Culicoides trapping with Rothamsted suction traps before and during the bluetongue epidemic of 2006 in Belgium.

The collection of biting midges was taking place some months before the first bluetongue outbreak in Belgium in August 2006. The Walloon Agricultural Research Centre had been monitoring aphid populations at two sites annually in Belgium (Gembloux and Libramont), using two stationary '12-m' Rothamsted suction traps. For the Gembloux trap, collections of insects captured daily from 11 May 2006 onwards were already available at the time of the outbreak. An examination of these samples revealed the presence of Culicoides, some species of which are considered as potential vectors of the bluetongue virus (BTV). The trapping was therefore extended beyond the normal aphid activity period and the Culicoides captured were identified to species level. From 11 May to 31 December 2006, the Gembloux trap caught 664 Culicoides specimens belonging to 19 species comprising known BTV-vectors. The second trap, at Libramont, was reactivated from 12 September to 13 October and caught 97 specimens belonging to nine species, all of which had been found at the Gembloux site. Among the 19 species identified, four were new to Belgian fauna: Culicoides achrayi, C. deltus, C. lupicaris and C. newsteadi. This paper examines the overall phenology and the physiological status of Culicoides in 2006 before and during the bluetongue epidemic. It discusses the potential of the Rothamsted suction trap to monitor Culicoides.

Epidemiological, biological and histological characterization of patients with indeterminate third-generation recombinant immunoblot assay antibody results for hepatitis C virus.

We studied the epidemiological, laboratory and histological characteristics of a group of patients with positive antibodies against hepatitis C virus (HCV) as determined by third-generation enzyme-linked immunosorbent assay (ELISA), and with indeterminate HCV antibody positivity as established by third-generation recombinant immunoblot assay (RIBA-3). The results obtained were compared with those recorded in a group of RIBA-3-positive patients. Both groups correspond to blood donors in whom the prevalence of hepatitis C is low. There were no statistically significant intergroup differences in mean age, or in the presence of infection risk factors. RNA positivity was much more frequent in the RIBA-positive group (71%vs 10%; P < 0.05), as was transaminase elevation during the 3 years of follow-up (54%vs 13%; P < 0.05). In 46% of the RIBA-indeterminate patients the liver biopsy proved normal, or only liver steatosis or minimal changes were detected, while 33% had persistent chronic hepatitis, and 21% showed active chronic hepatitis. A mean Knodell index score of 2.28 was recorded; 50% of the subjects showed no fibrosis, 46% grade 1 fibrosis (fibrous portal expansion), 4% grade 2 fibrosis (bridging fibrosis), and none grade 3 fibrosis (liver cirrhosis). In the RIBA-positive group, a greater percentage of patients had active chronic hepatitis, a greater Knodell index, and increased-grade fibrosis. It can be concluded that the RIBA-3-indeterminate group is epidemiologically similar to the RIBA-3-positive series, although with a lesser prevalence of laboratory test alterations, a lower viral replication index, and more likely to have benign disease - particularly in subjects without viral replication.

Adenoma hepático gigante en varón de 64 años / Giant liver-cell adenoma in a 64 years old male

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Long-term response to interferon plus ribavirin in patients with chronic hepatitis C refractory to interferon.

OBJECTIVE: A sustained response (SR) to interferon (IFN) is only observed in 15-20% of patients with chronic hepatitis C (CHC). The aim of this study was to determine the long-term effectiveness and safety of the treatment with IFN plus ribavirin (RIB) over two years in CHC patients without SR to IFN. DESIGN: A prospective and open longitudinal follow-up study was conducted over 3 years. PATIENTS AND METHODS: A total of 77 CHC patients were included: 63 non-responders (NR) and 14 relapsers (R) to IFN. Patients were treated with IFN (3 MU s.c. three times a week) and RIB (1,000-1,200 mg p.o. daily) for 12 months. Treatment tolerance and viral response (HCV-RNA in serum < 1,000 copies/ml) were assessed after 1, 3, 6 and 12 months of treatment. SR and relapsing rates were subsequently evaluated 6, 12 and 24 months after the end of the treatment, together with those variables capable of predicting SR. RESULTS: At the end of the treatment, 19/77 patients responded (24.7%), 9/63 (14.3%) were non-responders and 10/14 (71.4%) relapsers, and these same patients exhibited SR after 6 months. The SR rate two years after treatment was 22.1% [8/63 (12.7%) NR and 9/14 (64.3%) R]. The relapse rate after 6 months and two years was respectively 0 and 10.5% (2/77). Independent variables capable of predicting SR were negative viremia conversion within the first month of treatment, maintenance of such negative viremia after 6 months, and R status to IFN. Side effects were recorded in 90.9% of cases (70/77), the most frequent being pseudoinfluenza syndrome. Treatment had to be discontinued in 33.8% of patients (26/77). CONCLUSIONS: Combined IFN-RIB therapy for 12 months in CHC patients without SR to IFN obtains a long-term SR of 22.1%, this rate being higher in relapsers to prior IFN therapy (64.3% in R versus 12.7% in NR).

