Comparison of clinical, virologic and pathologic features in patients with acute hepatitis B and C

Energy Requirements for Loss of Viral Infectivity

Outside the host, viruses will eventually lose their ability to infect cells due to conformational changes that occur to proteins on the viral capsid. In order to undergo a conformational change, these proteins require energy to activate the chemical reaction that leads to the conformational change. In this study, data from the literature is used to calculate the energy required for viral inactivation for a variety of different viruses by means of the Arrhenius equation. We find that some viruses (rhinovirus, poliovirus, human immunodeficiency virus, Alkhumra hemorrhagic fever virus, and hepatitis A virus) have high inactivation energies, indicative of breaking of a chemical double bond. We also find that several viruses (respiratory syncytial virus, poliovirus, and norovirus) have nonlinear Arrhenius plots, suggesting that there is more than a single pathway for inactivation of these viruses.

Integrated quantum dot barcode smartphone optical device for wireless multiplexed diagnosis of infected patients

Inorganic nanoparticles are ideal precursors for engineering barcodes for rapidly detecting diseases. Despite advances in the chemical design of these barcodes, they have not advanced to clinical use because they lack sensitivity and are not cost-effective due to requirement of a large read-out system. Here we combined recent advances in quantum dot barcode technology with smartphones and isothermal amplification to engineer a simple and low-cost chip-based wireless multiplex diagnostic device. We characterized the analytical performance of this device and demonstrated that the device is capable of detecting down to 1000 viral genetic copies per milliliter, and this enabled the diagnosis of patients infected with HIV or hepatitis B. More importantly, the barcoding enabled us to detect multiple infectious pathogens simultaneously, in a single test, in less than 1 h. This multiplexing capability of the device enables the diagnosis of infections that are difficult to differentiate clinically due to common symptoms such as a fever or rash. The integration of quantum dot barcoding technology with a smartphone reader provides a capacity for global surveillance of infectious diseases and the potential to accelerate knowledge exchange transfer of emerging or exigent disease threats with healthcare and military organizations in real time.

The need for liver biopsy in a patient with acute HCV infection

BACKGROUND

A 45-year-old white female was admitted to hospital with a 1-week history of right upper quadrant abdominal pain, progressive tiredness and jaundice. Physical examination confirmed jaundice and revealed mild epigastric tenderness. Laboratory test results revealed an extremely elevated alanine aminotransferase concentration, a high bilirubin concentration, the presence of HCV RNA, and a significantly elevated antinuclear antibody titer.

INVESTIGATIONS

History and physical examination, laboratory investigations (including complete blood counts, liver function tests, electrolyte analysis, serological and genetic tests), Doppler ultrasound and CT scan of the abdomen, and liver biopsy.

DIAGNOSIS

Acute infection with HCV genotype 1a.

MANAGEMENT

Supportive care, which included monitoring vital signs and laboratory test results, and management of acute symptoms.

Changing prevalence, clinical features, and outcome of acute hepatitis in Spain (1982-2003)

BACKGROUND

Diagnostic and preventive measures have contributed to a change in the epidemiology of acute hepatitis. The purpose of the present paper was to assess the changing prevalence of acute hepatitis from 1982 to 2003.

METHODS

Trends in the epidemiology, clinical findings, and outcome of acute viral hepatitis from 1982 to 2003 were examined. A total of 548 episodes of acute hepatitis diagnosed between 1982 and 2003, the clinical course of which was monitored up to the year 2003, were included. Annual changes as well as for the intervals 1982-1992 and 1993-2003 were compared.

RESULTS

Severe infections occurred in 1.3% of cases, with a mortality of 0.6%, with progression into chronicity in 25.1%. The annual incidences of acute hepatitis and the comparative intervals 1982-1992 and 1993-2003 showed a decline of parenterally -B, delta and C virus- transmitted infections, unchanged number of cases of acute hepatitis A, an increase in the number of cases of drug-induced hepatitis, increase in median ages, and a decrease in the proportion of hepatitis in injecting drug users. Ages of patients with hepatitis A tended to increase.

CONCLUSIONS

A decline of parenterally transmitted acute hepatitis was documented throughout a 22-year period, while the number of cases of hepatitis A was unchanged and that of drug-induced hepatitis increased. Evaluation of the current targeted hepatitis A vaccination approach and adequate pharmacovigilance measures are required in the near future.

Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies

A large number of studies have reported on spontaneous viral clearance rates in acute hepatitis C infection, however most have been small, and reported rates have varied quite widely. To improve the precision of the estimated rate of spontaneous viral clearance, a systematic review was conducted of longitudinal studies. Factors associated with viral clearance were also examined. Inclusion criteria for studies were: longitudinal assessment from time of acute hepatitis C; hepatitis C virus RNA analysis as determinant of viral clearance; untreated for acute hepatitis C. Information on study population, and factors that may influence viral clearance were extracted from each study. Viral clearance was defined among individuals with at least 6 months follow-up following acute hepatitis C. The number of subjects with viral clearance was expressed as a proportion for each study and a weighted mean for proportion was calculated. A total of 31 studies were examined. Study populations included nine studies of post-transfusion hepatitis, 19 of acute clinical hepatitis, and three of sero-incident cases. In total, data was available for 675 subjects and the mean study population was 22 (range 4-67). The proportion with viral clearance ranged from 0.0 to 0.8, with a weighted mean of 0.26 (95% CI 0.22-0.29). Factors associated with viral clearance were female gender and acute clinical hepatitis C study population. Further studies are required to more clearly define predictors of clearance and guide therapeutic intervention strategies.