[Incidence of sporadic hepatitis E in Ivory Coast based on still problematic serology]. / Fréquence de l'hépatite sporadique E en Côte d'Ivoire, vue au travers d'une sérologie encore problématique.

The first well-documented outbreak of viral hepatitis E in Africa was described in 1986 in Côte d'lvoire. Subsequently, no other outbreaks have been observed in the country. Côte d'lvoire therefore offers an excellent opportunity to evaluate the prevalence of sporadic viral hepatitis E in a country where the frequency of non-A, non-B, non-C viral hepatitis appears to be high. The study was carried out in Abidjan, the most populous city, and involved 111 hospitalized patients suffering from non-A, non-B and presumed non-C acute viral hepatitis. Screening for leptospirosis or a toxic etiology was carried out and the risk of including such patients eliminated. Diagnosis of viral hepatitis A was excluded from the absence of IgM anti-HAV antibodies. Patients with HBsAg and anti-HCV antibodies were not included in the study, although co-infection in asymptomatic HBV carriers or subsequent infection in patients who had recovered from a past HCV infection remained possible. There was a risk that some patients with late appearance of anti-HCV antibodies were included since PCR tests could not be performed. Cytomegalovirus or Epstein-Barr virus was not involved, since no specific IgMs against these viruses were detectable. Large discrepancies between the two commercial enzyme-linked immunosorbent assays (ELISAs) available for serological diagnosis of hepatitis E (Abbott and Genelabs) were observed. Among the 53 sera screened using both tests, only 20 gave positive results in both, and all such sera were confirmed using a domestic immunological test involving inhibition of labelled, well-documented anti-HEV-specific human IgG. Immunological confirmation was obtained for only half of the sera with discordant results in the commercial ELISAs. Full agreement between both commercial tests was observed for only 59% of the sera studied. The minimal incidence of sporadic viral hepatitis E among hospitalized patients in Abidjan with an acute hepatitis was estimated to be 27%.

ELISA in serodiagnosis of HCV infection.

A high level of anti-HCV is generally associated with viral replication and the number of recognized epitopes appears to be correlated with the viral charge. Nevertheless, the absence of detectable antibodies in about 60% of patients during the acute phase of the disease and in 10% of chronically infected (generally immunocompromised subjects) are heavy handicaps for HCV serology. Moreover, low levels of anti-HCV antibodies can persist after complete recovery, and HCV viremia does not appear to be associated with the presence of a special antibody specificity. The immunoblots presented as 'confirmatory test' always appear to be less sensitive than the screening tests and therefore are unable to discriminate between post-infection antibodies and false-positive reactions, as rare as they can be. In these cases, as in non-responder patients, PCR appears essential. The possible reasons of immune response limitations and the possible improvements of HCV serology are discussed.

[High incidence of sporadic non-A, non-B hepatitis in Morocco: epidemiologic study]. / Forte incidence des hépatites non-A, non-B sporadiques au Maroc: étude épidémiologique.

Non-A, Non-B hepatitis and their sequelae seem to be as frequent as HBV infections in Morocco. These diseases represent an important problem of public health because their high incidence and high fatal rate. Some aspects of the epidemiology of Non-A, Non B acute hepatitis were evoking a high incidence of enterically transmitted hepatitis E. That was confirmed by serum studies having shown that hepatitis E antibodies were detected in more than 60% of patients with acute Non-A, Non-B hepatitis. However this type of hepatitis has been recognized only as sporadic (non-epidemic), mainly transmitted by personal contacts in low hygiene conditions. Other Non-A, Non-B acute hepatitis (around 35%) were certainly due to hepatitis C virus infection, because the presence of hepatitis C antibodies in the serum of the patients. However, in our study, hepatitis C seemed to be rarely transmitted by transfusion or other blood related route. Chronic liver diseases related to Non-A, Non-B virus infection appeared to be as frequent as the ones due to hepatitis B virus. Serological studies had shown that about seventy-four per cent of the studied cases were related to an infection by hepatitis C virus (presence of hepatitis C antibodies). Among other Non-A, Non-B chronic liver diseases the possible existence of some cases due to hepatitis E virus infection cannot be ruled out but this hypothesis needs further investigations to be verified. The prevalence of the markers of past hepatitis B infection in convalescent patients from Non-A, Non-B hepatitis is comparable to the prevalence of hepatitis B infection markers in blood donors. However, chronic HBV infection could be a factor facilitating the clinical expression of the Non-A, Non-B hepatitis.

