Search PubMed⌕ Search

Biomedical subjects

G Lunghi

Publications and source records attributed to G Lunghi.

At least 55 records · Page 3Linked to original sources
PubMed1997

Diffusion of HCV through peritoneal membrane in HCV positive patients treated with continuous ambulatory peritoneal dialysis.

PURPOSE OF THE STUDY: We evaluated the presence of HCV in the peritoneal effluents of viraemic patients treated with continuous ambulatory peritoneal dialysis (CAPD) to evaluate the risk of transmitting the infection with this procedure. PROCEDURE: Fifteen of 81 CAPD patients (18.5%) had anti-HCV antibodies and eight were viraemic. At the beginning of CAPD two of the viraemic patients had ascites with a clinical picture of chronic active hepatitis and cirrhosis. Peritoneal dialysates were collected after an overnight exchange with 1.36% glucose and after a 4-h exchange with 3.86% glucose. Fluids from the overnight exchange were spun to obtain a cellular pellet and the supernatant 100-fold concentrated. RESULTS: No viral genome could be detected in unconcentrated samples and in cellular pellets, while HCV-RNA at low titre was detected in concentrated dialysates from the two patients with active liver disease. CONCLUSIONS: Our findings confirm that HCV may be present in the CAPD effluent of some patients; however, the titre of virus in the effluent was extremely low, at the limit of detection of the PCR assay. Peritoneal fluids originating from patients with HCV associated severe liver disease may be a potential source of infection.

Adult↗
PubMed1997

Influence of hepatitis C virus (HCV) viraemia upon serum aminotransferase activity in chronic dialysis patients.

BACKGROUND: There are many reports concerning HCV in dialysis patients and most of them conclude that the clinical and biochemical features of hepatitis C are often silent in chronic dialysis patients. Elevated levels of serum alanine aminotransferase activity are a sensitive measure of hepatocellular injury, but so far the relationship between anti-HCV and ALT among chronic dialysis patients has been considered imperfect. To our knowledge, however, such an issue has not been adequately addressed. METHODS: Demographic, biochemical, and virological data from 506 patients undergoing chronic dialysis treatment in four dialysis units in Lombardy, northern Italy were collected in order to assess the influence of virological and host factors on serum aminotransferase values. RESULTS: Analysis of covariance showed that positivity for anti-HCV antibody was significantly associated with raised serum AST (P = 0.0001) and ALT (P = 0.0001) levels in the dialysis patients of the whole study group. Logistic regression analysis performed in the subset of patients tested for HCV viraemia and genotype showed that detectable HCV RNA in serum is a strong predictor of raised AST (P = 0.0001) and ALT (P = 0.000001) values. Gender showed an independent weak influence on AST levels (P = 0.055), serum levels of ferritin were significantly (P = 0.042) associated with AST values, the coexistence of HBsAg infection and positivity for anti-HCV antibody was independently associated with raised ALT levels (P = 0.016). The other factors (including positivity for anti-HCV) showed no independent effect on serum aminotransferase levels when they were matched with HCV viraemia in our multivariate analysis. HCV RNA positive patients showed serum AST (P < 0.008) and ALT levels (P < 0.0001) higher than HCV RNA negative patients. There was no relationship between HCV genotypes and liver enzymes. CONCLUSIONS: Our data show that detectable HCV RNA in serum is a strong independent predictor of raised aminotransferase values in chronic dialysis patients; the relationship between serum aminotransferase values and anti-HCV antibody was exclusively related to the association between raised aminotransferase values and HCV viraemia; HCV RNA positive patients show higher hepatic enzyme levels than dialysis patients with no detectable HCV RNA; no association between HCV genotype and serum aminotransferase activity was apparent.

Adult↗
PubMed1997

Hepatitis G virus infection in chronic dialysis patients and kidney transplant recipients.

