An economic evaluation of vaccination against hepatitis A for frequent travellers.
Fenn P. McGuire A. Gray A.
School of Management and Finance, University of Nottingham, UK.
This paper compares the cost of using inactive Hepatitis A vaccine relative to immunoglobulin as a means of protecting frequent travellers against Hepatitis A. The number of trips to 'at risk' areas is modelled as a Poisson process and results are reported in terms of the discounted gross cost per protected trip over a 10-year period. We find that the expected cost of immunization is lower with immunoglobulin for travellers visiting 'at risk' areas less than five times in 10 years, and lower with Hepatitis A vaccine for those visiting 'at risk' areas more than five times in 10 years.
Prevalence of antibodies against varicella zoster, herpes simplex (types 1 and 2), hepatitis B and hepatitis A viruses among Spanish adolescents.
Gil A. Gonzalez A. Dal-Re R. Ortega P. Dominguez V.
Preventive Medicine and Public Health Department, School of Medicine, Complutense University, Madrid, Spain.
The aim of this cross-sectional study was to assess the seroprevalence of antibodies against varicella zoster (VZV), herpes simplex type 1 (HSV-1) and type 2 (HSV-2), hepatitis B (HBV) and hepatitis A (HAV) viruses in adolescents (14-17 years of age) in Madrid, Spain. At the study visit, demographic data and blood samples were obtained. The enzyme linked immunosorbent assay (ELISA) method was used to assess the presence of anti-VZV, anti-HSV-1, anti-HSV-2, anti-HBc and anti-HAV antibodies. A total of 1191 serum samples were collected. Mean age (SD) and male/female ratio of the study population were 15.3 (1.1) years and 0.9, respectively. Seroprevalences obtained were as follows: anti-VZV (94%), anti-HSV-1 (46%), anti-HSV-2 (5%), anti-HBc (3%) and anti-HAV (5%). These data show that Spanish adolescents should be considered a target group for prevention programmes against HSV-2, HBV and HAV infections.
Prostatitis and hepatitis due to Brucella melitensis: a case report.
Aygen B. Sumerkan B. Doganay M. Sehmen E.
Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
A case is reported of a 43-year-old man who presented prostatitis and hepatitis due to Brucella melitensis. His symptoms were icterus, weakness, anorexia, fever, and urinary discomfort. Physical examination revealed icterus and hepatosplenomegaly. Lymphomonocytosis, elevated erythrocyte sedimentation rate and abnormal liver functions had been detected in laboratory tests. Brucella melitensis was isolated from prostatic fluid and blood cultures.
Effect of faecal consistency on virological diagnosis.
McCaughey C. O'Neill HJ. Wyatt DE. Christie SN. Jackson PT. Coyle PV.
Department of Microbiology and Immunobiology, Royal Hospitals Trust, Belfast, UK.
A study was set up to investigate the effect of consistency of routine faecal specimens on the diagnostic yield by electron microscopy (EM) and virus isolation. A total of 3078 specimens were characterized as solid, semisolid, or liquid. Of 2568 specimens processed by EM a virus was demonstrated in 8.6% of liquid, 19.9% of semisolid and 25.2% of solid specimens (Chi-squared for linear trend, P value
Diffuse necrotic hepatic lesions due to visceral leishmaniasis in AIDS.
Angarano G. Maggi P. Rollo MA. Larocca AM. Quarto M. Scalone A. Gradoni L.
Clinic of Infectious Disease and Institute of Hygiene of the University of Bari, Policlinico, Italy.
A rare case of an AIDS patient who developed scattered necrotic involvement of the liver caused by Leishmania infantum is described. Of interest, marked splenomegaly, hypergammaglobulinemia and serum anti-Leishmania antibodies were absent and an incomplete response to therapy was observed. Diagnosis of visceral leishmaniasis (VL) was achieved by the demonstration of numerous amastigotes in both hepatocytes and macrophages on liver biopsy. Hepatic necrotic lesions, which when extensive could lead to acute hepatic failure, possibly reflect an atypical manifestation of liver involvement caused by L. infantum and depend on the immunological impairment which characterizes AIDS patients, thus preventing the formation of granulomas. Our observation confirms that VL can manifest atypical aspects in HIV-positive patients depending on the degree of the immunodeficiency. The frequency and severity of this pathology accounts for the need to list VL among AIDS-defining conditions.
The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients.
Lewis SJ. Potts LF. Barry RE.
Department of Medicine, Bristol Royal Infirmary, UK.
Diarrhoea is a common side effect of antibiotic therapy, especially in the elderly. Saccharomyces boulardii is a non-pathogenic yeast which has been demonstrated to reduce the frequency of diarrhoea in patients due to a variety of causes. We set out to assess its role in preventing antibiotic-related diarrhoea. Consecutive patients over the age of 65 admitted to medical wards, and who were being prescribed antibiotics, were randomized to receive either S. boulardii 113 g twice daily or placebo for as long as they received antibiotics. Bowel habit was monitored using a record of interdefaecatory intervals (IDI) and stool form graded 1-4 (hard to liquid). Stool samples were tested every fourth day for Clostridium difficile toxin. Of the 72 patients randomized, 69 completed the study. There was no difference in sex, age, duration of antibiotic use, length of hospital stay, IDI, stool form, the proportion of patients receiving laxatives, the number of patients experiencing watery stools (seven vs. five), or the presence of C. difficile toxin (five vs. three). No side effects were attributable to S. boulardii. There was no evidence that the concomitant use of S. boulardii with antibiotics alters patients' bowel habits or prevents the appearance of C. difficile toxin in the stool. Thus, S. boulardii cannot be recommended as a 'natural' way to prevent antibiotic-related diarrhoea. This highlights the need for proper evaluation of probiotics before their unrestricted use in medical practice.
Serum hepatitis G virus (HGV) RNA in multitransfused thalassemics from eastern Sicily.
Cacopardo B. Berger A. Cosentino S. Lombardo S. Morrone ML. Boscia V. Vinci G. Restivo R. Brancati G. Doerr HW. Nunnari A.
Department of Infectious Diseases, University of Catania, Italy.
The prevalence of hepatitis G in a multitransfused population was studied. HGV did not appear to be a major contributor to liver pathology in this group and the prevalence was surprisingly low.
Enterocytozoon bieneusi multiorgan microsporidiosis in a HIV-infected patient.
Georges E. Rabaud C. Amiel C. Kures L. Guedenet JC. Allamagny E. May T. Canton P.
Laboratoire de Parasitologie, Centre Hospitalier Universitaire de Nancy, France.
Multiorgan microsporidiosis due to Enterocytozoon bieneusi was diagnosed in an HIV-infected patient. The parasite was found and identified as E. bieneusi by transmission electron microscopy in stools, duodenal biopsy, nasal discharge and sputum. No clinical improvement or parasite eradication was obtained after albendazole therapy, but the patient remained alive 9 months after diagnosis.
Acute exacerbation of vasculitis during interferon-alpha therapy for hepatitis C-associated cryoglobulinaemia.
Gordon AC. Edgar JD. Finch RG.
Department of Microbiology and Infectious Diseases, Nottingham City Hospital, UK.
A significant, previously unreported, adverse reaction to interferon-alpha therapy is reported. Immediately after the commencement of low dose therapy a man with hepatitis-C associated cryoglobulinaemia developed a purpuric rash and a severe, reversible impairment of renal function. This observation may elucidate the immunopathogenesis of vasculitis.