A case of dengue from Pune, India

Dengue is an acute infectious disease, caused by a single stranded ribonucleic acid (RNA) virus of the family of Flaviviridae, genus Flavivirus, transmitted by Aedes mosquitos, the most important vectors being Aedes aegypti and Aedes albopictus. There are four serotypes, DEN-1, DEN-2, DEN-3, DEN-4 that are nearly human specific. The geographical distribution of dengue is pantropical, except for Madagascar and some African regions. It is endemo-epidemic in tropical and subtropical countries included between 25 degrees north latitude and 25 degrees south latitude, particularly in southeast Asia and epidemic in the Caribbean, West-Africa, tropical American and Pacific Islands. Further spread will depend on the invasion of Aedes aegypti into new areas in South America. Maintenance of dengue is supported by an increasing demography, uncontrolled urbanization and climatic conditions favorable to the vectors. Spread of dengue is primarily caused by modern transportation, especially aircraft. No vaccine and no specific treatment exist so that mosquito control is the only way to reduce the incidence of dengue around the world. Dengue is, obviously, an important risk for travelers going to endemic areas.

Interferon alpha-2B and ribavirin in combination for patients with chronic hepatitis C who failed to respond to, or relapsed after, interferon alpha therapy: a randomized trial

PURPOSE

To assess the efficacy of interferon alpha-2b and ribavirin in combination in the treatment of patients with chronic hepatitis C who had either failed to respond to therapy with interferon alpha (nonresponders), or who had relapsed after interferon therapy (relapsers).

SUBJECTS AND METHODS

Four hundred patients with chronic hepatitis C (200 nonresponders and 200 relapsers) were randomly assigned in equal numbers to receive either subcutaneous administration of recombinant interferon alpha-2b (3 million units three times per week) and ribavirin (1,000 to 1,200 mg/daily orally) or interferon alpha-2b alone (6 million units three times per week). Both ribavirin and interferon alpha-2b were given for 24 weeks. The patients were then followed for an additional 24 weeks.

RESULTS

At the end of the treatment period, normalization of serum alanine aminotransferase levels and absence of hepatitis C virus RNA were seen in 21% of nonresponders and in 39% of relapsers who were treated with interferon alpha-2b and ribavirin, compared with 5% of nonresponders (P = 0.001) and 9% of relapsers treated with interferon alpha-2b alone (P <0.001). At the end of follow-up, 14% of nonresponders and 30% of relapsers treated with the combination therapy had a sustained response, compared with 1% of nonresponders (P = 0.001) and 5% of relapsers treated with interferon alpha alone (P <0.001).

CONCLUSIONS

A 24-week course of treatment with interferon alpha-2b and ribavirin offers a chance of sustained response, whereas retreatment with interferon alpha-2b alone does not give satisfactory results. The role of long-term therapy in inducing prolonged remission remains to be explored.

Anti-HBV vaccination before therapy with interferon (IFN) in chronic B hepatitis

Thirty-five outpatients (7 F, 28 M, mean age 39.8 years) with histologically confirmed active chronic B hepatitis, have been immunised with specific anti-HBV vaccine (Engerix B 20 mcg, SmithKline Beecham Biologicals, Rioxensart, Belgium) on days 0, 30 and 60. Hepatitis B markers, HBV-DNA and anti-HDV antibodies were determined on the same day of vaccination. One week after the last dose of anti-HBV vaccine, 15 and 10 patients have been treated respectively with alpha-leukocyte-IFN and beta-natural-IFN at the dose of 6 mU three times/week for one year; the remaining 10 patients were included in the control group. Hepatitis B and D markers and transaminases were monitored monthly during IFN therapy. Within one month from the last dose of anti-HBV vaccine, 20 patients out 35 have shown a transitory disappearance of HBV-DNA. After the 2nd dose in 4 patients a marked increase in AST and ALT levels was observed (up to 10 times the normal values). After the 3rd dose (last dose) five HBV-DNA-negative patients have shown transitory low levels of anti-HBs antibodies; moreover, after the last dose of anti-HBV, one HBV-DNA-negative patient resulted HBV-DNA-positive. After one year of IFN-therapy, 8 patients out 15 treated with alpha-leukocyte-IFN and 2 treated with beta-natural-IFN, have shown normalisation of transaminases. These results confirm the effectiveness of an anti-HBV vaccination before an IFN treatment and a better response achieved with alpha-leukocyte-IFN.

