Viral hepatitis in pregnant women at term.
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Biomedical subjects
Publications and source records attributed to L Magnius.
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Hepatitis B virus (HBV) markers were determined in 821 patients receiving renal allografts and undergoing immunosuppressive therapy during 1970-1986. Twenty-four of the patients with a renal transplant functioning for longer than 1 year originally were or became chronic carriers of hepatitis B surface antigen (HBsAg). These patients remained carriers during the follow-up period, which lasted until death or until the end of 1986. Follow-up time was 1.2-15.3 years (mean 9.1 years). A total of 301 samples from the HBsAg-positive patients were tested for HBV DNA and HBeAg/DNA and HBeAg/anti-HBe. Nine patients who were constantly positive for HBeAg also remained positive for HBV DNA. Reactivation of HBV replication occurred in 11 patients. Among these, HBV DNA and HBeAg varied in parallel in six patients, three patients developed anti-HBe, and two patients were constantly positive for anti-HBe. Another four of the 24 patients seroconverted to anti-HBe, and two of these also lost HBV DNA. Three of 12 deceased patients died from liver failure during follow-up. None of these three had been constantly positive for HBeAg or HBV DNA, but they had had reactivations of HBV; two were also positive for HBV DNA in serum specimens available from their terminal month. HBV DNA was demonstrated in 99% of HBeAg-positive and 53% of anti-HBe-positive sera and in at least two samples from each of the 24 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies to hepatitis B core antigen (anti-HBc) and e antigen (anti-HBe) were assayed in 46 sera from ten patients with acute hepatitis B utilizing immunoglobulin class- and subclass-specific enzyme immunoassays (EIAs). The sera were sampled 1 to 512 days after onset of hepatic symptoms. Four patients cleared HBsAg rapidly, within 24 days, and six patients cleared HBsAg slowly, within 27-74 days after the onset of symptoms. In three of the patients with rapid clearance of HBsAg, hepatitis B virus (HBV) DNA was not detected in sera tested during the first week after onset. The fourth patient was not tested until 12 days after onset and was then found to be negative for HBV DNA. In four of the patients with slow clearance of HBsAg, HBV DNA was present during the first week of illness. In the other two patients, HBV DNA was not detected in the first serum, 11 and 17 days after the onset of illness. Anti-HBc IgM and IgA1 were detected in all patients, with maximum titers shortly after onset. Anti-HBc IgG1 was present in all sera tested. Anti-HBc IgG2 was not detected in any of the sera. Anti-HBc IgG3 and IgG4 were detected in all patient sera, with IgG3 paralleling IgG1, and IgG4 mainly in sera long after onset. Anti-HBe IgG1, IgG3, and IgG4 were detected in three, two, and two patients, respectively. Anti-HBe IgG2, IgM, IgA1, or IgA2 was not found in any patient. The time required for maximum titer of anti-HBc IgG1 was shorter in the patients with rapid clearance of HBsAg.(ABSTRACT TRUNCATED AT 250 WORDS)
Since 1970 pregnant women with contagious infections in the country of Stockholm have been delivered at the Danderyd Hospital, the only hospital in the area which has departments of obstetrics and pediatrics as well as infectious diseases. This paper presents data from a prospective study carried out during a period of 10 years (1975-1984). The study includes 303 women and their newborns who for various reasons were transferred to the Department of Infectious Diseases (DID) before or after delivery. A comprehensive microbiological investigation was made in order to establish an etiological diagnosis in all women included in the study. A possible transmission of the infection from the mother to her fetus/child before or after delivery was also investigated. Only 0.17% of the pregnant women in the area needed care at the DID at delivery or in the puerperal period. 9% of the deliveries occurred at another hospital, 32% at the DID and the remaining at the obstetrical department, Danderyd Hospital. The rate of complications, including cesarean sections, was 12%. Of the 165 women suffering from an infectious disease at the time of delivery, 40% had a verified viral disease--in most cases varicella or mumps, 28% had a bacterial infection and for 32% no etiology of the disease could be established. The study population also includes women suspected either to be incubated with a contagious disease or to be carriers of infectious agents, as well as healthy mothers whose newborns were expected to be carriers of infectious agents such as rubella and varicella. None of the women died during the study period but 5 were seriously ill and 3 needed intensive care. The rate of stillbirths was the same as reported among all births in the country of Stockholm but the perinatal mortality rate was significantly higher (see also a following article, ref. 27). Our routines prove the necessity to take special care of pregnant women carrying a contagious infectious agent at term.
