Búsqueda de infección por Hepatitis B en familiares de portadores crónicos de la provincia de Huanta, Ayacucho -Perú / Search of Hepatitis-B infection in relatives of chronic carriers in the province of Huanta, Ayacucho, Peru

RESUMEN Un plan de eliminación del virus de hepatitis B (HBV) es factible porque la inmunización ha tenido buen impacto, tal como ha sucedido en la provincia de Huanta en Perú. El objetivo de nuestro estudio fue determinar la frecuencia de la infección por HBV en familiares de portadores del antígeno de superficie del virus de la hepatitis B (HBsAg). Este estudio transversal incluyó a 39 familiares de portadores crónicos, identificados en el Hospital de Apoyo de Huanta. Se recolectaron datos sociodemográficos y muestras de sangre. La frecuencia total de infección por HBV fue de 10,3 % y la mayoría correspondía a infección crónica (7,7 %). Una tercera parte tenía antecedentes de infección por HBV. Los miembros de la familia con infección por HBV fueron mayormente adultos alcohólicos y no vacunados. En conclusión, encontramos una alta frecuencia de HBV en familiares de portadores de HBsAg, esta estrategia ayudaría a identificar portadores crónicos que pueden ser tratados y contribuir a un plan de eliminación de HBV.

ABSTRACTS A plan of elimination of the virus of B hepatitis (HBV) is feasible because the immunization has had good impact, as it has been documented in the province of Huanta in Peru. The objective of our study was to determine the frequency of the infection by HBV in relatives of carriers of the surface antigen of the virus of hepatitis B (HBsAg). This cross-sectional study included 39 relatives of chronic carriers, identified at Hospital de Apoyo de Huanta. Sociodemographic data and blood samples were collected. The total frequency of infection by HBV was 10.3%, and the majority corresponded to chronic infection (7.7%). One third had a history of infection by HBV. The family members with HBV infection were mainly adult alcoholics who had not been vaccinated. In conclusion, we found a high frequency of HBV in relatives of carriers of HBsAg. This strategy would help identify chronic carriers that can be treated and to contribute to a plan for the elimination of HBV.

Characteristics of an outpatient chronic hepatitis B virus infection cohort / Caracterização de uma coorte ambulatorial de pacientes com infecção por vírus da hepatite B crônica

ABSTRACT Objective: To characterize a chronic hepatitis B cohort based on initial and follow-up clinical evaluations. Methods: A retrospective and descriptive analysis of clinical and laboratory data from chronic HBsAg adult carriers, without HIV, unexposed to treatment, with at least two outpatient visits, between February 2006 and November 2012. Fisher´s exact test, χ², Wilcoxon, Spearman, multiple comparisons and Kappa tests were applied, the level of significance adopted was 5%, with a 95% confidence interval. Results: 175 patients with mean age of 42.95±12.53 years were included: 93 (53.1%) were men, 152 (86.9%) were negative for hepatitis B e-antigen (HBeAg), 3 (1.7%) had hepatitis C coinfection, 15 (8.6%) had cirrhosis, and 2 (1.1%) had hepatocellular carcinoma. Genotype A predominated. Sixty-six patients (37.7%) had active hepatitis, 6 (3.4%) presented immune tolerance, and 38 (21.7%) were inactive carriers. Exacerbations and/or viral breakthrough were detected in 16 patients (9.1%). In 32 patients (18.3%), hepatitis B virus DNA remained persistently elevated and alanine aminotransferase levels were normal, whereas in 17 (9.7%), there was low hepatitis B virus DNA and alterated alanine aminotransferase. If only initial alanine aminotransferase and hepatitis B virus DNA values were considered, 15 cases of active hepatitis would not have been detected. Advanced fibrosis was more common in HBeAg-positive patients, and it was significantly associated with transaminases, hepatitis B virus DNA, and age. Conclusion: Many patients had active hepatitis, but almost 25%, who were HBeAg non-reactive, were only identified because of combined analyses of the hepatitis B virus DNA and transaminases levels, sometimes associated with histological data, after clinical follow-up. .