BACKGROUND: The cloning of the hepatitis G virus (HGV), a novel RNA virus of the Flaviviridae family, has been very recently developed. HGV is known to be parenterally transmitted and has been detected in several patients with cryptogenic hepatitis. However, little information exists about the epidemiology of HGV infection in renal patients. We studied 178 chronic dialysis patients and 11 renal transplant individuals to evaluate prevalence, risk factors, and clinical manifestations of HGV infection in this population. METHODS: Hepatitis G virus infection has been detected by a modified PCR technology which incorporates digoxigenin-labelled nucleotides into the amplicon. Primers from the non-coding region and the NS-5 region of HGV are utilized for a single round amplification. Using a streptavidin surface and a biotin-labelled capture probe, the labelled nucleic acid is bound through the capture probe to the surface, and the amplified nucleic acid is detected using antibody to digoxigenin. RESULTS: HGV RNA was detected in 6% of chronic haemodialysis (HD) patients (11/172), 36% of renal transplant recipients (4/11), and 17% (1/6) of patients on peritoneal dialysis treatment (CAPD). There were no significant differences between HGV positive and negative patients on chronic HD treatment with regard to several demographic, biochemical and virological features. However, the frequency of anti-HCV antibody was significantly higher in HGV-positive than HGV-negative patients (9/11 (82%) vs 51/161 (32%), P = 0.006). In the whole group of HGV RNA-positive patients, 78% (11/14) had a history of blood transfusion requirements, 14/16 (87%) had co-infection with HCV, and 1 (6%) had co-infection with HBsAg. There was no significant association between HCV genotypes and HGV RNA positivity. Six (37.5%) of 16 HGV RNA-positive patients showed raised aminotransferase values in serum. CONCLUSIONS: Patients on maintenance dialysis and kidney transplant recipients are at increased risk of HGV infection; HGV is very frequently associated to hepatitis C co-infection, regardless of HCV genotype. HGV may be transmitted by blood transfusions but transmission routes other than transfusion are possible; 37.5% of HGV RNA-positive patients showed raised serum aminotransferase levels. Further investigations are necessary to clarify the role of HGV infection in the development of liver disease in this clinical setting.

Aged↗
PubMed1997

Liver iron influences the response to interferon alpha therapy in chronic hepatitis C.

OBJECTIVE: To define whether there is any relation between the iron status of patients with hepatitis C virus (HCV) chronic liver disease and their response to interferon therapy. DESIGN: To evaluate the long-term response to 1 year of interferon therapy with addition of phlebotomies after 3 months of treatment if at that time alanine aminotransferase (ALT) had not normalized in a group of patients with HCV-positive chronic liver disease whose iron status had been characterized. SETTING: A northern Italian hospital. PARTICIPANTS: Fifty-eight anti-HCV-positive patients (four HCV-RNA negative) with biopsy proven chronic hepatitis and no evidence of iron overload as indicated by normal transferrin saturation at the time of enrollment in the study. INTERVENTION: Three times a week intramuscular injection of alpha interferon 3 MU for 1 year with addition of phlebotomies (350 ml/week) till iron depletion if after 3 months of interferon therapy ALT had not normalized. RESULTS: A long-term response was observed in 19 of the 52 patients who completed the treatment, four HCV-RNA negative and 15 positive. The four RNA-negative and seven of the 15 RNA-positive long-term responders had been treated with interferon alone, and the other eight also with phlebotomies. At univariate analysis only HCV genotype, gamma-glutamyltranspeptidase and liver iron concentration were significantly associated with response whereas sinusoidal iron deposition was of borderline significance. No association was found with sex, age, duration of disease, histology, Knodell score, transferrin saturation %, serum ferritin, hepatocytic iron score, and portal iron score. HCV-RNA serum levels, measured in 29 patients, did not correlate with response. At multivariate analysis liver iron concentration was still significant and one unit reduction of liver iron concentration (natural logarithm transformed) was associated with 2.95 odds ratio of response. CONCLUSION: These results indicate that iron in the liver is more closely related to response to interferon than the other variables considered, including HCV characteristics.

Adult↗
PubMed1997

Molecular epidemiology of hepatitis C virus infection in dialysis patients.

There are very few data on the molecular biology of hepatitis C virus (HCV) infection in dialysis patients. 101 patients undergoing dialysis treatment in 4 units in the Lombardy, northern Italy, were analyzed by RT-PCR for HCV viremia, by line probe assay technology for HCV genotyping and by a serological analysis for detecting type-specific antibodies. 61 of 101 (60%) patients showed detectable HCV RNA in serum; HCV genotype 2a was dominant (30/53 = 57%), followed by HCV genotype 1b (20/53 = 37%). There was no relationship between HCV genotyping and the clinical or demographic features of the patients. The antibody response toward the c33-c, c100-3, and 5-1-1 antigens was more frequent in HCV genotype 1b compared with genotype 2a (p = 0.046, p = 0.001 and p = 0.0001, respectively). The antibody levels to NS-3 and NS-4 HCV proteins were significantly higher in patients with-HCV genotype 1b in comparison with HCV 2a-infected individuals (p = 0.0001). There was a high level (82%) of agreement between HCV genotyping by RT-PCR and the assessment of type-specific antibodies by serological analysis; further, it was possible to detect type-specific antibodies in 6 of 22 (27%) patients in whom PCR amplification was unsuccessful. In conclusion, HCV subtype 2a was dominant in our population of HCV-infected dialysis patients, dialysis patients infected by different genotypes showed similar demographic and clinical characteristics, the antibody response toward the NS-3- and NS-4-related antigen of HCV was genotype dependent. There was a high level of agreement between HCV genotyping by RT-PCR and the detection of type-specific antibodies by serological analysis. As significant biological differences may exist among HCV strains, the assessment of HCV types may be very useful in the routine clinical activity of nephrologists in dialysis units.

