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H B Krarup

Publications and source records attributed to H B Krarup.

18 recordsLinked to original sources
PubMed2001

Outbreak of Hepatitis B among injecting drug users in Denmark.

BACKGROUND: The incidence of hepatitis B is low in Denmark, but injecting drug users (IDUs) remains a high-risk group for this infection. OBJECTIVES: The aim of the study was to describe a hepatitis B outbreak among IDUs by comparing existing registers. Additionally, we wanted to analyze the genetic variation of the hepatitis B virus involved in the outbreak. STUDY DESIGN: In the County of Funen, registers of laboratory diagnosis, hospital records and reports from clinicians to the Medical Officer of Health (MOH) were compared between 1992 and 1998. HBsAg positive sera recovered from the epidemic were sequenced and compared to known HBV strains. RESULTS: We identified 648 cases of hepatitis B of which 51% (332) were acute infections. The laboratory database identified 96% (319/332) of these, 45% (150/332) were admitted to hospital and 38% (127/332) were reported to public health. By capture-recapture analysis based on MOH reports and hospital records the estimated total number of acute cases were 334 (95% C.I. 283-385). We sequenced 75 HBsAg positive samples and identified two very similar strains of genotype D (serotype ayw3) among IDUs involved in the outbreak. CONCLUSIONS: The current surveillance system did not detect the majority of acute hepatitis B cases in County of Funen. We suggest laboratory-based surveillance of hepatitis B to be implemented at a national level as this may identify new outbreaks faster and more complete than the current surveillance system.

Denmark↗
PubMed2000

[Transfusion-related hepatitis C. The Danish "look back" survey].

This study accumulated results of the HCV lookback in Denmark and described the morbidity of the infected recipients. Donor records were identified for at least ten years back, and recipients still alive were tested for hepatitis C. Those with positive results were referred for clinical evaluation. A total of 150 Danish anti-HCV positive donors had donated blood to 1018 recipients of whom 288 (29%) were still alive. Because of age, malignancy or other severe diseases 118 (41%) of these were not contacted. Of 157 recipients screened for HCV, 128 (82%) were anti-HCV positive and 88 (56%) were HCV-RNA positive. Among the HCV-RNA positive recipients symptoms were present in 38% (25/66 reported), elevated ALT was found in 53% (41/77 tested) and cirrhosis was found in 11% (6/54 biopsied). Treatment with interferon-alpha was initiated in 23 patients, corresponding to 26% of HCV-RNA positive recipients.

Blood Donors↗
PubMed2000

Prevalence and incidence of bloodborne viral infections among Danish prisoners.

In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.

Adult↗
PubMed2000

Haemophilic patients with hepatitis C have higher viral load compared to other well-defined patient groups.

Comparison of hepatitis C viral load between different patient populations has been hampered by the use of different technology in individual studies. We had the impression that haemophilic (HAEM) patients had a higher serum load of hepatitis C virus (HCV) compared to other HCV-infected patients. We therefore studied viral load and genotypes in active illicit drug users (IDU), HAEM patients and patients with post-transfusion hepatitis (PTH). The study comprises 225 HCV-RNA positive patients, 117 IDU, 60 HAEM patients and 48 PTH patients. All patients were anti-HIV negative. HCV-RNA was measured with a quantitative reverse transcription polymerase chain reaction (RT-PCR) method, HCV-genotypes were determined with genotype specific primers in RT-PCR in 221 patients. Four patients could not be genotyped with our assay and were excluded. Overall viral load was higher in genotypes 1 and 2 compared to genotype 3, median values of HCV-RNA were 1,400 x 10(3) geq ml(-1), 2,700 x 10(3) geq ml(-1) and 270 x 10(3) geq ml(-1), respectively. HAEM patients had significantly higher viral load for both genotypes 1 and 3 compared to the IDU and PTH patients. In a multiple linear regression model HCV-RNA viral load was independently associated with HAEM and genotype, but not to age, gender or disease duration. In conclusion, HAEM patients have higher viral load than IDU and PTH patients. The reason for this is unknown, but it may be due to host factors or mode of transmission with multiple inoculations.

