[Legionnaires' disease--the riddle nears solution?].
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Biomedical subjects
Publications and source records attributed to S Iwarson.
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Immune serum globulin prophylaxis for foreign travellers should be reserved for those at high risk having no immunity against hepatitis A. In this study from Sweden the incidence of tourist hepatitis in different age groups was correlated to the prevalence of antibodies to hepatitis A virus (anti-HAV) in the population. 58% of individuals over 50 years had anti-HAV and travellers in these ages seldom experienced "tourist hepatitis". In younger age groups a low prevalence of anti-HAV (11%) was combined with a higher incidence of tourist hepatitis.
Twenty-five patients with chronic active hepatitis triggered by external factors (viruses or drugs) and 20 patients with cryptogenic chronic active hepatitis were studied for two to five years. The first group showed a significantly higher frequency of clinical and biochemical resolution at the end of the observation period than did the second group. The group with cryptogenic disease had a predominance of females carrying the histocompatibility antigen HLA-B8, whereas the group with virus- or drug-induced hepatitis did not differ from normal controls in regard to the distribution of HLA antigens. HLA-B8 and HLA-B12 were found in all but two patients in the group with cryptogenic hepatitis; this group of patients had elevated levels of gamma-globulin and autoantibodies in their sera more frequently than did the group with virus- or drug-induced disease. The results suggest that there are at least two types of chronic active hepatitis: one genetically determined, with signs of enhanced immunoreactivity and with a low degree of healing in five years; and another type triggered by external factors and without predisposing genetic factors. The data suggest that the clinical outcome is more favorable for patients with the second type of chronic active hepatitis.
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Sera from 44 patients with a well-documented diagnosis of chronic active hepatitis (CAH) were analysed for antibodies to hepatitis A virus (anti-HAV), hepatitis B surface antigen (HBsAg) and anti-HBs, e-antigen (HBeAg) and anti-HBe, as well as antibodies to hepatitis B core antigen (anti-HBc). Twenty-two patients had serologic evidence of hepatitis A infection. The frequency of anti-HAV was low in patients under 50 years of age (21%) but high among older patients (72%). There was, however, no significant difference between patients and age-matched controls regarding the prevalence of anti-HAV in serum. Markers for hepatitis B virus were found in 10 patients or 23% as compared with about 10% in Swedish blood donors. The results indicate that hepatitis A virus is of little importance in the pathogenesis of CAH and confirm the association between hepatitis B virus and development of chronic active hepatitis.
In a clinical series of 148 patients with acute hepatitis, serological analysis of hepatitis A and hepatitis B markers revealed 16% of the cases as hepatitis type non-A, non-b. Hepatitis A was diagnosed in 27% of the patients with drug addicts as the predominating category, while serological evidence of hepatitis B infection was found in 57%, again with drug addicts in the majority. Drug addicts also predominated among the non-A, non-B cases, and possibly this category of patients is today the main reservoir not only of hepatitis B but also of hepatitis A and non-A, non-B.
The prevalence of antibodies against hepatitis A virus (anti-HAV) was studied in a Swedish city population. A great difference was observed in different age groups. Anti-HAV was not found in the serum of young individuals while the prevalence was high in older ages (87% in individuals 60 years or older). This pattern of hepatitis A exposure is quite different from that reported for instance from the Mediterranean area and may indicate a very low frequency of hepatitis A exposure in Scandinavia today. The high prevalence of anti-HAV in older Swedes possibly reflects hepatitis A exposure in childhood during World War I and II when hepatitis A was more common.
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