Blood transfusions and HIV infections (HIV1, HIV2/LAV2) in Ivory Coast.

Sera from 500 blood donors, 67 multiply-transfused children with sickle-cell anaemia and 320 healthy children who had not been transfused were tested for HIV1 and HIV2 antibodies. Amongst blood donors, 49 (9.8%) exhibited antibodies to retroviruses: 12 (2.4%) to HIV1, 17 (3.4%) to HIV2 and 20 (4%) to both HIV1 and HIV2. Fifteen (22.4%) of the 67 multiply-transfused children had retroviral antibodies: five (7.4%) to HIV1 four (6%) to HIV2 and six (9%) to both HIV1 and HIV2. In contrast, among 320 non-transfused children only two (0.62%) exhibited HIV1 infection. These results suggest that children with sickle-cell anaemia who have been repeatedly transfused, constitute a high risk group for HIV1 and HIV2 infections in Ivory Coast.

[Selective immune deficiency in IgA. Intestinal malabsorption syndrome and mixed connective tissue disease]. / Déficit immunitaire sélectif en IgA. Syndrome de malabsorption intestinale et connectivite mixte.

We report the case of a 22-year old unmarried woman who presented with selective IgA immune deficiency, moderate intestinal malabsorption syndrome with pseudo-atrophy of the villi, and mixed connective tissue disease. Although immune deficiency and malabsorption syndrome are frequently associated, association with an autoimmune disease is rare and we were unable to find any case of association with a connective tissue disease in the literature.

[Low occurrence of delta agent infections in Morocco]. / Faible incidence des infections par l'agent delta au Maroc.

The incidence of delta infections in Morocco has been investigated to explain the high rate of severe hepatitis B (HB) observed in this country. The presence of delta antigen (D Ag) and antibodies to delta agent (D Ab) was tested by radio-immuno-assay in the sera from 85 HBs Ag positive patients, hospitalized in Casablanca: among them 57 suffered from acute or fulminant HB (12 deceased), 10 from chronic hepatitis and 18 from cirrhosis. Neither D Ag nor D Ab were found, excepted once in a patient with cirrhosis having shown the presence of D Ab. In contrast with the high endemicity of delta agent reported in other countries of North Africa, the incidence of delta infections seems to be very low in Morocco.

[Prevalence of markers of the HBs system of hepatitis B among hospital personnel in Morocco: evaluation of the risk of hepatitis B infection]. / Prévalence des marqueurs du système HBs de l'hépatite B parmi le personnel hospitalier au Maroc: evaluation du risque d'infection par le virus de l'hépatite B.

The prevalences of HBs Ag and HBs Ab were investigated among 221 hospital or laboratory staffs in Casablanca (Morocco) to estimate the importance of risks of infection by HBV at which they were exposed with regard to a control group including 195 blood givers from the city. Staff originated from following departments: infectious diseases, emergency, blood center, haemodialysis and a laboratory associated to this one. HBs Ag has been investigated by inhibition of haemagglutination and HBs Ab by passive haemagglutination. X2 test, with Yates correction if need, was used as statistical. method. HBs Ag and Ab prevalences, higher among hospital staff than in controls (p less than 0.05), showed an increased risk of HBV infection in the formers. Among staff, whatever one's occupation may be, HBs Ab prevalence did not shown appreciable changes. In contrast, the HBs Ag one varied significantly from one department to the other, depending on factors such as hygiene and asepsis, reducing the risk, and contagiousness of some hospitalized patients or more or less frequent exposures to infectious blood, increasing the risk. The influence of these factors was illustrated and discussed by comparison of HBs Ag prevalence with frequency or importance of infectious exposures among staff from each studied department. As reported in various countries, in Morocco hospital and laboratory staff is exposed to a high risk of infection by HBV and the interest to vaccine such persons against hepatitis B is underlined.

