Varicella infection in a renal transplant recipient associated with abdominal pain, hepatitis, and glomerulonephritis.

A 36-year-old renal transplant patient developed 9 years after a successful transplantation a fatal secondary varicella infection. The disseminated varicella infection was associated with hepatitis with liver necrosis, disseminated intravascular coagulation and fibrinolysis and glomerulonephritis. To our knowledge this is the first description of glomerulonephritis associated with varicella infection in a renal transplanted patient. The autopsy showed morphologically a mesangial glomerulonephritis with minor proliferative activity and extensive deposits by electronmicroscopy, mainly in the mesangium. The ongoing immunosuppression may have modified the mesangial cell response to the deposition of immune complexes.

Treatment with interferon-alpha2a alone or interferon-alpha2a plus ribavirin in patients with chronic hepatitis C previously treated with interferon-alpha2a. CONSTRUCT Group.

BACKGROUND: Preliminary results from combination therapy with interferon-alpha and ribavirin (IFN/Rib) in patients with chronic hepatitis C have been promising, with up to 50% sustained hepatitis C virus (HCV) RNA response. The aim of this study was to investigate whether a sustained HCV RNA response could be obtained with combination therapy in patients who were non-responders or relapsers after IFN treatment. METHODS: In a multicenter study we randomized 53 HCV RNA-positive patients into 2 treatment groups. They all had biopsy-confirmed chronic hepatitis C, and all were recruited from a previous IFN study: 26 were previous non-responders and 27 responders with relapse. Group A received interferon-alpha2a, 4.5 MIU thrice weekly for 6 months, and group B received ribavirin, 1000-1200 mg/day, in combination with the same dose of interferon-alpha2a for 6 months. Median Knodell index was 5.0 in both groups. Genotype 1 was found in 24 (45%), type 2 in 3 (6%), and type 3 in 26 (49%). RESULTS: Sustained clearance of HCV viremia 6 months after interferon-alpha2a treatment stop was obtained in 12 of 53 patients (23%): 6 of 27 in the IFN group (22%) and 6 of 26 (23%) in the IFN/Rib group (NS). Nine of 27 (33%) former responders with relapse, compared with 3 of 26 (12%) non-responders, obtained a sustained HCV RNA response (P = 0.054). In previous relapse patients sustained loss of viremia was more frequent in genotype 3 (50%) than in genotype 1 (11%) patients (P = 0.022). CONCLUSIONS: In a group of previous IFN-alpha2a-treated chronic HCV patients we obtained a similar sustained clearance of viremia when retreated either with IFN-alpha2a alone or with a combination of IFN-alpha2a and ribavirin for 6 months. Previous relapse patients with HCV genotype 3 obtained sustained loss of viremia significantly more often (50%) than type-patients (11%). Previous IFN responders with relapse responded better than previous non-responders.

The effect of treatment with alpha-interferon on hepatitis G/GBV-C viraemia. The CONSTRUCT Group.

BACKGROUND: Hepatitis G virus (HGV) or GBV-C is frequently detected in patients co-infected with hepatitis C virus (HCV). This study investigated host and virologic factors influencing the response to HGV/GBV-C to alpha-interferon treatment. METHODS: HGV/GBV-C was detected and quantified by nested polymerase chain reaction. The influence of variables such as liver biopsy appearance, liver function abnormalities, and response of HCV to interferon treatment was monitored. RESULTS: Fourteen of the 25 HGV/GBV-C-infected patients treated with interferon (3-6 MIU three times a week for 6 months) became non-viraemic during treatment, although all relapsed after treatment withdrawal at 6 months, with no net change in virus load between 0 and 12 months. CONCLUSIONS: Predictive factors for clearance of HGV/GBV-C viraemia by interferon were pre-treatment severity of liver disease (median Knodell score of 4, compared with 7 for non-responders; P = 0.030) and alanine aminotransferase levels (median, 114, 182 for non-responders; P = 0.039). Clearance was associated with the treatment response of HCV. Nine of 13 who cleared HGV/GBV-C also cleared HCV, compared with 3 of 11 HGV/GBV-C non-responders; P = 0.05). The shared susceptibility of HGV/GBV-C and HCV to interferon treatment suggests a link between the mechanism of clearance of the two viruses.

Genotype, viral load and age as independent predictors of treatment outcome of interferon-alpha 2a treatment in patients with chronic hepatitis C. Construct group.

