Mucosal immunity and primary biliary cirrhosis: presence of antimitochondrial antibodies in urine

We have shown that IgA-class antimitochondrial autoantibodies (AMA) can be detected in the bile and saliva of patients with PBC, suggesting that AMA are secreted into the luminal fluid across bile ducts and salivary glands. These data prompted us to determine whether AMA of the IgA isotype may be transported across other epithelial mucosa. Therefore, we tested for the presence of AMA in the urine specimens of 83 patients with PBC and 58 non-PBC controls including healthy individuals and patients with other liver diseases. Patients enrolled in this study had no history of renal disease, and we confirmed there was less than 50 microgram/mL of protein in each of the urine specimens. Interestingly, we found that AMA were present in the urine of 71/83 (86%) of all patients with PBC and in 71/78 (91%) of patients with PBC that were serum AMA positive. In contrast, AMA were not detected in any of the 58 control urine specimens. Of particular interest, AMA of the IgA isotype was present in 57/83 (69%) of patients with PBC, and in 52 of these 57, we found secretory-type IgA. In a nested random subgroup of urine samples, the prevalence of the IgA2 AMA was 6/18 (33%), significantly lower than in matched serum samples, 13/16 (81%, P =.007). These data show that AMA of the IgA isotype is secreted into urine from the uroepithelium of patients with PBC, and support the thesis that PBC originated from either a mucosal challenge or a loss of mucosal tolerance.

[Distribution of the genotypes of hepatitis C virus in intravenous drug addicts in Argentina]

Intravenous drug addiction (IVD) is an unfrequent risk factor in Argentina, representing less than 10% of patients (pts) with chronic HCV infection seen in our Unit. In order to study the genotypes (Gt) in IVD and compare them with a non drug addicted control population, 68 pts with a history of IVD were enrolled in this study and compared with 68 non drug addict (NDA) pts with chronic HCV, with similar age and gender distribution. In all pts a liver biopsy was performed. Genotyping was done by INNO LiPA (Innogenetics, Belgium). Mean age in both groups was 35 +/- 7.8 years and 50 were males. No difference was observed between both groups in the prevalence of Gt1a, Gt2a/c and in those with mixed infections. The prevalence of Gt1b in IVD was 19.1% and in NDA 38.2% (p = 0.0228). A highly significant difference was also observed in the prevalence of Gt3a, of 42.6% in IVD and only 11.8% in NDA (p = 0.0001). Gt1a was the second most frequent genotype in IVD pts (26.5%). Simultaneous HIV infection was present in 8 IVD pts (11.8%) and in none of NDA group. Liver biopsies showed a higher prevalence of mild chronic hepatitis in NDA (57.3%) than in IVD (32.4%) (p = 0.0058). Severe chronic hepatitis with advanced fibrosis or cirrhosis was more frequent in the Gt3 of the group with IVD when compared with Gt3 of the NDA group. It can be concluded that in accordance with other geographical areas, Gt3a is far more prevalent in intravenous drugs addicts than in the general population in Argentina where Gt1b is more frequent. Mild forms of chronic hepatitis are less frequent in IVD. In spite of the relatively small group with HCV co-infection with HIV, it seems important to note that 2/8 (25%) showed severe hepatitis C or cirrhosis.

Ketoconazole-induced liver damage

Five cases (four females, one male) of ketoconazole-related liver damage are presented, two of whom died. All patients received ketoconazole (400 mg/day) for various mycoses. In the four women the first signs of hepatotoxicity appeared after four weeks of therapy. One fatal case developed massive necrosis with fulminant liver failure and the other, submassive necrosis. In four cases cholestasis was a prominent finding. Biochemical evidence of biliary stasis may persist for several months, as occurred in the three surviving patients of our series. The two fatal cases continued receiving the drug in spite of its adverse effects. Consequently, repeated evaluation is recommended to detect early signs of liver environment.

Prevalence of IgG Anti-HEV in Buenos Aires, a Nonendemic Area for Hepatitis E

Hepatitis E virus (HEV) is the main etiological agent for the enterically transmitted form of non-A, non-B hepatitis (ET-NANB), and is associated with epidemic and sporadic forms of the disease,1 mainly in some developing countries.2 In Argentina, no ET-NANB hepatitis epidemics have been described, and no epidemiological HEV data are known up to this time. The aim of the present study is to evaluate the prevalence of anti-HEV in different groups of the population of Buenos Aires, an area considered to be nonendemic.

[Cholestasis associated with ticlopidine]

The case of a 56-years-old male with cholestasis associated with ticlopidine is presented. Cholestasis is an infrequent adverse effect of this drug. The patient was admitted to hospital because of jaundice, choluria, and itching of one month of evolution. The patient had taken ticlopidine twice a day for 3 months up to one week prior to admission for peripheral arteriopathy. Biopsy was performed showing acinar cholestasis and portal inflammatory infiltrate compatible with cholestasis due to hypersensitivity. Ticlopidine was discontinued by the patient himself one week prior to admission. The drug was not readministered and the evolution of the clinical and biochemical parameters of cholestasis decreased. The patient was asymptomatic and laboratory data were normal 4 months later.

