Prevalence of markers of hepatitis B virus infection among the general population of the municipality of Slavonski Brod.

To assess the prevalence of hepatitis B viral infection in general population of the Community of Slavonski Brod, sera from 2,142 apparently healthy individuals were tested for the hepatitis B virus (HBV) markers: surface antigen and antibody (HBsAg and anti-HBs), and core antibody (anti-HBc), by radio and enzyme-immunoassay. The HBsAg results showed a general prevalence of 1.8%(38/2,142): for males 1.9% and for females 1.6%. The highest HBsAg incidence rates (2.1% and 1.9%) were found in young adults aged 21-30, respective in older children and adolescents, from 11 to 20 years. The lowest HBsAg prevalence (1.0%) was proved in children from 1 to 5 years, while in sera of 68 examined sucklings HBsAg was not detected. The HBsAg incidence was 1.9% (21/1132) in urban and 1.7% (17/1010) in rural inhabitants. The overall prevalence rate of total HBV infection in 13.7% (294/2,142) examinees was found. There was no difference in the prevalence of HBV infection in males 15.7% (177/1130) and females 11.6% (117/1012), as well as in persons living in rural 12.5% (126/1010) or in urban 14.8% (168/1132) areas. The prevalence rate of anti-HBs and anti-HBc gradually increased with increasing age, starting at about 3.2% in the youngest, and reaching 15.5% in adults over 50 years. The results obtained have place the Community of Slavonski Brod among areas with an intermediate endemicity of HBV infection.

Epidemiological characteristics of HBV and HDV chronic liver diseases.

The authors describe the results of prospective examination of the incidence and importance of hepatitis B virus and hepatitis D virus in the aetiology of chronic liver disease at Slavonski Brod Hospital. HBV incidence is significant in the aetiology of chronic liver disease, since it has been found in 100/144 (69.4%) of the examinees. Most of the patients were male (75.0%), their mean age was 32.8, and their age ranged between 15 and 60. A high percentage (37.0%) was found in the category of HBV infection high-risk patients. Most of them were intravenous drug addicts, their mean age was 24.9, and they were mostly male (96.9%). In most patients HBV infection caused a milder histological and clinical form of chronic liver disease, i.e., chronic persistent hepatitis. The disease was recorded in 62.9% of the patients outside of the high-risk category, and it was found in 52.6% of the high-risk patients. The incidence of the hepatitis D virus in the aetiology of chronic liver disease was found in 19/100 (19.0%) of the HBV positive patients. 18/19 of the HDV infection patients belonged to the high-risk category, 16 of them being drug addicts. Hepatitis D virus infection led to serious clinical and histological forms of chronic liver disease in most cases: chronic active hepatitis and cirrhosis of the liver in 89.5% of the cases, and chronic persistent hepatitis in only 19.5% of the cases.

The HBe antigen-antibody system and its relationship to epidemiological, histological and biochemical findings in patients with HBV+ HDV chronic liver diseases.

The authors describe the results of prospective research on the HBeAg-anti-HBe system in 81 HBV patients and on HBV+ HDV chronic liver disease in 19 patients who were treated at Slavonski Brod Medical Centre. They analyze the correlation between various epidemiological groups of patients, liver disease activity and the condition of the HBeAg-anti-HBe system in chronic HBV and HDV infection. A clear correlation was established between the presence of HBe antigen and the patients' youth, the pathological alanin aminotransferase values and pathohistological liver findings. In as many as 64.4% of the HBeAg-positive patients the active chronic liver disease process was verified. However, this pathological activity was also verified in 36.4% of the HBeAg-negative patients with chronic HBV infection. Moreover, anti-HBe was found more often in the serum of the hepatitis D infected patients (68.4%). Serious forms of chronic liver disease were found in all of the HDV-positive patients with the anti-HBe finding in serum. However, chronic active hepatitis or cirrhosis of the liver was found in only 23.5% of the HBeAg-positive patients suffering from HDV infection. We should point out that the HBeAg-anti-HBe system does not have an absolute value in the estimation of histological liver changes and in the prognosis of chronic liver disease for individual patients.