Patients with chronic hepatitis C respond differently when treated with interferon. We randomized 116 patients with chronic hepatitis C in order to compare two dosage regimens of recombinant interferon alpha 2a:3 MIU x 3 per week for 6 months (arm A) or 6 MIU x 3 per week for 3 months and then 3 MIU x 3 per week for 3 months (arm B). There were no significant differences concerning outcome between the two dose regimens: sustained clearance of HCV viremia 6 months after the end of treatment was obtained in 12/59 (20%) in group A compared with 18/57 (32%) in group B (p = 0.24). In patients with genotype 1a, 4/31 (13%), in genotype 1b, none of 9 (0%), 9/15 (60%) in genotype 2, and 17/58 (29%) in genotype 3, showed sustained clearance of HCV viremia 6 months after the end of treatment (p = 0.002). In a stepwise logistic regression analysis, only pretreatment viral load (p = 0.0001), genotype (p = 0.001) and age (p = 0.04) were identified as independent predictors of sustained clearance of HCV viremia. Liver histology as assessed by Knodell index was significantly improved in patients with sustained HCV RNA response 6 months after the end of treatment (5.2 +/- 2.2 vs 2.6 +/- 2.2, p < 0.001), but not in responders with relapse or in non-responders. In conclusion, stepwise logistic regression analysis showed that viral load, HCV genotype and age were the only independent predictors for sustained HCV RNA response.

Interferon-alpha 2b therapy in low-activity hepatitis C: a pilot study.

BACKGROUND: Many patients with chronic hepatitis C have long periods of normal or near-normal liver enzyme levels, even though histologic alterations have been confirmed. The recommendation today is not to treat this patient group. METHODS: In a pilot study 23 hepatitis C virus (HCV) RNA-positive patients with alanine aminotransferase (ALAT) levels less than 1.5 times upper normal limits for at least 6 months on more than three occasions and with histologic liver abnormalities compatible with chronic hepatitis C were treated with 3 MU of interferon-alpha 2b three times a week for 6 months. RESULTS: Nine patients (39%) became HCV RNA-negative in serum during treatment, but only two (8.7%) remained so after 6 months' follow-up. Significantly more patients with genotype other than type 1 became HCV RNA-negative than patients with genotype 1 during treatment (P = 0.005). CONCLUSIONS: Patients with low-activity chronic hepatitis C have a response to interferon-alpha treatment similar to that of patients with increased ALAT levels. Genotype seems to influence the rate of response.

Prevalence of hepatitis C genotypes among patients with chronic hepatitis C in Norway. Construct Group.

Among 116 patients with biopsy-confirmed chronic hepatitis C (Riba 2 or Riba 3 positive) in a multicenter study in southern Norway on interferon, we determined hepatitis C virus genotype by restriction fragment length polymorphism (RFLP) of the 5' NCR. The RFLP method was supplemented by and compared with a serological typing method based on the detection of type-specific antibody to peptide from the NS-4 region. A total of 102/106 (96%) patient sera showed detectable type-specific antibody to NS-4 peptides and corresponded in all cases, except two, to the genotype detected by polymerase chain reaction. Combining the results from RFLP genotyping and serotyping, genotype 1 was found in 40 (35%) (27 with 1a and 10 with 1b, 3 subtypes not determined), genotype 2 in 15 (13%) (subtype 2b in 14 and 1 subtype not determined), and genotype 3 in 58 (50%) of patients. The low mean age of the patients (34 years), the low prevalence of cirrhosis (3.5%), the short duration of the disease, and a high prevalence of intravenous-drug abusers may account for the low prevalence of infection with genotype 1b (9%). The epidemiological features of hepatitis C patients are markedly different from patient groups described in southern Europe in terms of risk factors, age, and genotype distribution.

[The end of antibiotics? Increasing bacterial resistance in global and Norwegian perspective]. / Antibiotika snart over og ut? Okende bakteriell resistens i globalt og norsk perspektiv.

During the last 20 years there has emerged a growing world-wide problem with regard to multidrug-resistant microbes. The most serious examples so far are vancomycin-resistant strains of Enterococcus faecium, totally resistant isolates of Mycobacterium tuberculosis and multiple-resistant Staphylococcus aureus and Streptococcus pneumoniae. With the exception of some few strains of methicillin-resistant S. aureus and vancomycin-resistant enterococci, such bacteria have not been found in Norway. In this article we discuss possible ways of preventing further selection and spread of multiple-resistant microbes. We stress the importance of infection control programmes and restrictive use of antibiotics.

