High prevalence of hepatitis B virus infection among tuberculosis patients with and without HIV in Rio de Janeiro, Brazil

To determine the prevalence and exposure factors associated with hepatitis B infection in tuberculosis patients with and without HIV type 1 coinfection, the presence of hepatitis B virus serological markers was investigated in a retrospective study. The seroprevalence of hepatitis B virus in patients with tuberculosis only was 14.6%, and in tuberculosis patients coinfected with HIV it increased to 35.8%. In patients with HIV and tuberculosis coinfection, homosexuality constituted the principal exposure factor, while in tuberculosis patients without HIV, a gradual increase in hepatitis B virus seroprevalence was noted along with increasing age. The results demonstrate that hepatitis B infection is highly prevalent in tuberculosis patients in Brazil and suggest that a vaccination program for the general population should be considered in order to prevent further hepatitis B infections.

Crystal structure and kinetic analysis of beta-lactamase inhibitor protein-II in complex with TEM-1 beta-lactamase

The structure of the 28 kDa beta-lactamase inhibitor protein-II (BLIP-II) in complex with the TEM-1 beta-lactamase has been determined to 2.3 A resolution. BLIP-II is a secreted protein produced by the soil bacterium Streptomyces exfoliatus SMF19 and is able to bind and inhibit TEM-1 with subnanomolar affinity. BLIP-II is a seven-bladed beta-propeller with a unique blade motif consisting of only three antiparallel beta-strands. The overall fold is highly similar to the core structure of the human regulator of chromosome condensation (RCC1). Although BLIP-II does not share the same fold with BLIP, the first beta-lactamase inhibitor protein for which structural data was available, a comparison of the two complexes reveals a number of similarities and provides further insights into key components of the TEM-1-BLIP and TEM-1-BLIP-II interfaces. Our preliminary results from gene knock-out studies and scanning electron microscopy also reveal a critical role of BLIP-II in sporulation.

Insights into the molecular basis for the carbenicillinase activity of PSE-4 beta-lactamase from crystallographic and kinetic studies

PSE-4 is a class A beta-lactamase produced by strains of Pseudomonas aeruginosa and is highly active for the penicillin derivative carbenicillin. The crystal structure of the wild-type PSE-4 carbenicillinase has been determined to 1.95 A resolution by molecular replacement and represents the first structure of a carbenicillinase published to date. A superposition of the PSE-4 structure with that of TEM-1 shows a rms deviation of 1.3 A for 263 Calpha atoms. Most carbenicillinases are unique among class A beta-lactamases in that residue 234 is an arginine (ABL standard numbering scheme), while in all other class A enzymes this residue is a lysine. Kinetic characterization of a R234K PSE-4 mutant reveals a 50-fold reduction in k(cat)/K(m) and confirms the importance of Arg 234 for carbenicillinase activity. A comparison of the structure of the R234K mutant refined to 1.75 A resolution with the wild-type structure shows that Arg 234 stabilizes an alternate conformation of the Ser 130 side chain, not seen in other class A beta-lactamase structures. Our molecular modeling studies suggest that the position of a bound carbenicillin would be shifted relative to that of a bound benzylpenicillin in order to avoid a steric clash between the carbenicillin alpha-carboxylate group and the conserved side chain of Asn 170. The alternate conformation of the catalytic Ser 130 in wild-type PSE-4 may be involved in accommodating this shift in the bound substrate position.

Serological and vaccination profile of hemodialysis patients during an outbreak of hepatitis B virus infection

During an outbreak of hepatitis B virus (HBV) infection in a hemodialysis unit, patients were assessed for serological viral markers and vaccination status. HBV infection was identified in 26 patients. Twenty of these were positive for hepatitis B surface antigen (HBsAg), and 6 were negative for HBsAg but positive for IgM antibody to hepatitis B core (anti-HBc) and HBV DNA. The primary source of infection was not clearly identified, although 2 patients were suspected to be the index cases. A multiple logistic regression analysis revealed low anti-HBs titers and vaccination status to be independently associated with the risk of acquiring HBV infection. Both the high prevalence of HBV infection (31%) detected in this unit and the low vaccine response (53%) observed reinforce the importance of universal and preventive measures in controlling HBV infection. The detection of HBV DNA in HBsAg-negative/IgM anti-HBc-positive patients emphasizes the value of anti-HBc testing in the routine screening of HBV in hemodialysis units.

Nosocomial spread of hepatitis B virus in two hemodialysis units, investigated by restriction fragment length polymorphism analysis

A method for genotyping hepatitis B virus (HBV) strains, based on restriction fragment length polymorphism (RFLP) analysis of four different amplified fragments of the HBV genome, was used to investigate nosocomial infections that occurred in two Brazilian hemodialysis centers. Viral isolates from hepatitis B surface antigen (HBsAg)-positive serum samples from 27 hemodialysis patients and 39 HBV-positive unrelated control patients were grouped according to their RFLP patterns. Strains isolated from the control patients were divided into nine RFLP patterns: A1, A2, A3 (genotype A), D1, D2, D3, D4 (genotype D), F1, and F2 (genotype F). In hemodialysis unit A (Rio de Janeiro), 14 HBV isolates were grouped into five different RFLP patterns: A1, A2, A3, D3, and D4. Pattern A2, present at a relatively low prevalence (18%) in the control group, was observed in the majority (53%) of the hemodialysis patients. Notably, all five patients who seroconverted to HBsAg positivity in 1995 carried the strain A2. In hemodialysis unit B (state of São Paulo), where an outbreak of HBV infection occurred in 1996-1997, RFLP analysis showed that all 13 patients who seroconverted were infected with HBV isolates of genotype D. Coinfection with strain A1 was detected in seven of them. The results demonstrate the value of RFLP analysis in establishing common sources of infection in hemodialysis centers.