Data are presented from a long-term follow-up study of 308 live born children to women admitted post partum to the Department of Infectious Diseases (DID), Danderyd Hospital, Sweden, during a 10-year period (1975-1984) for avoiding nosocomial transmission of infections in the obstetrical wards. The rate of stillbirths (1/309 deliveries) was not higher than reported for all births in Stockholm. 20% of the live born children were transferred within 24 h after birth to the pediatric department for observation, but half of them could return to their mothers at the DID within 6 days (generally 3 days). Four newborns were treated at an intensive care unit. Only 3 fatalities occurred, all of them among newborns to mothers with an overt infection at delivery. The fatality rate (1.8%) was significantly higher among the newborns of these mothers than normally (0.3%) noted among all children born in Stockholm county during the period studied. Two of the 3 newborns, who all died within 3 days of life, had a low birth weight (600 and 1,000 g). The total number of newborns with low birth weights (less than 2,500 g) was, however, not higher in the above-mentioned group of newborns than for all children born in Stockholm county 1980. None of the 3 fatalities was caused by infection transmitted from the mother. No further deaths occurred. Infections in pregnancy at term, at birth or post partum were transmitted from the women to 41 (13%) of their newborns.(ABSTRACT TRUNCATED AT 250 WORDS)
In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a "routine" serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p less than 0.05).
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Hepatitis B markers were determined by radioimmunoassay in 383 adults from different areas of Somalia and in 135 pregnant females and 428 children from Mogadishu. The highest incidence of HBsAg among adults was among nomadic males (20/85; 23%). The frequencies were lower in males from the agricultural and coastal area, i.e. 16/93 (17%) and 14/98 (14%) respectively. The lowest frequency of HBsAg was among women from the coastal area (6/72; 8%). Among the pregnant women 14 were positive for HBsAg, none of whom had HBeAg. Low levels of positivity for HBsAg were found both among children under 4 years and among those between 4 and 13 years of age - 3/94 (3%) and 5/128 (4%) respectively. In the age group 15-19 years, 50% showed seroconversion from HBeAg to anti-HBe. 7 out of 41 HBsAg carriers of ages over 20 had HBeAg. Early seroconversion from HBeAg to anti-HBe and a low level of HBsAg positivity in children indicate that vertical transmission is not important in Somalia. The low frequency of HBsAg in Mogadishu children may have one of the following explanations: (i) the infection occurs during adolescence, (ii) Mogadishu is a low-prevalence area and the examined adults were not born in Mogadishu, or (iii) a change in hepatitis B epidemiology has taken place in the area during the last 2 decades and the relatively higher prevalence of HBsAg in adults might reflect higher rates of infection in their childhood.
A high titer of hepatitis B antigen (HBsAg) was found in a patient with acute hepatitis B infection complicated by bone marrow aplasia. A possible antimitotic effect of HBsAg as an aetiological factor of the aplasia in this patient is discussed.
The presence of antibodies against the basal cells of squamous epithelium (BCL-Ab) was studied by indirect immunofluorescence in Rumanian and Swedish carriers of hepatitis B surface antigen (HBsAg), in patients with acute viral hepatitis (AVH), chronic liver diseases (CLD), and various other diseases, and in apparently healthy subjects. Titers of BCL-Ab greater than or equal to 40 were found in 8% of 320 HBsAg carriers, in 20% of 292 patients with CLD associated with HBsAg, and in 2% of 816 patients with HBsAg-negative CLD. BCL-Ab were not found in 167 patients with AVH, nor in 1389 patients with various nonhepatic conditions, nor in 344 apparently healthy subjects. These data indicate an association of BCL-Ab with CLD predominantly of hepatitis B etiology. Possibly hepatitis B virus may induce a form of liver metaplasia with the expression of an antigen with a specificity in common with the regenerative layer of basal cells in the squamous epithelium.
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To examine the association between e antigen and hepatitis-B surface antigen (HBs Ag) we studied 90 inpatients with acute viral hepatitis type B. e Antigen was present in 24 of the patients; these patients had detectable levels of HBs Ag for significantly longer than the 66 with no e antigen in their serum. The HBs Ag subtypes D (adw) and Y (ayw) were similarly distributed among patients with e antigen and among those without, and no differences in the results of biochemical liver function tests were observed between the two groups during the acute phase of illness. Three of the five patients who developed clinical and histological signs of chronic liver disease were positive for e antigen, a finding which supports the hypothesis that e antigen has a prognostic value in hepatitis B.
Screening for hepatitis B antigen (HB-sAg) in the serum of blood donors and exclusion of antigen-positive blood units have reduced the frequency of post-transfusion hepatitis but several cases of hepatitis B still occur in association with transfusions. One explanation for this is probably that HB-sAg is not an indicator of infectivity. Thus healthy carriers of the antigen seem to have low infectivity while carriers with chronic liver disease as well as donors incubating hepatitis B probably present a great risk.
One hundred and three samples from hepatitis B surface antigen (HB(s)Ag) positive Californian blood donors were subtyped in immunodiffusion with respect to d/y, w/r and a21, a23, a3. Spur formation with a human antiserum indicated a previously unrecognized determinant q, which was detected in 96 sera (4 a21yw, 15 a23yw, 69 a21dw and 8 adr). Out of 8 sera which by spur formation were demonstrated to lack q, 7 were further subtyped (2 a21dw and 5 a3dw). Hence all 5 a3 dw specimens were demonstrated to lack q, thus indicating that q is specified by the virus. The possible relation of q to x with further implications for the specification of x is discussed.
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