RESUMO Objetivo: Caracterizar uma coorte de pacientes com hepatite B crônica, segundo parâmetros iniciais e evolutivos. Métodos: Análise retrospectiva e descritiva dos dados clínicos e laboratoriais de portadores crônicos adultos do HBsAg, sem HIV, virgens de tratamento, com ao menos duas consultas ambulatoriais entre fevereiro de 2006 a novembro de 2012. Empregaram-se os testes exato de Fisher, χ², Wilcoxon, Spearman, Kappa e comparações múltiplas, o nível de significância estatística adotado foi de 5% e intervalo de confiança de 95%. Resultados: Foram incluídos 175 pacientes com média de idade de 42,95±12,53 anos, 93 (53,1%) do sexo masculino, 152 (86,9%) não reagentes para o antígeno e (HBeAg), 3 (1,7%) coinfectados com hepatite C, 15 (8,6%) cirróticos e 2 (1,1%) com carcinoma hepatocelular. Predominou o genótipo A. Constataram-se hepatite ativa em 66 pacientes (37,7%), imunotolerância em 6 (3,4%), estado de portador inativo em 38 (21,7%), exacerbações e/ou escapes virais em 16 (9,1%). Em 32 (18,3%), havia DNA viral persistentemente elevado e alanina aminotransferase normal; em 17 (9,7%), carga viral constantemente baixa e alanina aminotransferase alterada. Se fossem considerados apenas transaminases e DNA viral iniciais, 15 casos de hepatite ativa não teriam sido evidenciados. Fibrose avançada foi mais prevalente em HBeAg reagentes e associou-se direta e significativamente ao DNA do vírus da hepatite, idade e transaminases. Conclusão: Grande parte dos pacientes apresentou hepatite ativa. Porém, aproximadamente um quarto (todos pertencentes ao grupo HBeAg não reagente) foram identificados somente em função da análise conjunta das mensurações sequenciais de DNA do vírus da hepatite e transaminases, por vezes aliada a dados histológicos, após seguimento. .

Influence of the socioeconomic status on the prevalence of malocclusion in the primary dentition

OBJECTIVE: To assess the influence of socioeconomic background on malocclusion prevalence in primary dentition in a population from the Brazilian Amazon. METHODS: This cross-sectional study comprised 652 children (males and females) aged between 3 to 6 years old. Subjects were enrolled in private preschools (higher socioeconomic status - HSS, n = 312) or public preschools (lower socioeconomic status - LSS, n = 340) in Belém, Pará, Brazil. Chi-square and binomial statistics were used to assess differences between both socioeconomic groups, with significance level set at P < 0.05. RESULTS: A high prevalence of malocclusion (81.44%) was found in the sample. LSS females exhibited significantly lower prevalence (72.1%) in comparison to HSS females (84.7%), particularly with regard to Class II (P < 0.0001), posterior crossbite (P = 0.006), increased overbite (P = 0.005) and overjet (P < 0.0001). Overall, malocclusion prevalence was similar between HSS and LSS male children (P = 0.36). Early loss of primary teeth was significantly more prevalent in the LSS group (20.9%) in comparison to children in the HSS group (0.9%), for both males and females (P < 0.0001). CONCLUSION: Socioeconomic background influences the occurrence of malocclusion in the primary dentition. In the largest metropolitan area of the Amazon, one in every five LSS children has lost at least one primary tooth before the age of seven. .

