Diagnóstico accidental de hepatitis B crónica. a propósito de dos casos / Incidental diagnosis of chronic hepatitis B. report of two cases

Se reporta el diagnóstico accidental de dos casos de hepatitis B crónica por probable transmisión vertical. El primer caso es una gestante de 32 años que es derivada al hospital para monitoreo fetal por oligoamnios; durante su internación entra en trabajo de parto, y es asistida por una profesional sin usar guantes y se produce un importante contacto con sangre. Se realiza a la paciente un control serológico revelando ser portadora de HBsAg pero negativa para HBeAg; positiva para anti-HBe Ac y HBcIgG, negativa para anti HBs y HBc Ac IgM. El segundo caso es un paciente portador de Lupus Eritematoso Sistémico bajo tratamiento inmunosupresor, con antecedentes de tener una madre fallecida y dos hermanos portadores de VHB. La serología reveló: HBsAg (+) con carga viral de 113 copias, HBeAg (-), anti-HBe (+), HBcIgG (+), HBcIgM (-), hepatitis C (-). El paciente recibió tratamiento con tenofovir. Ambos pacientes fueron diagnosticados en forma accidental y considerados ser portadores de hepatitis B crónica inactiva por probable trasmisión vertical por los antecedentes familiares. Estos dos casos constituyen una llamada de atención sobre la transmisión vertical del virus y la importancia de realizar el despistaje en la embarazada en el primer control prenatal.

Two cases of incidentally diagnosed chronic hepatitis B of probable vertical transmissionare reported. The first case is a 32 year-old pregnant patient referred to our center for fetalmonitoring due to oligohydramnios; during her hospitalization the patient went into labor,the professional assisted her without gloves and there was an important contact with blood.Serological tests were performed to the patientrevealing to be a HBsAg carrier, but negativefor HBeAg, positive for anti-HBe Ac and HBcIgG, negative for anti HBs and HBc Ac IgM. Thesecond case is a patient with Systemic Lupus Erythematosus under immunosuppressivetreatment, with a history of having a deceased mother and two siblings with HBV infection.Serology revealedHBsAg (+) with viral load of 113 copies, HBeAg (-),hepatitis C (-), HBcIgG(+), HBcIgM (-), anti-HBe (+). The patient received treatment with ten of ovir. Bothpatients were incidentally diagnosed and considered to be chronic inactive hepatitis Bcarriers due to probable vertical transmission based on their family history. These two casesconstitute a wake-up call about the vertical transmission of the virus and the importance ofperforming the screening in all pregnant women in the first prenatal care.

Frequency and significance of concurrent presence of HBsAg and anti-HBs among Korean HBsAg-positive patients / 대한임상병리학회지

BACKGROUND: Although the development of antibodies(anti-HBs) against hepatitis B surface antigen(HBsAg) generally leads to the clearance of the infecting hepatitis B virus(HBV), anti-HBs reactivity has been reported in patients with chronic hepatitis. Some reports suggested that concurrent presence of HBsAg and anti-HBs was a common serologic pattern in HBV carriers, however, the others insisted concurrence was associated with evidence of viral replication and features of active inflammation. This study was to investigate the frequency and significance of concurrent presence of HBsAg and anti-HBs among Korean HBsAg-positive patients. METHODS: HBV serological markers were analyzed by Abbott Axym. Anti-HBs titer was assessed quantitatively using 6 standard calibrators(0, 10, 50, 100, 500 & 1,000 mIU/mL), and reported as positive when more than 10 mIU/mL. RESULTS: Of 959 consecutive HBsAg-positive patients who had simultaneous anti-HBs determinations, HBsAg and anti-HBs were found concurrently in 31(3.2%). Anti-HBs was quantitated 10-100 mIU/mL in 25(80.6%) and more than 100 mIU/mL in 6(19.4%) among 31 HBsAg-positive patients with concurrent presence of anti-HBs. HBeAg positive rate of concurrent HBsAg/anti-HBs-positive patients(15/22 or 68.2%) was higher than that of HBsAg-positive patients without anti-HBs(227/562 or 40.4%). Of 31 HBsAg-positive patients with concurrent anti-HBs, 15 were patients with chronic hepatits, 5 with primary hepatocellular carcinoma and 2 with liver cirrhosis. CONCLUSIONS: Concurrent HBsAg/anti-HBs-positive patients were found in about 3% of Korean HBsAg-positive patients and their anti-HBs titers were less than 100 mIU/mL in 80% of concurrent HBsAg/anti-HBs-positive patients. In patients with chronic hepatits B who possessed HBsAg and anti-HBs above 100 mIU/mL, infections of HBV variants with mutations in the envelope gene might be suspected.