[ Subtypes of HBsAG in Morocco: general distribution in HBsAG carriers in Casablanca in terms of their clinical state. Relations with the markers of the HBe system]. / Sous-types de l'Ag HBs au Maroc: répartition d'ensemble et en fonction de la situation clinique chez les porteurs d'Ag HBs de Casablanca. Relation avec les marqueurs du système HBe.

HBs Ag subtypes ad and ay were determined by counter-electrophoresis (CEP) among 301 persons from Casablanca found HBs Ag positive by CEP: 147 were asymptomatic HBs Ag carriers and 154 were patients with acute or chronic hepatitis. w and r determinants were investigated among 82 from them only. HBe antigen and antibody (AB) were investigated by gel double immunodiffusion among 294 persons. Into the whole population, the prevalence of ad and ay subtypes was respectively 20 and 80%. This distribution, intermediate between those reported in West Europe and West Africa, was in agreement with data previously reported by others in the Maghreb, but differing from these ones in the distribution of w and r determinants. ayr subtype was found dominant (39%) and adw rare (2.4%), the prevalences of adr and ayw being intermediate (25-30%). Among asymptomatic HBs carriers and patients only adr and ayr distribution differed: in the formers, adr was dominant and ayr rare and, in contrast, ayr was frequent and adr rare among patients. Elsewhere, some findings were in agreement with previously reported data by others, such as the frequent association of ad to chronic liver disease or long-term HBs Ag carriage, ay being rather associated to short-term carriage, the frequency of HBe Ab in ad subtype and the presence of ay among almost all HBs positive haemodialysed patients.

[Bioclinical significance of the specificities of the hepatitis B HBe system]. / Signification bioclinique des spécificités du système HBe de l'hépatite B.

The distribution and meaning of the three antigenic specificities (HBe Ag 1, 2, 3) of hepatitis B HBe system and corresponding antibodies (HBe Ab 1, 2, 3) were studied in Casablanca, Morocco, in two groups of HBs Ag carriers: patients with acute or chronic hepatitis and asymptomatic carriers (controls). The distribution of HBe Ag and Ab specificities was generally in agreement with published data: dominant HBe 1 specificity was always present, sometimes associated with HBe 2, rarely with HBe 3. However, the association of HBe Ag 1 + 2 + 3 was frequently observed among patients whereas the HBe Ab 1 + 2 + 3 one was as rare in patients as in the controls. In HBe Ag positive individuals, the HBs Ag amounts were all the higher as the specificities present in sera more numerous, index of proportionality between the number of HBe Ag specificities present in the serum and the intensity of the replication of the hepatitis B virus. In the clinical field, HBe Ag 1 was observed individually only among controls and patients with acute hepatitis leading to recovery. Two associated HBe Ag specificities (HBe Ag 1 + 2 or 1 + 3) were found both in these former cases and in fatal cases and in chronic hepatitis. The presence of HBe Ag 1 + 2 + 3, very rare among controls, was seen only among patients with chronic hepatitis, and with a high frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

[Augmentation of the sensitivity of immunoprecipitation reactions. Test under oblique lighting on a black background of arcs stained with Coomassie blue, applied to the detection of the specificity of the HBe system in hepatitis B]. / Augmentation de la sensibilité des réactions d'immunoprécipitation. Examen en éclairage oblique sur fond noir des arcs colorés par le bleu de Coomassie, appliqué au dépistage des spécificités du système HBe de l'hépatite B.