Adult↗
PubMed1999

Natural history and etiology of liver disease in patients with previous community-acquired acute non-A, non-B hepatitis. A follow-up study of 178 Danish patients consecutively enrolled in The Copenhagen Hepatitis Acuta Programme in the period 1969-1987.

BACKGROUND/AIMS: Consecutive patients originally diagnosed with acute non-A, non-B hepatitis were followed up to assess the long-term morbidity and mortality and to re-evaluate the etiology in surviving patients. METHODS: Follow-up was performed in 178 patients with acute non-A, non-B hepatitis enrolled in the Copenhagen Hepatitis Acuta Programme in the period 1969-1987. Mortality and morbidity were assessed using: i) death certificates and ii) diagnoses at discharge following all somatic admissions. All patients who were alive were offered a re-examination encompassing clinical, biochemical and virological evaluation. RESULTS: After a median of 23 years, 71 (40%) had died and seven (4%) were untraceable. Overall mortality and mortality due to cirrhosis and accidents, mainly intoxication with drugs, were significantly higher compared to those of an age- and sex-matched Danish population. Chronic hepatitis had been diagnosed in 19 (11%) and cirrhosis in 16 (9%). Of 100 patients who were alive, 57 accepted a re-examination. Anti-HCV was detected in 24 (42%) and 19 (33%) were HCV-RNA positive. Of the viremic patients, 11 (58%) had elevated P-ALT, but only three (16%) had already been diagnosed with HCV infection. A history of intravenous drug use was tantamount to anti-HCV positivity. CONCLUSIONS: Danish patients with community-acquired acute non-A, non-B hepatitis had an increased mortality due to liver cirrhosis during the first years after the acute infection. Alcohol was the etiological agent in several cases, but HCV infection may also have been present. However, the long-term HCV-related morbidity and mortality were low.

Acute Disease↗
PubMed1999

Transfusion-acquired hepatitis C: the Danish lookback experience. The Danish HCV [hepatitis C virus] Lookback Group.

BACKGROUND: In 1996, the Danish National Board of Health recommended hepatitis C virus (HCV) lookback to identify recipients of blood components from donors found to be positive since the implementation of anti-HCV screening in 1991. STUDY DESIGN AND METHODS: The aim was to accumulate results of the lookback at a national level and to describe the morbidity of the infected recipients. Records of transfusion were identified for at least 10 years back, and recipients still alive were tested for hepatitis C. Those with positive results were referred for clinical evaluation. RESULTS: A total of 150 anti-HCV-positive Danish donors had donated blood to 1018 transfusion recipients, of whom 288 (29%) were still alive. Because of age, malignancy, or other severe diseases, 118 (41%) of these were not contacted. Of 157 recipients screened for HCV, 128 (82%) were anti-HCV positive on enzyme-linked immunosorbent assay, and 88 (56%) were HCV RNA positive. Among the HCV RNA-positive recipients, symptoms were present in 38 percent (25/66 reported), elevated alanine aminotransferase was found in 53 percent (41/77 tested), and cirrhosis was found in 11 percent (6/54 biopsied). Treatment with interferon alpha was initiated in 23 patients, corresponding to 26 percent of HCV RNA positive recipients. CONCLUSION: Among tested recipients in the Danish HCV lookback, most were anti-HCV positive and more than half were still viremic. The morbidity was considerable, and one-fourth of viremic recipients entered treatment.

Blood Banks↗
PubMed1998

A quantitative HCV-PCR test for routine diagnostics.