[Proper use of antibiotics--what is that?]. / Fornuftig antibiotikabruk--hva er det?

Antibiotics are one of the cornerstones of modern medicine. During the last 20 years there has been an alarming world-wide spread of multiple-resistant bacteria. One of the main reasons is the overuse of all types of antibiotics, especially broad-spectrum drugs. This paper gives general advice on antibiotic therapy in Norway. We adovcate the use of drugs with little ecological impact, such as the penicillins. Whenever possible, empiric treatment with macrolides, tetracyclines cefalosporines, imipenem and fluoroquinolones should be avoided.

[Infections in intensive care units. A challenge for the specialist of infectious diseases?]. / Infeksjoner i intensivavdelingen. En utfordring for infeksjonsmedisineren?

There is an obvious need for teamwork between different specialists on the diagnosis and treatment of patients in an intensive care unit. The infectious disease specialist must contribute by establishing definite and quick diagnosis of infections and by employing an adequate and sensible antibiotic policy for successful treatment. The local microbiological flora should be kept at an acceptable level of resistance to antibiotics, and preventive measures should be chosen carefully. To achieve this goal, extensive knowledge on antibiotics and microbial epidemiology is essential.

Three cases of acute hepatitis E virus infection imported into Norway.

We report 3 cases of acute hepatitis E virus (HEV) infection imported from Asia. All 3 patients had fever and upper abdominal discomfort preceding jaundice which lasted 2-3 weeks with maximum bilirubin levels of 141-254 mmol/l. The ALT values peaked between 1,347 and 3,690 U/l. Both values normalized within 1-2 months. During the acute phase of the disease, all patients had high levels of IgG and IgM antibodies against HEV (anti-HEV) recombinant and synthetic peptides. The duration of the anti-HEV IgM was about 1-2 months.

[Pneumocystis carinii pneumonia--not only in AIDS]. / Pneumocystis carinii-pneumoni--ikke bare ved AIDS.

Two patients with haematologic malignancies developed Pneumocystis carinii pneumonia while under outpatient treatment, one on busulphan for chronic myelogen leukemia, and the other on prednisone plus chlorambucil for non-Hodgkin's lymphoma. The first patient was moderately ill and required hospitalization for 12 days while the second patient was critically ill and needed assisted ventilation for two weeks. Eventually they both recovered and returned to work. Tests for serum antibodies to the human immunodeficiency virus (HIV) were negative in both patients. We review the problem of P. carinii pneumonia in patients receiving immunosuppressive drugs.

Endogenous candida endophthalmitis. Report of two cases.

Two cases of endogenous endophthalmitis as a complication to spontaneous abortion, truly caused by candida albicans are presented. One patient received no antimycotic treatment. Endophthalmitis resulted in amaurosis in the affected eye, which had to be enucleated. The second patient was treated with intravenously administered amphotericin B and flucytocine, and was cured. The importance of early diagnosis and treatment is stressed.

Prevalence and clinical effects of delta agent. Infections in Norwegian population subgroups.

The distribution of antibodies against the delta agent was studied in different groups of hepatitis B patients in Norway. Such antibodies were detected only in drug addicts, predominantly among chronic HBsAg carriers. The results support the notion that the delta agent was introduced into Scandinavia in 1970-75. Although the proportion of anti-delta positive individuals among chronic HBsAg carriers increased, the annual increase of new anti-delta carriers was essentially stable. One death caused by hepatic failure was registered among 43 anti-delta negative and none among 21 anti-delta positive chronic HBsAg carrier addicts.

Chemical analyses for early differential diagnosis between bacterial and viral meningitis.

The present study was undertaken to evaluate the benefit of measuring different chemical parameters in the cerebrospinal fluid (CSF), at the time of admittance to hospital, for rapid differentiation between bacterial and viral meningitis. In addition to the leucocyte count, the CSF concentration of total protein, glucose (together with blood glucose), lactate, lactate dehydrogenase and creatine kinase was determined. The results revealed that the CSF lactate and the CSF:blood glucose ratio were the two best parameters for this purpose. When the information from these analyses was combined a complete separation between the two kinds of meningitis could be obtained.