OBJETIVO: avaliar a influência da condição socioeconômica na prevalência de má oclusão na dentição decídua em uma população amazônica. MÉTODOS: esse estudo transversal compreendeu 652 crianças, de ambos os sexos, entre 3 e 6 anos de idade. Os indivíduos estavam matriculados na pré-escola na rede privada de ensino (alto nível socioeconômico; n = 312) ou, rede pública (baixo nível socioeconômico; n = 340), em Belém, no Pará. O teste chi-quadrado e estatística binominal foram usados para avaliar as diferenças entre os grupos socioeconômicos, com nível de significância considerado em p < 0,05. RESULTADOS: foi observada uma alta prevalência de má oclusão (81,44%) na amostra examinada. As meninas das escolas públicas exibiram uma prevalência significativamente menor (72,1%) em comparação às das escolas privadas (84,7%), principalmente com relação à prevalência da má oclusão de Classe II (p < 0,0001), mordida cruzada posterior (p = 0,006), sobremordida (p = 0,005) e sobressaliência (p < 0,0001). De maneira geral, a prevalência de má oclusão foi similar entre as crianças do sexo masculino dos dois grupos (p = 0,36). A perda precoce de dente decíduo foi significativamente mais prevalente no grupo com menor nível socioeconômico (20,9%) quando comparada à de crianças nas escolas privadas (0.9%), em ambos os sexos (p < 0,0001). CONCLUSÃO: a condição socioeconômica influencia a ocorrência de má oclusão na dentição decídua. Na maior metrópole da Amazônia, uma em cada cinco crianças do grupo com baixo nível socioeconômico perdeu, no mínimo, um dente decíduo antes dos sete anos. .

Seroprevalence of Toxocariasis among Healthy People with Eosinophilia

The aim of this study is to determine the Toxocara seropositive rate among healthy people with eosinophilia. A total of 97 people residing in Seoul who were healthy and whose blood eosinophilia was over 10%, as shown by regular health check-ups in 2004, were subjected to this study. Their sera were tested by immunoblotting and ELISA with the antigen of larval Toxocara canis excretory-secretory (ES) protein. Sixty-five sera were band-positive (67.0%). The seropositve control sera were positive to band sizes of 66 kDa, 56 kDa, 32 kDa, and 13 kDa. In ELISA, 63 sera (65.0%) were positive to T. canis ES protein. There was no significant correlation between the IgG ELISA titer and the level of eosinophilia (r = 0.156, P = 0.156). As there were insufficient data to determine whether there were cross-reactions with other helminthic infections, or whether atopy occurred, further studies are required to verify the cause of the seropositive reactions against T. canis ES antigen. Toxocariasis seropositivity is suggested to be the major cause of eosinophilia, since the Toxocara seroprevalence among Korean rural adults was shown to be approximately 5%.

Seroprevalence of Toxocariasis among Healthy People with Eosinophilia

The aim of this study is to determine the Toxocara seropositive rate among healthy people with eosinophilia. A total of 97 people residing in Seoul who were healthy and whose blood eosinophilia was over 10%, as shown by regular health check-ups in 2004, were subjected to this study. Their sera were tested by immunoblotting and ELISA with the antigen of larval Toxocara canis excretory-secretory (ES) protein. Sixty-five sera were band-positive (67.0%). The seropositve control sera were positive to band sizes of 66 kDa, 56 kDa, 32 kDa, and 13 kDa. In ELISA, 63 sera (65.0%) were positive to T. canis ES protein. There was no significant correlation between the IgG ELISA titer and the level of eosinophilia (r = 0.156, P = 0.156). As there were insufficient data to determine whether there were cross-reactions with other helminthic infections, or whether atopy occurred, further studies are required to verify the cause of the seropositive reactions against T. canis ES antigen. Toxocariasis seropositivity is suggested to be the major cause of eosinophilia, since the Toxocara seroprevalence among Korean rural adults was shown to be approximately 5%.

Profile of asymptomatic chronic HBV infection in India.

