[Primary parvovirus B19 infection in immunocompetent adults: clinical and biological manifestations. Retrospective study of 16 patients]. / Primo-infection à parvovirus B19 chez l'adulte immunocompétent: variété d'expression clinique et biologique. Etude rétrospective de 16 patients.

PURPOSE: The spectrum of clinical and biological expressions of parvovirus B19 infection is incompletely described. METHODS: We report 16 retrospective cases of primary parvovirus B19 infection that occurred in immunocompetent adults and were diagnosed by serology. RESULTS AND CONCLUSION: Most cases conformed to the classical descriptions of parvovirus-induced arthropathy (transient polyarthritis often accompanied by erythema, dysesthesia and pruritus). However, the diagnosis of primary parvovirus B19 infection should also be considered in other clinical and biological situations such as edema, acute anemia or cytopenia, vascular purpura, neuro-ophthalmologic manifestations, and hepatitis. Parvovirus infection may mimic diseases such as lupus erythematosus or systemic necrotizing vasculitis. The risk for confusion with both diseases is increased, as immunological abnormalities such as hypocomplementemia, when they are systematically searched for, prove to be common.

Impact of hepatitis C on renal transplantation: a long-term study.

Viral hepatitis, especially "C" type (HCV), is an important cause of morbidity and mortality among recipients of renal transplants. In a retrospective long-term study, we reviewed 399 renal transplant patients (133F, 266M) who received 415 kidneys during the past eight-years. We evaluated their HCV infection and liver status. Stored sera (frozen at 80 C) as well as fresh sera collected at the time of transplant and/or at the last observation were used. The donors were cadavers in 386 and living related in 29 renal transplants. The mean follow-up period was 74 months (range 24-124 months). At the time of transplantation 105 recipients (26%) were HCV positive. A the last follow-up 105 (26%) recipients remained positive, 12 (2.8%) seroconverted from negative to positive due to graft and/or blood transfusion and 277 remained negative. Liver biopsy was obtained from 71 to 117 (60.6%) HCV +ve patients. Liver biopsy showed normal histology in 57 (80%) patients, chronic active hepatitis in 42 (59%) patients according to scoring of Knodle's classification. Recurrence of glomerulonephritis in renal allografts occurred in 21 patients. Membrano proliferative glomerulonephritis ( PGN) occurred in nine patients; seven (78%) of them were HCV +ve compared to 29% HCV +ve in the whole group (117/399) (P< 0.001). The actuarial patient and graft survival was similar in HCV-ve and HCV +ve patients. We conclude that HCV is an important cause of liver disease in renal allograft recipients, it might be the cause of recurrence of MPGN, however, it affects neither patients nor graft survival.

[Seroprevalence of viral hepatitis A in France in homosexuals and intravenous drug users]. / Séroprévalence de l'hépatite virale A en France métropolitaine chez les homosexuels et les toxicomanes intraveineux.

OBJECTIVES: In industrialized countries with a high level of sanitation, immunity against hepatitis A (HVA) is not acquired during childhood, and infection typically occurs in adults, mainly in travelers returning from developing countries where infection is endemic. However, the introduction of hepatitis A virus (HAV) among certain population groups, such as intravenous drug users (IVDU) or homosexual men, leads to a significant increase in the disease. We conducted a retrospective analysis of seroprevalence of anti-HAV antibodies. METHODS: The study group included 296 patients (174 homosexual men and 122 IVDU) for comparison with 76 control subjects (nurses in pediatric wards and workers in hospital kitchen). RESULTS: We found a significantly higher anti-HAV seroprevalence among less than 35-year old IVDU, HIV positive or negative, in comparison with control subjects but not among homosexual men, whatever their HIV status. CONCLUSION: Our experience illustrates that HVA is a health risk for IVDU in industrialized nations, and given its morbidity among adults population, IVDU should receive HVA vaccine.

Structure, genomic organization, replication and variability of hepatitis C virus.

Hepatitis C virus (HCV) is an enveloped, single-stranded RNA virus that has been classified in the Flaviviridae family. The genome of 9400 nucleotides comprises two non-coding regions in 5' and 3' flanking a large reading frame which codes for a polyprotein of 3000 amino acids; this polyprotein is further cleaved into structural (C, E1, E2) and non-structural (NS1, NS2, NS3, NS4, NS5) proteins. The positive RNA acts as a cap-independent messenger; the transcription is mediated by the NS5 RNA polymerase. After the maturation step, the virion is liberated by budding through the cytoplasmic membrane. As for many other RNA viruses, the HCV genome exhibits a high degree of variability, especially in the E2/NS1, E1, NS3 and NS5b regions. Conversely the 5' non-coding region is highly conserved, at least in part, and can be used for diagnostic purposes by PCR technique. Six genotypes of HCV have already been reported, numbered from 1 to 6 in Simmonds' classification. The same genotype can be divided into subtypes (for instance, genotype 1 comprises three subtypes: 1a, 1b and 1c). Various minor variants of the same strain, called quasispecies, are commonly present in the blood of the same patient. Strains of genotype 1b--which is the most widespread worldwide--are correlated with more severe clinical manifestations, greater viral loads and lower response to interferon treatment. The high variability of the HCV genome contributes greatly to the difficulty of designing potent vaccines.

[Tolerance of influenza vaccination in the aged and the nursing staff in a geriatric hospital]. / Tolérance de la vaccination grippale chez les sujets âgés et le personnel soignant d'un hôpital gériatrique.

The tolerance of influenza vaccination (Vaxigrip, Pasteur-Mérieux) was evaluated during four consecutive years (1989-1992) in the geriatric hospital of Saint-Etienne from questionnaires concerning 327 vaccinations in the aged (group 1) and 88 vaccinations in members of the nursing staff (group 2). Minor local symptoms were the more common incidents, respectively for each group: blotch (9.8 and 21.6%), pain (9.2 and 47.7%), nodule (2.4 and 13.6%). Fatigue (4.0 vs 12.5%) and fever (6.1 vs 4.5%) were the more frequent among general symptoms, respectively in each group. No major vaccinal accident was recorded. These results underline that influenza vaccination is well tolerated, much more in aged people than in members of the nursing staff.

[Vaccination against hepatitis B in immunosuppressed children. Apropos of 31 personal cases]. / Vaccination contre l'hépatite, B chez l'enfant immunodéprime. A propos de 31 cas personnels.

Anti HbS antibody levels were retrospectively studied in 31 children who received at least 4 immunisations with HEVAC vaccine. Results were as follow: 305 mUI/l (6 immunocompetent patients), 263 mUI/l (4 patients with solid tumors of therapy), 26 mUI/l (16 acute leukemias receiving intermittent reinduction therapy), 0.7 mUI/l (3 acute leukemias on maintenance therapy), 0 mUI/l (2 patients allografted for severe aplastic anemia, on immunosuppressive therapy). Antibody levels of patients who received immunisation during reinduction therapy were not correlated with intervall between immunisation and previous or next reinduction, not correlated with intervall from start of therapy, but seemed inversely correlated to age at time of diagnosis and at time of immunisation.