Respuesta a largo plazo al interferón y ribavirina en pacientes con hepatitis crónica C sin respuesta al interferon / Long term response to interferon plus ribavirin in patients with crhonic hepatitis C refractory to interferon

Objetivo: sólo un 15-20 por ciento de los pacientes con hepatitis crónica por el virus C (HCC) obtienen respuesta sostenida (RS) con el interferón (IFN). El objetivo de este estudio ha sido evaluar la eficacia a largo plazo y la seguridad del tratamiento con IFN y ribavirina (RIB) durante 2 años en pacientes sin RS al IFN. Diseño: estudio de seguimiento longitudinal, prospectivo y abierto, realizado a lo largo de 3 años. Pacientes y métodos: se incluyeron 77 pacientes con HCC, 63 no respondedores (NR) y 14 recaedores (RR) al IFN. Fueron tratados con IFN (3 MU subcutáneo, 3 veces por semana) y RIB (1.000-1.200 mg oral/día) durante 12 meses. Durante el tratamiento se analizó la tolerancia al mismo y la respuesta virológica (RNA-VHC en suero <1.000 copias/ml) en los meses 1, 3, 6 y 12 del tratamiento. Posteriormente se evaluó la RS y tasa de recaídas a los 6, 12 y 24 meses de finalizar el mismo, así como las variables que podían predecir la RS. Resultados: al final del tratamiento obtuvieron respuesta 19 de los 77 pacientes, el 24,7 por ciento (9/63 NR, el 14,3 por ciento y 10/14 RR, el 71,4 por ciento) y los mismos pacientes obtuvieron RS al cabo de 6 meses. La RS 2 años después del tratamiento fue del 22,1 por ciento (8/63 NR, el 12,7 por ciento y 9/14 RR, el 64,3 por ciento). La tasa de recaídas a los 6 meses fue nula y 2 años después del 10,5 por ciento (2/77). Las variables independientes que podían predecir la RS fueron negativizar la viremia el 1º mes de tratamiento y mantenerla al 6º mes y ser RR al IFN. Los efectos secundarios aparecieron en el 90,9 por ciento (70/77) siendo el más frecuente el síndrome pseudogripal. La suspensión del tratamiento fue necesaria en el 33,8 por ciento (26/77). Conclusiones: el tratamiento combinado con IFN y RIB durante 12 meses en pacientes con HCC sin RS al IFN consigue una RS a largo plazo del 22,1 por ciento, siendo ésta mayor en pacientes recaedores al tratamiento previo con IFN (64,3 por ciento en los RR y 12,7 por ciento en los NR). (AU)

[Prevalence of anti-hepatitis A in patients with chronic liver disease]. / Prevalencia de anti-VHA en pacientes con hepatopatías crónicas.

The recent availability of an effective vaccine for preventing hepatitis A has led to the performance of a prevalence study of antibodies versus the hepatitis A virus (HAV) in our patients with chronic liver disease by hepatitis B and C, as a step prior to vaccination. The sera of 425 patients with a mean age of 40 years was studied, with the global antibodies versus HAV being determined (Abbott). The prevalence was to 75.2% varying from 20% at 19 years to 93% in those over the age of 40. The prevalence was not related to sex, previous parenteral history, or drug addiction or infection by hepatitis B or C. Due to previous cost-benefit studies and the high prevalence found, the determination of anti-HAV in patients with chronic viral liver diseases prior to vaccination against HAV is recommended.

Preliminary investigation of the association of oral lichen planus and hepatitis C.