BACKGROUND & OBJECTIVES: In India, horizontal transmission in early childhood has been shown to be a significant mode of transmission of hepatitis B virus (HBV). This prospective, cross-sectional study was undertaken to study the biochemical, serological and histological profile of incidentally detected asymptomatic HBsAg positive subjects (IDAHS) picked up at a tertiary care referral centre. METHODS: In 157 (M:F::123:34) HBsAg positive subjects, clinical, biochemical, virological and histological assessment was done. The histological activity index (HAI) of > 3 was considered as chronic hepatitis. Serum was tested for HBsAg, HBeAg, HBeAb, HBV DNA and alanine transaminase (ALT). RESULTS: Seventy (45%) subjects were HBeAg and 83 (53%) anti-HBe positive. While 71 per cent of the subjects with elevated ALT had an HAI > 3, only 36 per cent with normal ALT showed significant histological changes (P < 0.001). Significant histopathological lesions in the liver biopsy were seen in 92 (59%) subjects, with moderate to severe lesions in 14. IDAHS who were HBeAg +ve were more likely to have significant histological lesion than those who were anti-HBe +ve (P < 0.01). In the anti-HBe +ve group, 35 of 57 (61%) subjects for whom HBV-DNA was available, were HBV-DNA positive. Anti-HBe+ve, HBV-DNA+ ve IDAHS with elevated ALT were more likely to have chronic hepatitis vis-a-vis those subjects in this group who had a normal ALT (P < 0.001). INTERPRETATION & CONCLUSION: ALT is a reliable discriminant of significant histological lesion in IDAHS. The relatively young mean age of Anti-HBe +ve IDAHS suggests an early age of infection and hence, early seroconversion or mutant virus infection in this cohort. A significant proportion of these IDAHS have HBV-DNA positivity and HAI > 3. Our results clearly demonstrate ongoing liver disease in asymptomatic, so-called "HBV carriers". We propose that the term hepatitis B 'carrier' should be abandoned and replaced by 'chronic HBV infection'.

Serum interleukin-6 and interferon-gamma levels in patients with hepatitis B-associated chronic liver disease.

Hepatitis B virus (HBV) infection can elicit a variety of clinical sequelae ranging from acute self-limited hepatitis to hepatocellular carcinoma, which are not attributable to a direct cytopathic effect of the virus but rather to the individual host's immune response. Cytokines, low-molecular-weight proteins with a broad range of activity, have been shown to be involved in the regulation of hepatocyte functions, as well as in the pathogenesis leading to liver damage. In the present study, we investigated the correlation between serum interleukin 6 (IL-6) and interferon gamma (IFN-gamma) in altogether 75 patients chronically infected with HBV. They comprised 15 asymptomatic carriers, 15 chronic persistent hepatitis (CPH) and 15 chronic active hepatitis (CAH) patients, 15 cases of cirrhosis and 15 patients with hepatocellular carcinoma (HCC) previously diagnosed by serology and histology, respectively. IL-6 and IFN-gamma levels in their sera were determined using a commercially available kit. Our results showed various concentrations of serum IL-6 detectable in 6.7% of asymptomatic carriers, 13.3% of patients with CPH, 20% of patients with CAH, 33.3% in cirrhotic patients and 66.7% in HCC. In contrast, serum IFN-gamma was only found in 13.3% of asymptomatic carriers and CAH, but could not be detected in the other groups. Our data demonstrated a positive correlation between serum IL-6 and clinical severity of chronic HBV infection, whereas the IFN-gamma levels appeared not to be correlated. From this we conclude that among chronic hepatitis patients IFN-gamma is mostly not expressed at a level detectable by serology, whereas according to other authors it is involved in the immediate immune response triggered by acute hepatitis. IL-6 on the other hand, might rather be responsible for liver inflammation and regeneration in chronic liver disease.

Prevalencia de la infección por el virus de la hepatitis B (VHB) en mujeres embarazadas / Prevalence of the hepatitis B virus infection in pregnant women

De los diferentes virus de la hepatitis, el tipo B (VHB) es el que presenta una mayor transmisión perinatal. Una característica importante de la infección vertical por el VHB es el alto riesgo de progresar hasta una infección crónica. Se estudiaron los sueros de mujeres embarazadas que acudieron para realizarse estudios básicos de laboratorio de control prenatal, en búsqueda de marcadores serológicos de infección por el VHB. Se analizaron 1,443 sueros, identificándose cuatro positivos para el AgsHB y 28 con anticuerpos IgG contra el Ag core, lo que proporcionó una prevalencia de madres portadoras de la AgsHB del 0.27 por ciento y de pacientes con antiHBc de 1.95 por ciento. No se detectó ninguna mujer con Ige ni con anticuerpos IgM contra el Ag core. La importancia del escrutinio de embarazadas en búsqueda del AgsHB es identificar a las pacientes cuyos recién nacidos deben ser inmunizados contra el VHB y así reducir la posibilidad de transmisión

Upper airway carriage by Haemophilus influenzae and Streptococcus pneumoniae in Australian aboriginal children hospitalised with acute lower respiratory infection.