Response to Hepatitis A Vaccine in Children after a Single Dose with a Booster Administration 6 Months Later

Background: Children are of an age group susceptible to infection by the hepatitis A virus (HAV). Active immunization of children against HAV became reality in 1993, when the first pediatric hepatitis A vaccine was licensed. This initial vaccine required two injections to induce a full immune response in recipients. The purpose of this study was to assess the feasibility of a single dose primary vaccine plus a booster after 6 months against hepatitis A in children. Methods: A total of 60 healthy and seronegative children between 2 and 13 years of age were administered inactivated hepatitis A vaccine, containing 720 enzyme-linked immunosorbent assay (ELISA) units (EL.U) of hepatitis A antigen, intramuscularly in the deltoid region at months 0 and 6. Symptoms were recorded by parents or guardians on individual diary cards. Antibodies against HAV (antiHAV) were measured using an ELISA inhibition assay, and a seropositive titer was defined as being >=20 mIU/mL. Results: Fifteen days after the single primary dose, 96% of the vaccinees were seropositive with a geometric mean titer (GMT) of 351 mIU/mL. The seropositivity rate reached 100% 1 month after the first dose, with a GMT of 305 mIU/mL. Prior to the second dose at month 6, 93% remained seropositive, and the GMT was 153 mIU/mL. By month 7, 1 month after the second vaccination, the seropositivity rate recovered to 100% with a rise in GMTs to 3644 mIU/mL. Local symptoms were reported after 23.9% of doses, and general symptoms after 19.7% of doses. All symptoms were of short duration and resolved spontaneously. Conclusions: This inactivated vaccine against hepatitis A is safe, well-tolerated, and excellently immunogenic when administered to children following a single dose plus booster course at months 0 and 6.

[Hepatitis B (HBV) and C (HBC) virus infections in Down's syndrome and in neuropsychiatric patients without Down's syndrome]

Hepatitis B virus (HBV) markers are found with high frequency in immunocompromised individuals. In order to find out if this is also true for the hepatitis C virus (HCV), we have analyzed a group (G.1) of 46 patients (pts.) with Down syndrome, situation known to be associated with immunodepression G. 1. We compared them with a G. of 310 mentally retarded pts. without Down syndrome G. 2 and without evidence of immunological disfunction. All of them were studied for infection with HBV. All pts. in G. 1 and G. 2 were also tested for HCV. The pts. have been hospitalized in a specialized medical institution for mentally retarded on a long term basis and were followed during 1 year. Finally G 3 was composed of 5454 voluntary blood donors.

MATERIAL AND METHODS

In all pts. search for HBV infection markers (anti-HBc, HBsAg, HBeAg by EIA test and HBV-DNA by nucleic acids hybridization) were performed. Search for HCV markers was done by a second generation EIA kit (Abbott Hepatitis C (rDNA) (Antigen).

RESULTS

HBsAg was found to be positive in 12/46 (26%) of G. I and 25/310 (8%) of G. II (p < 0.001). HBeAg was positive in 8/12 (67%) of G. I and in 2/25 (8%) of G. II (p < 0.001). All HBeAg positive pts. had elevated values of DNA-HBV. In G. I, 4/12 (33%) pts. lost HBeAg during the observation period, one of them remained HBV-DNA positive and none become HBsAg negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Intensive plasmapheresis as an alternative therapy for intractable pruritus of primary biliary cirrhosis

Primary biliary cirrhosis is a chronic disease of presumed autoimmune etiology, generally associated with other systemic abnormalities such as scleroderma, characteristic of Sjogren's syndrome and Raynaud's syndrome, for which pruritus is the most troublesome symptom. Treatment of this disease is a major unsolved problem. Although the use of cholestyramine has been effective, a considerable number of cases are refractory to the drug and to other agents such as corticosteroids, azathioprine and penicillamine. Plasma exchange has proven to be a useful option in four female patients with primary biliary cirrhosis--two with grade III histology and the other two with grade IV disease and intractable pruritus. The procedure was well tolerated and no side effects were observed. There was a temporary but significant attenuation of pruritus and improvement of melanoderma. Intensive plasma exchange is proposed as an alternative therapy in primary biliary cirrhosis with refractory pruritus.

[Polycystic hepatic and renal disease with portal hypertension and ascites (a case report)]

The case of a 50 years old man with polycystic liver and kidneys and ascites which had been diagnosed by laparoscopy and pyeloureterography, is reported. Chronic renal failure was the cause of death, and obvious signs of portal hypertension were found at necropsy. The loss of hepatic structure produced by pericystic fibrosis, regenerative nodules, thrombosis of portal branches, and necrotic areas, is stressed as an important cause of portal hypertension. This pathogenesis could be similar to that of cirrhosis. Both portal hypertension and ascites are highly uncommon facts in adults' polycystic livers.