The aim of this study was to develop a reliable and simple method for hepatitis C virus (HCV)-PCR using standard, automated laboratory equipment. HCV-RNA was extracted from serum and amplified in a single PCR with an internal standard. The PCR product was detected using fluoroimmunoassay. Quantification was based on external and internal standards. Linearity was observed over a wide range (10-10(7) geq). Mean inter and intra serial coefficients of variation were 35% and 23%, respectively. The limit of quantification was 1000 geq/ml based on intra and inter serial variations, while levels of 110 geq/ml were always detectable. Lower concentrations were intermittently positive. The ability to separate HCV-signals in healthy and infected persons was good, based on the distribution of HCV-signals from 353 random blood donors and 191 patient samples. To illustrate the applicability of the test, HCV-RNA quantification was performed in 11 patients during treatment with interferon alpha-2b. Ten of 11 patients showed a decline in HCV-RNA within the first few weeks of treatment. After four weeks most patients were still HCV-RNA positive but below the limit of quantification. The present method for quantification of HCV-RNA was shown to have sensitivity at the level of nested PCR techniques. Until now HCV-PCR has been complicated, time-consuming and costly, and therefore not suitable for routine diagnostics. The PCR method described here is easy to perform, fast and cost-effective.

Base Sequence↗
PubMed1998

Performance of hepatitis C virus (HCV) antibody test systems in relation to HCV-RNA detection in the diagnosis of HCV infection.

BACKGROUND: Hepatitis C virus antibody (anti-HCV) test systems for screening and confirmation of blood donations have proved their value. The systems were later adopted for diagnosing patients suspected of hepatitis C. OBJECTIVES: 1) to study the clinical value of the recombinant immunoblot assay (RIBA) in routine diagnostics of patients suspected of HCV infection using HCV-PCR as the most definitive test and 2) to compare the performance of RIBA-2 with RIBA-3. MATERIALS: From May 1991 to August 1996 more than 4300 patients were tested for anti-HCV. All anti-HCV (EIA) positive patients were tested with RIBA-2 or RIBA-3 and HCV-PCR. RESULTS: We found no difference in the overall performance of RIBA-2 compared to RIBA-3. There was a tendency to fewer indeterminate results using RIBA-3 compared to RIBA-2 (5% vs. 9%), but this was not statistically significant. The NS5 band in RIBA-3 did not improve sensitivity or predictive value. Of RIBA-2 and RIBA-3 positive patients, 71% and 66% respectively were found to be HCV-RNA positive. Two samples that were negative using RIBA were HCV-RNA positive. CONCLUSION: RIBA testing in anti-HCV (EIA) positive patients added no clinically useful information to the screening results. We have therefore changed the diagnostic strategy so that all anti-HCV (EIA) positive patients are tested for HCV-RNA.

Hepacivirus↗
PubMed1997

[Euricterus. A European database on icterus with emphasis on the Danish contribution].

Clinical and biochemical data were collected prospectively from 8032 jaundiced patients to form a database as part of a EU-supported project on computer-aided diagnosis. Patients were recruited prospectively from centres in all EU-countries and some other countries as well. Five hundred and twenty-eight jaundiced patients were collected from four centres in Denmark. Alcoholic cirrhosis, acute alcoholic liver disease and malignancy of the pancreas or the biliary tract were more common in the Danish data base: 49% of cases in Denmark as compared to 30% of cases in the international database. Viral hepatitis was underrepresented in Denmark, 16% as compared to 23% in the international group. A crude Bayesian diagnostic programme on the total database with 17 diagnostic groups achieved 63% accuracy. For the 528 Danish cases the diagnostic accuracy was 64% when the European data base was used, whereas it increased to 81% when only the Danish data base was taken as basis for the calculations. In conclusion, we found a drop in diagnostic accuracy for the Danish patients when using the large European data base instead of the national one.

Databases, Factual↗
PubMed1997

Experimental pain in the stomach: a model based on electrical stimulation guided by gastroscopy.