Western blot analysis of the reactivity between envelope proteins of hepatitis B viruses from Brazilian carriers and antibodies raised against recombinant hepatitis B vaccines

A Western blot assay was standardized to evaluate the antigenic reactivity of hepatitis B virus (HBV) strains circulating in Brazilian population with antibodies raised against recombinant hepatitis B (HB) vaccines. In this assay, HBV envelope proteins from infected human blood were detected by antibodies from rabbits immunized with either of two recombinant vaccines. These were Engerix B (Smith Kline Beecham, Belgium) containing exclusively S protein particles and TGP-943 (Takeda Chemical Industries, Japan) containing M protein particles. Forty-seven serum samples, presenting HB surface antigen. (HBsAg) reverse passive haemagglutination assay (RPHA) titers ranging from 1:32 to > or =1:4096 after HBV particles concentration, were tested. Twenty-seven samples were from acute hepatitis cases and 20 were from chronic cases (11 from cirrhotic patients and 9 from asymptomatic carriers). Four HBV serotypes, adw2, adw4, ayw2 and ayw3, were identified in these samples. Infectivity of these sera was evaluated by HBV DNA detection by polymerase chain reaction (PCR). HBV DNA was present in 62% of samples from acute cases and in all samples from chronic cases. Despite the differences between serotypes, genotypes, forms of infection, and infectivity of the samples, antibodies against both vaccines reacted with HBV envelope proteins from all but one sample. In one sample from cirrhotic patient, only a small protein of unexpected size reacted with TGP-943 antibodies.

Cyclosporine inhibition of leukocyte calcineurin is much less in whole blood than in culture medium

Recent reports have shown that cyclosporine (CsA)-treated patients have abundant calcineurin phosphatase (CN) activity in vivo despite CsA blood concentrations that would be completely inhibitory in vitro. We sought to determine whether this disparity was a result of altered distribution of CsA in culture medium (CM) compared with whole blood (WB). CN activity was measured in peripheral blood leukocytes (PBL) that had been exposed in vitro to CsA in either WB or CM. Cells from both groups were also stimulated with OKT3 to determine the effect of CsA on the induction of IFN-gamma synthesis. CsA accumulation in PBL was determined by liquid scintillation counting of PBL exposed to 3H-CsA. The IC50 for CsA inhibition of CN activity was significantly lower for PBL in CM (2 micrograms/L) compared with PBL in WB (102 micrograms/L, P < or = 0.005). Likewise, for CsA inhibition of IFN-gamma induction, the IC50 was 18 micrograms/L for PBL in CM compared with 690 micrograms/L for PBL in WB (P < or = 0.005). The shift in IC50 was accompanied by a 10-fold increase in 3H-CsA in PBL in CM compared with PBL in WB. We conclude that PBL exposed to CsA in CM accumulate significantly more CsA than PBL in WB. The result is that CsA inhibition of CN activity and cytokine induction appears at least an order of magnitude greater than its true effect in biologic fluids. This disparity is due to partitioning of CsA to irrelevant CsA binding sites, which are abundant in WB and in vivo, but absent in culture medium.

Serological evidence of rotavirus infection in a guinea pig colony

Antibodies reacting with simian rotavirus SA11 were detected by enzyme immunoassay (EIA) and Western blot assay (WBA) in sera from guinea pigs bred for experimental use at the Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. The proportion of antibody-positive animals and the antibody titres rose sharply in 1985, were maintained at a high levels in 1986 and declined in 1987. There were no obvious signs of disease coinciding with serological evidence of infection. Results of WBA suggest that the virus involved belongs to subgroup 1 of group A rotaviruses.

A combined enzyme immunoassay for rotavirus and adenovirus (EIARA)

A combined enzyme immunoassay for rotavirus and adenovirus (EIARA) was developed as a double-antibody sandwich assay in which test samples are added to plastic wells coated with rotavirus or adenovirus goat antibody. The presence of antigens is detected by mixed-guinea pig antisera to the same viruses followed by rabbit anti-guinea pig IgG conjugated with peroxidase and subsequently by ortho-phenylenediamine substrate. Titrations of rotavirus (SA11) and adenovirus type 2 tissue culture grown viruses in the presence of separate capture sera and mixed detector sera revealed that the two virus-antibody reactions occurred independently and were not affected by each other. Comparison with another enzyme immunoassay for rotavirus, with immunoelectron microscopy and with polyacrylamide gel electrophoresis showed that EIARA is a sensitive and specific method for detecting rotaviruses and adenoviruses in faeces from children with gastroenteritis.