Gel immunoprecipitation reactions (double immuno-diffusion) are the only techniques capable of identifying the specificity of the HBe systems of hepatitis B. These techniques were studied after rinsing of the gels without staining (LD) and after desiccation and staining with Coomassie blue. The stained plates were examined on a light background (CB) and on a dark background with an oblique light beam (CN). This process (CN) results in bright red precipitation arcs on a black background and, because of its increased sensitivity, detects a greater number of "HBe positive" sera than the "LD" and "CB" examinations and also frequently reveals the presence of 2 or 3 HBe antigen or antibody specificities, which are not apparent on the other two examinations. The "CN" examination also allows a better resolution of the precipitation arcs due to the increased contrast, enabling the confirmation of the specificity of certain arcs which appear doubtful on the other two tests.

[Current status of leptospirosis in Morocco (1979-1981)]. / Etat actuel de la leptospirose au Maroc (1979-1981).

Leptospiroses in Morocco have been studied from 1979 to 1981. In man, L. icterohaemorrhagiae is the most frequently diagnosed serotype. The highest incidence of positive diagnoses is found in Fès-Meknès area. Leptospirosis is a severe disease: 1 out of 3 patients is hospitalized in Intensive Care Unit. Rat is an essential carrier of germs in Casablanca.

Complement fixing activity and immunoglobulin classes of antinuclear antibodies occurring in systemic lupus erythematosus and rheumatoid arthritis.

The sera of 88 patient suffering from systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) containing antinuclear antibodies (ANA) were studied for: I) the complement fixing capacity of these ANAs: II) their immunoglobulin class. The results showed that: I) ANAs bind complement to a significant extent in 2 patients with SLE out of 3, but not in RA; II) the ANAs which bind complement belong partially or totally to the IgG class, while most of the ANAs from SLE not fixing complement belong to other classes; III) the ANAs from RA were most often from the IgM class and, surprisingly, they did not bind complement; IV) the occurrence of IgM ANA in SLE patients seems to be associated with clinical manifestations of arthritis. This double test (identification of ANA class and complement binding capacity), appears to be a valuable aid in the cases where diagnosis between RA and SLE is questionable.

[An enzootic with pseudo-tumoral manifestations in Vipera lebetina in captivity]. / Une enzootie à manifestations pseudo-tumorales chez des vipères lébétines en captivité.

The authors report the clinical and epizootic evolution of an epizooty, characterized by pseudo-tumours, observed on some vipers (Vipera lebetina) maintained in captivity at the "institut Pasteur de Tunis". The disease was characterized by 2.3 cm size nodules, scattered under the skin or into splanchnic cavities. These ones, spherical and well capsuled, were formed by a mass of clear rounded cells (histiocytes or monocytes), the necrotic central area of which contained innumerable bacteria. Several reviewed works show that this appearance of chronic abcess is a common and univocal reaction to various pathogenic factors, such as bacteria and parasites. As to etiology, the authors have doubt about the pathological role of the germs which they have identified (Salmonella and other anterobacteria) because these latter belong to the normal microbial flora of snakes and are, in the present case, probably occasional infective agents only.

[A technique of accelerated immunization of animals producing antivenom serum]. / Essai d'une technique d'immunisation "accélérée" des animaux producteurs de sérums antivenimeux.

A technique of "fast" immunization, for antivenom serum production, is reported. Comparatively to the common technique, this fast method is characterized by more numerous immunizing injections (15 instead of 8) during the two first cycles of immunisation, higher venom doses and the lack of the rest period taking place between the two first cycles of immunization in the common technique. By this fast technique one may obtain a highly efficient anti-venmous serum within 2 1/2 to 3 months whereas the common technique needs 3 1/2 to 4 months to obtain the same results.

[Bioclinical study of the electro-immunodiffusion technic for the assay of serum alpha fetoprotein]. / Etude bioclinique du procédé d'électro-immunodiffusion pour la recherche de l'alpha-foetoprotéine sérique

The author discusses the result that may be expected in clinical medicine from an electro-immunodiffusion method for the detection of alpha-foetoprotein. The samples studied were obtained from pregnant women, patients with liver cell carcinoma or severe digestive diseases, whether malignant or not, and a few amniotic fluids and sera obtained from the umbilical cord. This simple, rapid method is characterized by a sensitivity threshold of about 300 ng/ml and permits one to detect about 75% of cases of liver cell carcinoma.