Adult↗
PubMed1996

Hepatitis C virus genotypes and reinfection of the graft during long-term follow-up in 35 liver transplant recipients.

To understand the clinical outcome of hepatitis C virus (HCV) recurrence, data from 35 liver transplant recipients who survived more than 6 months were reviewed. The presence of HCV-RNA was evaluated and genotyping was performed. On the basis of alanine aminotransferase (ALT) levels, patients were sorted into four groups. In 20 patients, a chronic elevation in ALT was found; HCV-RNA detection was positive in 17/17 and the following genotypes were found in 15 of them: 1b in ten patients, 2a in four patients, and 3a in one patient. In 11 patients, ALT levels remained normal throughout follow-up; in nine of them HCV-RNA was positive; HCV genotyping was available in eight patients and identified type 1b in two, type 2a in five, and type 3a in another patient. In two patients, ALT fluctuated above and below the upper limits of normality; type 1b HCV-RNA was found in one of them. In two patients, after an initial period of normality, ALT levels showed an abrupt rise; HCV-RNA was positive and type 1b was identified in both patients. Eight patients developed HCV-related deep jaundice and three of them spontaneously recovered. Progressive hepatic injury occurred in eight patients, six with chronic ALT elevation and two showing a late ALT elevation; genotype 1b was present in seven patients while in one, genotype 3a was found; sub-acute graft failure developed in five of them, leading to death in two and retransplantation in the others; the other three patients are alive with recurrent overt cirrhosis. The 1, 3, and 5 year actuarial survivals were 89%, 79%, and 63% respectively. The 1, 3, and 5 year actuarial risks of progressive graft damage were 6%, 7%, and 15%, respectively. In conclusion, HCV reinfection causes a slow decrease in the long-term patients' survival. Persistent elevation of ALT is more frequently observed in patients with genotype 1b infection.

Adolescent↗
PubMed1996

IgM antibody response to hepatitis C virus in end-stage renal disease.

BACKGROUND: In HBV infection, as in other viral diseases, antibodies of the IgM class are associated with acute or ongoing infection. In contrast, the significance of this antibody in HCV infection is unclear and data regarding end-stage renal disease (ESRD) patients are lacking. METHODS: We tested sera from 78 ESRD patients (66 chronic dialysis patients, 12 renal allograft recipients) showing anti-HCV IgG antibody, for serum anti-HCV IgM core antibody. A specific solid-phase enzyme-linked immunoassay (HCV IgM EIA, Abbot) was used. In all patients serum HCV RNA was detected by RT-PCR technique, with primers from the 5' untranslated region of the viral genome. RESULTS: Prevalence of anti-HCV IgM core antibody was 22% (17/78). We observed association between prevalence of anti-HCV IgM core antibody and frequency of HCV RNA in the serum. Thus 15 of 45 (33%) sera containing HCV RNA also contained anti-HCV IgM, while two of 33 (6%) HCV RNA negative sera showed anti-HCV IgM core antibody (P = 0.01). There was a significant relationship between absorbance values of anti-HCV IgM core antibody and NS3 (P = 0.01), NS5 (P = 0.04), and core (P = 0.0001) reactivity in RIBA-2 and RIBA-3 assays. Optical density values of anti-HCV IgM were significantly associated with the number of reactive bands in RIBA-2 (P = 0.04) and RIBA-3 (P = 0.03) assays. CONCLUSIONS: 22% of ESRD patients with anti-HCV IgG activity showed anti-HCV IgM core antibody in the serum. Anti-HCV IgM activity seems to correlate positively with HCV viraemia in ESRD population. Testing for this antibody may be useful as a serological marker to indicate the presence of ongoing HCV infection.

Adult↗
PubMed1996

Hepatitis C virus genotypes in chronic dialysis patients.