The Incidence of Hepatitis B in Military Service ad the Effect of Asymptomatic HBsAg Carriers on the Incidence / 예방의학회지

The purpose of this study was to investigate the incidence rate of hepatitis B in the military service and to examine the effect of the asymptomatic HBsAg carriers on the incidence of hepatitis B. The subject were 223,270 men who were conscripted to the Korean Army from 1991 to 1994 year. According to the conscripted year, four conscription cohort were constructed. At the screening examination for military service no test for hepatitis B were performed in 1991 and 1992. In 1993, a screening test for hepatitis B were performed and those who were confirmed as HBsAg positive or > or = SGPT 100IU were excluded from conscription. In 1994, the criteria for conscription was changed and those who were HBsAg positive were not excluded from conscription. Only those who were > or =SGPT 100IU were excluded. The main results were as follows ; 1. The positive rate of HBsAg is 5.5% in the conscripted men. 2. The incidence rates of the hepatitis B in 1991 and 1992 conscription cohort were 9.96 and 8.10 per ten thousand per son - year, respectively. The incidence rate of the hepatitis B was 1.34 per ten thousand per son - year in 1993 conscription cohort which was confirmed as HBsAg negative at the screening test, and 7.41 per ten thousand per son - year in 1994 conscription cohort which included the HBsAg positive. 3. The incidence rate of hepatitis B was 99.98 per ten thousand per son- year in HBsAg positive group and 2.25 per ten thousand per son - year in HBsAg negative group. The incidence rate of the group with high SGPT and HBsAg positive was 255 times higher than that of normal population. 4. The incidence of hepatitis B in HBsAg negative group did not increase even though the probability of personal contact with HBsAg positive had been increased. From the above result s, the men who have high SGPT with HBsAg positive should be excluded from military service, and it can not be said that asymptomatic HBsAg carrier s influence on the hepatitis B incidence among the HBsAg negative through personal contact.

Peritoneoscopic liver biopsy findings in asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly

Asymptomatic chronic HBsAg carriers with normal liver function tests are, in general regarded as having no liver pathology. Most of the histologic findings in asymptomatic chronic carriers have been reported from areas with low incidence of Hepatitis B virus (HBV) infection, such as North America and Western Europe. It is well known that there are many differences in HBV infection between low and high endemic areas, but there have been few reports on the histologic findings of asymptomatic chronic HBsAg carriers from endemic areas. The present study was undertaken in Korea which is one of the endemic areas for HBV infection and was designed to assess the prevalence of chronic liver disease by peritoneoscopic liver biopsy among asymptomatic chronic HBsAg carriers and to make a basis for the follow-up of asymptomatic chronic HBsAg carriers according to the results obtained. One hundred and ten asymptomatic HBsAg-positive carriers with normal liver function tests and no hepatomegaly were included in the study. Final diagnosis by peritoneoscopic liver biopsy revealed that of the 110 asymptomatic carriers only 27 (24.5%) had a histologically normal liver, while 51 (46.4%) had chronic liver diseases, and the remaining 32 (29.1%) had nonspecific histologic abnormalities (nonspecific reactive changes in 18 cases, cholestasis in 6 cases, and fatty change in 8 cases). Of the 51 patients with chronic liver diseases, 3 had liver cirrhosis, 4 chronic active hepatitis with cirrhosis, 11 chronic active hepatitis and 33 chronic persistent hepatitis. The frequency of liver cirrhosis and chronic active hepatitis with cirrhosis was significantly high in the over 30 years of age group (12.1%) than in the under 30 years of age group (0%; p = 0.011 by Fisher's exact test). In conclusion, 46.4% of the Korean asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly had chronic liver disease. This finding contrasted with reports from low incidence areas of HBV infection. Our results suggest that in endemic areas, a liver biopsy should be considered to assess the status of liver disease in asymptomatic chronic HBsAg carriers even if liver function tests are normal and hepatomegaly is absent, and the result can be used as a basis for the follow-up of each asymptomatic chronic HBsAg carriers.

A FOLLOW-UP OBSERVATION OF 222 HBsAG CARRIERS OVER FOUR YEARS / 重庆医科大学学报

A follow-up observation of 222 HBsAg carriers was carried out over four years. The serological results showed that 46 out of 222 HBsAg carriers were negative converted (20.7%) , 25 out of 72 HBeAg positive carriers were negative converted (34.72%). The clinical results showed that 12 suffered from acute hepatitis, 10 from chronic persistent hepatitis (CPH), 8 chronic active hepatitis(CAH), 3 hepa-tocirrhosis, 1 primary hepatic carcinoma (PHC), 25 with slight liver function damage, 117 were asymptomatic carriers, and 46 persons recovered.This follow-up study indicated that the negative-conversion rate of HBsAg carriers with high titer or HBeAg positive was significantly lower than those with low titer or HBeAg negative and that the negative-conversion rate of HBsAg carriers or HBeAg positive increased with age