When nasopharyngeal secretions from 171 Australian Aboriginal children hospitalized with acute lower respiratory tract infections (ALRI) were cultured selectively for Streptococcus pneumoniae and Haemophilus influenzae, 136 (79.5%) and 151 (88.3%) children yielded 166 and 254 isolates of S. pneumoniae and H. influenzae, respectively. In colonized subjects multiple populations of S. pneumoniae (20% of carriage-positive patients) and H. influenzae (55%) were common. Pneumococci belonging to 27 types or groups were identified. H. influenzae serotype b colonized 16.4% of all children studied. More than one half of 152 children tested were excreting antibiotics at the time of admission to hospital. Significantly fewer children with serum antibiotic residues were colonized with S. pneumoniae than were antibiotic free children. Antibiotic usage had no measurable impact on the isolation rate of H. influenzae.

Status of lymphatic filariasis in some select slum clusters of Delhi.

Filaria surveys conducted in some select slum clusters namely Hari Nagar, Yamuna pusht near Vijaya Ghat along the Ring Road and Timarpur in Delhi during 1989, 1991 and 1992 respectively, covering a population of approximately 5000 slum dwellers revealed the presence of bancroftian microfilaria (mf) carriers and disease cases. The mf and disease rates (per cent) in these three slum areas were in the order of 6.3, 2.2, 3.7 and 1.4, 0.5 and 0.1 respectively. The mf density varied from 3.1 to 12.3 per 20 cumm. blood. High ten man hour densities of Culex quinquefasciatus (581) in Yamuna pusht followed by (355) in Timarpur were recorded during entomological investigations. Hari Nagar accounted for least ten man hour density of Cx. quinquefasciatus (160), because collection was made during winter months (November-December). The dissection of Cx. quinquefasciatus did not reveal any human filarial infection except in Yamuna pusht where out of 139 only one Cx. quinquefasciatus was found infective.

Avaliaçäo da parasitemia em mulheres portadoras de infecçäo pelo Trypanosoma cruzi durante e após a gestaçäo / Evaluation of parasitaemia in women who are carriers of Trypanosoma cruzi infection during and after pregnancy

Avaliou-se o perfil parasitêmico de 119 chagásicos crônicos, através de 828 xenodiagnósticos, realizados durante (465 xenos) e após a gravidez (363 xenos) visando rastrear uma possível variaçäo da parasitemia nesses períodos. A freqüência de xenos positivos foi maior durante a gestaçäo. Por outro lado, a freqüência de triatomíneos infectados foi, também maior durante a gravidez, indicando níveis parasitêmicos mais elevados neste período. Apenas 17 por cento das mäes estudadas tiveram dois ou mais xenos positivos durante a gravidez. Nestas mulheres, a diferença entre a freqüência de xenos positivos durante e após a gravidez foi elevada, sugerindo ter havido exacerbaçäo da infecçäo chagásica, pelo menos em algumas delas

Daily diethylcarbamazine for the treatment of Brugia malayi microfilaria carriers.

BACKGROUND. Diethylcarbamazine is effective for the treatment of brugian filaria carriers. However, the 12-day course with a daily dose of 6 mg per kg body weight is rarely completed. The World Health Organization has indicated the need for better regimes to control filariasis. METHODS. We evaluated the long term effects of three different dosage regimes of diethylcarbamazine--6, 9 and 12 mg per kg body weight--to a total of 72 mg on 93 microfilaria carriers of Brugia malayi. RESULTS. All cases treated with the 6 mg daily dose showed complete clearance of microfilaria immediately after the treatment. However, at the 9 and 12 mg daily doses only 91% and 85% of cases respectively showed complete clearance. There was a close association between the daily dose and the proportion of cases developing side-effects. The mean initial microfilaria counts were significantly higher in those who had side-effects than in those who did not. An 11-month follow up showed that with the 6 mg daily dose the recurrence rate of microfilaraemia was 29% while with the 12 mg daily dose it was 67%. Four per cent of patients on a daily dose of 6 and 9 mg discontinued treatment while 21% of those on the 12 mg daily dose did so. CONCLUSION. The 6 mg daily dose of diethylcarbamazine was the most effective and best accepted regime.