BACKGROUND: Hepatitis C virus (HCV) infection is highly prevalent in dialysis patients. To further characterize HCV infection in this patient population, we studied the distribution of viral genotypes in 55 patients undergoing chronic dialysis treatment with seropositivity for HCV markers. METHODS: Thirty-two of 55 (58%) patients showed HCV RNA in the serum using reverse transcription polymerase chain reaction (RT-PCR) in the 5'-untranslated region (UTR) of the viral genome. HCV genotyping was performed using biotinylated type-specific oligonucleotide probes after hybridization with amplified sample material. RESULTS: HCV subtype 2a was dominant (56%), followed by HCV subtype 1b (31%), type 3 (3%) and 4 (3%). There was no association between demographic or clinical features of this cohort and HCV genotype. Genotype dependence was observed for antibody response toward the NS4 (c 100-3 and 5-1-1) proteins, which was infrequent in genotype 2a carriers compared with genotype 1b (p = 0.004). CONCLUSIONS: HCV subtype 2a was dominant in our cohort of anti-HCV-positive dialysis patients; there was no association between HCV genotypes and demographic or clinical features of patients; the absence of antibody response toward the NS4-related antigens was frequent in genotype 2a carriers and may serve to predict responses to interferon therapy. The relative homogeneity of the viral population in dialysis patients attending our unit suggests a nosocomial transmission of HCV in this clinical setting.

Adult↗
PubMed1996

Virological and histological features of hepatitis C virus (HCV) infection in kidney transplant recipients.

BACKGROUND: Although there are some reports regarding prevalence of anti-HCV antibodies in kidney transplant patients, there are scarce data about viraemia, genotyping and liver histology of HCV infection in kidney transplant recipients. METHODS: We studied the prevalence of anti-HCV antibodies by second-generation screening and confirmatory assays in a cohort of 73 renal allograft recipients. All patients were tested for serum HCV RNA using reverse transcription polymerase chain reaction in the 5'-untranslated region (UTR) of the viral genome. HCV RNA positive patients were subjected to genotype analysis using biotinylated type-specific oligonucleotide probes after hybridization with amplified sample material. Eleven of 73 patients showing raised aminotransferase levels underwent hepatic biopsy. RESULTS: Fifteen of 73 (20%) patients were determined anti-HCV positive. Eleven of 73 (15%) showed detectable serum HCV RNA; no viraemic, seronegative patients were identified. Genotyping showed that HCV subtype 2a was dominant (64%), followed by HCV subtypes 1b (27%) and 1a (9%). Six of 11 (54%) HCV RNA patients and 12 of 62 (19%) HCV RNA negative patients showed raised aminotransferase levels (P = 0.03). Liver biopsies showed histological features of chronic hepatitis with mild or moderate degrees of activity. CONCLUSIONS: The prevalence of anti-HCV antibodies and HCV viraemia was 20% and 15% respectively; there was a good association between anti-HCV anti-bodies and HCV viraemia; hepatic enzyme levels were good indicators of ongoing HCV infection; HCV subtype 2a was prevalent; liver histology showed histological characteristics of chronic hepatitis with mild or moderate degrees of activity.

Adult↗
PubMed1995

Transfusion-transmitted human parvovirus B19 infection in a thalassemic patient.

BACKGROUND: Human parvovirus (HPV) B19 infection has been shown to be transmissible by clotting factor concentrates, most often resulting in asymptomatic seroconversion. So far, no case of B19 transmission due to single-donor transfusion has been documented. CASE REPORT: A case of transfusion-transmitted HPV B19 infection in a 22-year-old female thalassemia major patient is described. She presented with an aplastic crisis; this was followed 1 week later by transitory heart failure and acute tricuspid incompetence. The echocardiogram revealed a grade III tricuspid regurgitation and a floating vegetation on the atrial face of the tricuspid lateral leaflet. The tricuspid regurgitation and vegetation spontaneously disappeared within 15 days. Blood cultures for bacteria were repeatedly negative. IgM anti-HPV B19 seroconversion was documented in the acute phase. B19 DNA was detected by polymerase chain reaction and remained detectable up to 4 months after diagnosis. High-titer IgM anti-HPV and B19 DNA were also found in serum samples collected at the time of donation from one of the donors of the blood transfused before the onset of clinical symptoms. CONCLUSION: This case documents the transmission of HPV B19 by the transfusion of 1 red cell unit and the occurrence of possible transient cardiac involvement in this infectious complication.

Adult↗
PubMed1995

Virological characteristics of hepatitis C virus infection in chronic hemodialysis patients: a cross-sectional study.