OBJECTIVE: The aim of this investigation was to determine if an association exists between hepatitis C virus and oral lichen planus. STUDY DESIGN: Three groups of subjects were selected: 505 patients with hepatitis C virus infection (group 1), 100 patients with oral lichen planus (group 2), and a randomly selected control group (age- and gender-matched) of 100 healthy subjects (group 3). The prevalence of oral lichen planus was determined in groups 1 and 3, and the prevalence of hepatitis C virus infection was established in groups 2 and 3. RESULTS: The prevalence of oral lichen planus was 3.36% (n = 17) in group 1 and 1% (n = 1) in the control group; the prevalence of hepatitis C virus infection was 23% (n = 23) in group 2, and 5% (n = 5) in the control group. No significant differences were observed in the incidence of oral lichen planus in group 1 between those patients who received interferon and those who did not. The 17 patients in group 1 who manifested oral lichen planus and hepatitis C virus infection simultaneously exhibited a marked tendency to have only reticular lesions (70.6%), with involvement of the buccal mucosa in 88.2% of these patients, the tongue in 29.4%, and the gingiva in 11.8%. Analyzing a randomized subgroup of 143 patients from group 1 (subgroup 1) that was matched by age and gender with groups 2 and 3, we found that the incidence of oral lichen planus in patients with hepatitis C virus infection (subgroup 1) was greater than in the control group (5.59% vs 1%), though this was not statistically significant (chi2 = 0.119; p = 0.06). In contrast, group 2 exhibited a statistically significant higher incidence of hepatitis C virus infection (23%) than the controls (5%; chi2 = 0.259, p = 0.0002). CONCLUSIONS: The prevalence of hepatitis C virus infection in patients with oral lichen planus was greater than in the control series. In our opinion this observation warrants the investigation of potential concomitant hepatitis C virus infection in patients with oral lichen planus.

[Focal nodular liver hyperplasia of atypical presentation]. / Hiperplasia nodular focal del hígado de presentación atípica.

Focal nodular hyperplasia is a benign hepatic tumor that usually appears in young women. Diagnosis of focal nodular hyperplasia is often incidental when an ultrasonography or computed tomography is performed by other reasons, because its course is generally asymptomatic; the presence of a central fibrous scar is characteristic. Management in focal nodular hyperplasia must be conservative, with ultrasonographic follow-up, and it only must be treated when patients are symptomatics or in case of tumoral enlargement. We report a case of FNH in which symptomatic presentation and the absence of central stellate scar in ultrasonography, computed tomography and magnetic resonance leads to a misdiagnostic of hepatic adenoma, that conditioned a surgical resection. The later examination was diagnostic of focal nodular hyperplasia.

Intrafamily transmission of hepatitis C virus: sexual and non-sexual contacts.

BACKGROUND/METHODS: As a high number of patients with antibodies to hepatitis C (anti-HCV) do not have a known history of parenteral acquisition, other non-parenteral means of hepatitis C virus transmission must be studied. We investigated 1451 household contacts of 535 anti-HCV positive, human immunodeficiency virus-negative index patients. RESULTS: Overall, the prevalence of anti-HCV in household contacts was 4.5%. Thirty (7.6%) out of the 394 heterosexual stable partners were anti-HCV positive as compared to 35 (3.3%) out of 1057 non-sexual contacts (p < 0.01). The prevalence of anti-HCV was lowest in children of the index cases (1.8%). In this group, the prevalence of anti-HCV was 3% (10/330) when the mother was the index case, as opposed to 0.6% (2/328) when the father was the index case (p < 0.05). The prevalence of anti-HCV increased with age, being highest (18.6%) in family contacts older than 60 years. CONCLUSIONS: Transmission of hepatitis C virus may occur among household contacts of anti-HCV positive patients. Sexual contact or the use of non-disposable medical material in the past might explain the higher prevalence of anti-HCV found in sexual partners and in family contacts older than 60 years of age. Anti-HCV screening should be performed in family contacts of anti-HCV positive patients, particularly in those contacts older than 20.

[Mediastinal abscess secondary to esophageal perforation after dilatation]. / Absceso mediastínico secundario a perforación esofágica tras dilatación.

A case is presented of mediastinal abscess secondary to esophageal perforation after bougie dilation that evolved favorably with antibiotic treatment and without surgical drainage.