Hepatitis B y Delta: prevalencia de marcadores seroepidemiológicos en donadores de sangre voluntarios y su grupo familiar / Hepatitis B and Delta: Prevalence of seroepidemologic markers in blood donors and their family groups

Se estudiaron 41 donadores de sangre voluntarios para conocer la prevalencia de infecciones por virus B y D de la hepatitis, así como la epidemiología de estas infecciones en su grupo familiar (152 familiares). La frecuencia de portadores HBsAg+ en el Centro Nacional de la Transfusión Sanguínea fue de 0.34 por ciento y en el Banco Central de Sangre del IMSS del 0.15 por ciento. La mayoría de los donadores HBsAg+ se encontraban en el grupo de 21 a 40 años (87.8 por ciento); 21.9 por ciento tuvieron anticuerpos IgM anti-HBc y solamente 2.4 por ciento tenía HBsAg. En el grupo de 152 familiares, 41 (26.9 por ciento) tuvieron uno o más marcadores de VHB, 3.9 por ciento fueron portadores de HBsAg y 1.3 por ciento de HBsAg. En los familiares infectados, 36.6 por ciento de los casos correspondió a padres o hermanos y 14.6 por ciento a la esposa del caso índice. Ninguno de los donadores HBsAg+ o sus familiares tuvieron anticuerpos contra el agente delta. Este trabajo confirma que la proporción de portadores asintomáticos de HBsAg en el grupo de donadores voluntarios de sangre no difiere del de la población general, e identifica al grupo de familiares convivientes como de mayor riesgo por adquirir la infección por VHB

Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers.

Sixty-five adult asymptomatic chronic carriers of hepatitis B virus were enrolled to the randomized controlled efficacy study of Phyllanthus amarus. Thirty-four received Phyllanthus amarus 600 mg per day for 30 days and 31 received placebo in identical capsules. The conversion rate of HBsAg was 6 per cent in the study group at day 30. When 20 subjects in the Phyllanthus amarus group were given a further 30-day treatment and 22 placebo recipients given Phyllanthus amarus 1,200 mg per day for 30 days, the conversion was observed in 1 (5%) in the higher dose group. Adverse effects were not observed in all patients receiving the plant. The results indicated that Phyllanthus amarus, whole plant except root, grown in the central part of Thailand, given at the studied dosage and duration, had a very minimal effect on eradication of HBsAg from Thai adult asymptomatic chronic carriers.

HBsAg amongst unscreened operated patients.

Prevalence of asymptomatic Hepatitis B carrier state varies in different countries. Surgical procedures are an important mode of dissemination of Hepatitis B virus infection. Five hundred patients whose HBsAg status was not known and had undergone a major operative procedure in the Dhaka Medical College Hospital were screened for HBsAg. Of these, 43 (8.6%) were found to be HBsAg positive. Age, sex, and previous history of jaundice didn't show any relationship with the HBsAg status. But the HBsAg positivity was found to be positively related to the past history of blood transfusion, hospitalization and injections.

Geographic distribution of HBsAg subtypes in Brazil

Foram analisadas 896 amostras de soros HBsAg positivos de cinco regiöes brasileiras. A presença de cinco diferentes subtipos (ayw2, ayw3, ayw4, adw2 e adw4) foi determinada. Na regiäo Norte, os subtipos adw4 (41,2%) e adw2 (37,2%) foram predominantes. No Nordeste somente o subtipo adw2 foi encontrado. No centro Oeste, Sudeste e Sul os subtipos ayw2, ayw3, adw4 estäo presentes, com predominância do adw2 no Centro Oeste e Sudeste (84,3% e 69,4% respectivamente), enquanto que no Sul o subtipo predominante foi ayw3 (41,9%) seguido pelo ayw2 (36,4%). Os subtipos ayw1 e ayr e adr näo foram encontrados entre amostras estudadas. Estes resultados mostram a diferença na incidência dos subtipos do HBsAg em diferentes regiöes do Brasil e seu significado em relaçäo à colonizaçäo e migraçöes neste país