[Human dirofilariasis: extraction of the living nematode from the upper lip]

Calabar swellings appearing on the head during 2 months in a 53 year old man, living in Casale Monferrato (Piedmont), were followed by the formation of a nodule 2 x 1 cm wide, in the upper lip. A mobile filiform, 12 cm long, nematode was recovered from the excised nodule. It was diagnosed as Dirofilaria repens. The region where the case occurred, is to be considered as one of the most affected areas by this parasitic zoonosis in Europe.

[Two clinical cases of zoonotic filariasis probably caused by Dirofilaria repens: I. Passage of the nematode under the bulbar conjunctiva. II. Subcutaneous abscessed nodule]

Two new human cases of zoonotic filariasis are reported, one subconjunctival and the other subcutaneous, occurred both in 67 and 73 year-old women, respectively, living in the provinces of Alexandria and Pavia (Northern Italy). The morphology of the nematodes could not be examined. Nevertheless, the anamnesis, the course of infection, the symptomatology and the geographic area where the cases occurred, suggested that they were associated with Dirofilaria repens.

[The use of erythropoietin in HIV myelodysplasias. Preliminary study]

The authors gave recombinant human erythropoietin to four anaemic patients with HIV-infection treated with zidovudine. After erythropoietin administration an increase in haemoglobin, erythrocytes and haematocrit was observed and patients could continue AZT therapy.

Morphometric assessment of nucleolar activity in liver cells during the evolutive pathway of chronic hepatitis C to cirrhosis

Using a computer-assisted image analysis system, we performed a morphometric study of silver-stained nucleoli of hepatocytes in liver biopsy specimens from hepatitis C virus-positive patients with chronic persistent hepatitis (3 cases), chronic active hepatitis (4 cases), and cirrhosis (4 cases). The number and the total area of nucleoli, the average area of each nucleolus and the nuclear area were determined for each of 100 hepatocytes per case. A continuing increase in the area of both nucleoli and nuclei paralleled a progressive decrease in the number of nucleoli during the evolution of chronic hepatitis C to liver cirrhosis. These findings would indicate that the hepatitis C virus-induced liver damage causes reactive changes in surviving hepatocytes resulting in an increased nucleolar biosynthetic activity rather than in an increment of cell proliferation rate. Therefore, the liver response to hepatitis C virus injury seems to be mainly based on a condition of cell "hypertrophy", whereas we previously showed that a process also of compensatory hyperplasia occurs in chronic hepatitis B, possibly resulting from a different pathogenesis of the viral damage.

[Seroepidemiology of HIV-1 and HIV-2 in the USSL 76 area--Casale M.To. Preliminary study]

The reported results show a prevalence of HIV-1 antibodies in drug addicts by ELISA and Western Blot. In this case report the presence of persons (drug addicts) whose sera have antibodies to HIV-1 and HIV-2 by ELISA and Western Blot advise that further epidemiological studies are necessary to assess the real HIV-2 circulation in Italy.

[Imported malaria. Clinico-epidemiologic and therapeutic observations]

The authors notice a prevalence of P. falciparum in eight observed cases of imported malaria and confirm the increasing polychemioresistance of plasmodium and its prophylactic and therapeutic problems.

[A case of Plasmodium vivax malaria]

A case of malaria caused by Plasmodium vivax is reported in order to underline the importance of correct pharmacological prophylaxis and meticulous anamnestic and epidemiological investigations.

[A case of adenovirus-induced hepatitis]

A case of acute adenovirus-induced hepatitis is reported. The diagnosis was based on the increase in adenovirus antibodies and the absence of markers for HBV, HAV and other minor hepatitis viruses on a double serum sample. NANB hepatitis was excluded on the basis of the patient's history, epidemiological data and clinical course.