon. Three of them had consistently elevated levels of circulating Dane-particle markers, including Dane-particle-associated DNA polymerase activity, hepatitis B core antigen and Dane-particle-associated DNA. Parenteral interferon administration at a dosage between 6.0 X 10(3) and 17 X 10(4) U per kilogram per day was associated with a rapid and reproducible fall in all Dane-particle markers in the three patients. The suppressive effect was transient when the interferon was given for 10 days or less but appeared to be more permanent when administration was prolonged for a month or more. In addition, long-term interferon therapy was associated with a marked fall in hepatitis B surface antigen in two of three patients and a disappearance of e antigen in two of two patients. Interferon may be useful in limiting carrier infectivity or eradicating chronic infection.

[Comparative study of antigens specific for hepatitis B in transfected cell cultures]

A comparative study of antigens detected in the livers of patients with hepatitis B. in the mesonephros of the human tissue--chick embryo system infected with the agents isolated from the blood of hepatitis patients, as well as antigens detectable in cell cultures transfected by the DNA isolated from these tissues was carried out. The results are in favour of the hypothesis on the integrational nature of serum hepatitis.

A study of hepatitis B antigen carriers among schoolchildren in Netanya, Israel

In the town of Netanya 9162 elementary schoolchildren (age 6-14 years) were tested for hepatitis B antigen (HBsAg) by the counter-electrophoresis method. The overall prevalence was 1.8% with a higher rate for males (2.2%) than for females (1.4%). Higher rates were observed among children born in the autumn and winter, particularly among the boys. This seasonal trend and male-female difference may partially be explained if infection occurs at circumcision. The ethnic distribution showed highest rates among children of Libyan and Yemenite origin (3.9% and 2.6%, respectively), and lowest rates among children of European and Israeli born parents (0.4% and 0.2%, respectively). Prevalence of HBsAg among children from large families and those from families living in poor and crowded quarters was very significantly higher than among children from smaller families living in richer areas and in less crowded conditions. These variables, which are closely associated with social class, remain significant after adjustment for ethnic origin and seem to account for a large proportion of the variation among the Israeli schoolchildren. The variation due to ethnicity is markedly reduced when adjusted for five other pertinent variables: age, sex, season of birth, crowding and family size. Assuming that prevalence of HBsAg in a population reflects the rates of infection (past or present), the results of this study strongly support the hypothesis that type B hepatitis in Israel behaves essentially as a contagious infection manifested primarily as a subclinical disease of early and mid-childhood.

[Frequency of hepatitis after extra-corporeal circulation]

In cardio-vascular surgery the risk that the hepatitis-B (H.B.) virus be transmitted was measured in 3 groups of patients (Professor Ch. Dubost), before and since systematic screening for HBS antigen in donors' blood. The same questionnaire was sent to each patient in each group 6 months after extra-corporeal-circulation (ECC), in order to determine the efficiency of HB virus screening tests. The present study gives the following results: --in the first group (no screening for HBS antigen in donors' blood), the frequency of icteric hepatitis was 6.7% (26 cases of jaundice, probably due to hepatitis viruses, out of 386 ECC); --in the second group (screening for HBS antigen in donors' blood by immuno-diffusion (often made after transfusion of fresh blood) the frequency of icteric hepatitis after transfusion of HBS antigen positive blood); --in the third groups, icteric hepatitis was less frequent (4.6%) since systematic screening for HBS antigen by counter-electrophoresis and complement fixation was performed (29 cas out of 629 ECC). Additionally, viral hepatitis appeared more frequently in men than in women, and among older patients than younger ones. Recovery was generally complete in 2 months; however, the evolution of the disease was severe in 3 cases and fatal in one case. In sum, after ECC, hepatitis still remains a frequent side-effect, compelling blood centers to use th most sensitive screening tests now available for HBS screening: radio-immuno-assay and reverse passive haemagglutination tests. As a consequence of the present study, these 2 techniques are being applied on a daily basis in our laboratory for HBS antigen screening tests are ineffective in preventing the transmission of other strains of viral hepatitis by blood transfusion.