[A bronchiolitis epidemic caused by respiratory syncytial viruses]. / Epidemija bronhiolitisa uzrokovana respiratorno sincicijalnim virusom.

In the typical period of the year (autumn-winter 1986-1987) an outbreak of bronchiolitis in infants caused by respiratory syncytial virus (RSV) occurred. The acute course of the illness, a severe clinical picture, and a very fast spread of infection called for the very rapid techniques for detecting the etiological agent. Applying the direct immunofluorescent antibody test (DFTA) in samples of nasopharyngeal secretions, RSV was found to be responsible for the epidemic. Later the same samples of the material were inoculated into tissue cultures and RSV was isolated. Fourfold or higher titres of complement fixing antibodies in paired serum samples confirmed the infection with RSV. During the outbreak of bronchiolitis 72 children aged under 15 months (only one child was older than one year) were hospitalized. The majority of cases of RSV bronchiolitis was noticed in infants in the first six months of life (81.9%, chi 2 = 31.1, p less than 0.01). Boys against girls were in relation as 1.25:1. Because of the broncho-obstructive component of the illness, respiratory failure was the dominant sign in the clinical picture of bronchiolitis; 34.7% of the patients were afebrile, 16.7% were in the state of hyperpyrexy and 48.6% with temperature up to 38 degrees C. Oxygen and symptomatic therapy were the basic treatment. In severe cases corticosteroids and antibiotic were administered for a short time. The classical type of bronchiolitis in infancy as the most severe among acute infections of respiratory organs because of its poor prognosis at the very beginning and the long-term sequels is a serious medical problem. Emphasis is laid on the importance and usefulness of the virologic diagnosis, especially the application of rapid DFTA techniques in the acute stages of bronchiolitis caused by infections with respiratory syncytial virus during the epidemic occurrence of this agent.

[Recurrences of viral hepatitis A]. / Relapsi u toku virusnog hepatitisa A.

The aim of the study was to examine the frequency, severity, persistence and etiology of relapses occurring during the hepatitis A viral infection. Therefore, a prospective study of 910 patients suffering from hepatitis A (HA) was carried out. The clinical examination and determination of glutamyl pyruvic transaminase (GPT) in the serum every 7-14 days till recovery (usually during 6--8 months) were performed. HAV infection was confirmed by detecting anti-HAV IgM in the blood of all the examined by radioimmunoassay. In 876 (93.3%) patients HA had typical clinical features and a monophasic course. All cases made a rapid clinical recovery and liver function tests improved strikingly between 1 and 4 months after the onset of illness. However, in 34 (3.7%) of 910 patients, after an asymptomatic interval of 4--8 weeks, relapsing hepatitis occurred. Mild clinical symptoms: fatigue, myalgia, nausea, epigastric discomfort accompanied by the elevated levels of GPT in the serum were noticed in 11 patients, while 3 of them redeveloped jaundice. In 23 remaining patients relapses of hepatitis were asymptomatic, except for the reappearance of icterus in six cases. The only way to establish the exacerbation of the disease was through the pathological findings of GPT in the serum, which increased 10--60 times above the upper limit of the normal value. While 25 patients had one relapse, in 9 there were two or more relapses, so that hepatitis had a biphasic or polyphasic course. The second relapse was registered 3--6 weeks after the first one disappeared. Through biochemical tests the average values of the GPT were established: 1566 U/L in the acute stage, 107 U/L during the early stage of convalescence and 1016 U/L during the first relapse of hepatitis. After the first relapse and during remission, in 9 patients the average values of GPT in the serum were 84 U/L, while during the second relapse 518 U/L. Clinical signs of relapsing hepatitis disappeared approximately in 4 days, but liver function tests decreased slowly and persisted elevated between 5 and 12 months. A possibility of establishing the etiology of relapsing hepatitis, which has yet remained unknown, is discussed. Anti-HAV IgM were present in all 34 patients during the initial and relapsing phase of hepatitis and in 26 cases in the latter phase of convalescence between 9 and 11 months after the beginning of the disease. Serological tests excluded infection with hepatitis B, cytomegalovirus and Epstein-Barr virus. With a great probability other infections and toxic agents damaging the liver could have been excluded.(ABSTRACT TRUNCATED AT 400 WORDS)