Detection of hepatitis C virus viremia (HCV RNA) in serum of hemodialysis (HD) patients is crucial for documenting ongoing infection because the clinical and epidemiological importance of anti-HCV positivity is not clear. HCV viremia was studied in 104 HD patients by reverse transcription polymerase chain reaction (RT PCR) using primers localized in the 5' non-coding region of the viral genome. We used two different methods to detect HCV RNA: a direct PCR amplification of HCV RNA from human serum, and a standard RT PCR procedure (requiring the RNA extraction step). There were 50 (48%) anti-HCV positive patients in this population. Twenty-two (21.1%) out of 104 patients showed HCV RNA in serum by standard RT PCR technique: they belonged to the anti-HCV positive patient group, whereas all anti-HCV negative patients were HCV RNA negative. Prevalence of HCV RNA was more than doubled when standard RT PCR was used compared to direct RT PCR protocol. There was a good association between serum HCV RNA and circulating anti-HCV antibodies, tested by second-generation ELISA and RIBA assays. HCV viremia was not associated with either the presence or the absence of a particular RIBA antibody specificity. AST and ALT levels had no predictive value for HCV viremia, because they were repeatedly normal in the majority of viremic patients (16/22: 73%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Sectional Studies↗
PubMed1994

Incidence of seroconversion for hepatitis C virus in chronic haemodialysis patients: a prospective study.

We conducted a prospective study in HD patients of our unit to evaluate the incidence of seroconversion for HCV in this high-risk group. Two hundred and thirty-five patients were observed during the average follow-up of 29.4 months: 183 were seronegative and 52 seropositive for anti-HCV antibodies at the start of the study. During the observation period two of 183 patients developed anti-HCV antibodies late in the study, while the other 181 patients remained seronegative throughout the observation period; anti-HCV antibodies persisted through the follow-up in the 52 HCV-positive patients at the beginning of the study. Our results showed a very low incidence of HCV seropositivity (0.44% per year) after implementation of our operative protocol including 'universal precautions' and other infection control procedures. Once infected, there is no disappearance rate of anti-HCV. The 4-RIBA results did not change during the follow-up period. Prevalence of HCV RNA by PCR technique was 41% (22 of 54) among anti-HCV-positive patients. Future investigations are warranted to clarify the exact route of transmission of HCV among HD patients and to reduce the rate of HCV transmission in this clinical setting.

Adolescent↗
PubMed1993

Hepatitis C virus infection in liver allograft recipients.

The impact of HCV infection after liver transplantation remains a topic of discussion. The aims of this study were to define the prevalence of anti-HCV antibodies in liver donors; the risk of acquired HCV infection and HCV re-infection according to the pre-transplant anti-HCV status; the prevalence of HCV infection in post-transplant chronic hepatitis. Sera from 42 recipients with follow up longer than 6 months and their donors were tested for anti-HCV. By results at pre-transplant time patients were classified as follows: donor (D) negative and recipient (R) negative (D-/R-) 31; D-/R+ 9; D+/R- 1; D+/R+ 1. Twenty-one patients with sustained hepatic dysfunction underwent liver biopsy. In group D-/R-, 5 patients showed anti-HCV positivity and 3 (9.7%) of them had acquired HCV hepatitis. In group D-/R+, 6 patients showed persistent anti-HCV positivity and 4 (44.4%) of them had recurrent HCV hepatitis; of these 2 died due to liver failure. The 2 patients of groups D+/R- and D+/R+ had normal liver function. Anti-HCV negative hepatitis was found in 2 patients. The prevalence of anti-HCV positivity in liver donors appeared low (3.2%). Acquired HCV infection rate was 9.7%. Pre-transplant HCV infection led to a high incidence of recurrence (44.4%). HCV was the major etiological agent in post-transplant chronic hepatitis (77.8%).

Adolescent↗
PubMed1993

Primary infection by human parvovirus B19.

We describe a case of primary infection by human parvovirus B19 in a 20-year-old woman; it manifested as erythemato-maculo-papular lesions, pharyngotonsillitis, lymphadenopathy, fever, arthralgia and myalgia, asthenia and anorexia. Laboratory tests revealed anaemia, leucopenia, thrombocytopaenia and a rise in some inflammatory indices. Elisa test was positive for anti-human parvovirus B19 IgM. Clinical symptoms spontaneously regressed in 2 weeks. Thirty days after hospital admission all the laboratory tests returned to normal values; furthermore, specific IgM and IgG were detectable.

Adult↗