BACKGROUND: Abdominal pain is often variable in intensity and difficult to characterise due to its referred pain pattern. Clinical pain is furthermore confounded by various emotional and cognitive factors. AIMS: To develop and apply an experimental model to induce localised gastric pain. SUBJECTS: Twelve healthy male volunteers. METHODS: Stimulating electrodes were mounted on a biopsy forceps and electric stimuli were delivered during gastroscopy. Single, five repeated, and continuous stimuli were given at four locations in the stomach. Pain detection thresholds and pain intensities were assessed together with localisation of the referred pain area. RESULTS: Pain detection thresholds were higher in the prepyloric region compared with those obtained at the lesser and greater curvature. Increasing stimulus intensity resulted in augmented pain perception and repeated stimuli elicited pain at a lower stimulus intensity than single stimuli. Continuous stimuli evoked constant (33%), increasing (33%), or decreasing (33%) pain. The localisation of referred pain varied considerably in the subjects. CONCLUSIONS: The model seems relevant to study basic pain mechanisms elicited by localised stimuli in the stomach. The experimental data support the premise that a gastric focus should always be suspected in patients referred with different kinds of abdominal pain.

Abdominal Pain↗
PubMed1997

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.

Adult↗
PubMed1996

Biochemical, virological and histopathological changes in Danish blood donors with antibodies to hepatitis C virus.

BACKGROUND: Previous studies have indicated that the presence of antibodies to Hepatitis C virus (HCV) is indicative of current HCV infection irrespective of S-alanine aminotransferase (S-ALT) values. STUDY DESIGN AND METHODS: Over three years, all confirmed anti-HCV-positive blood donors form the Blood Banks of Copenhagen County were consecutively evaluated. Seven women and 14 men with a median age of 34 years were included. Serum HCV-RNA was measured with an in-house developed single PCR. Liver biopsies were classified according to standard criteria. RESULTS: All were asymptomatic at presentation with no history of liver disease. Previous intravenous drug abuse and/or tattooing were identified in 16. Seventeen blood donors were evaluated biochemically and histologically. Serum HCV-RNA was detectable in 14, all of whom had histopathological changes in their liver biopsy including chronic active hepatitis and active cirrhosis. Twelve of the 14 HCV-RNA-positive donors had elevated S-ALT. In the three HCV-RNA-negative donors, S-ALT was normal. Two of these had normal liver biopsies, whereas the third had minimal changes. CONCLUSION: To diagnose and evaluate the activity of chronic HCV infection, liver biopsy and HCV-RNA assessment are essential in confirmed anti-HCV-positive individuals irrespective of symptoms and S-ALT levels.

Adult↗
PubMed1995

The seroprevalence of hepatitis B and C in hospitalized Danish patients.

Health care workers are at risk of acquiring blood-borne infections. To assess the risk of exposure to hepatitis B or C in the case of occupational blood exposure, we determined the seroprevalence of these infections in 466 patients admitted to a Copenhagen university hospital. Serological markers for hepatitis B or C were detected in 56 patients (12.0%). The seroprevalence of HBsAg and anti-HCV was 0.9% and 1.5% respectively. HCV RNA, indicating ongoing hepatitis C, was found in five of seven anti-HCV-positive patients by polymerase chain reaction. The serological findings had not previously been diagnosed in 4 of 10 potentially infectious patients and only 6 of 10 patients belonged to high-risk groups. In conclusion, health care workers should be aware of the potential the occupational risk of hepatitis B and C even in a low-prevalence country like Denmark. Management of health care workers after blood exposure should include serological testing for both hepatitis B and C. Strict adherence to universal precautions is recommended and vaccination against hepatitis B should be encouraged.

Adolescent↗
PubMed1994

[Hepatitis C].

Hepatitis C virus (HCV) was recognized in 1989 as the main cause of transfusion-related hepatitis non-A, non-B (HNANB) as well as sporadically-acquired HNANB infections. The HCV genome has been sequenced but the virus has not yet been visualized. Anti-HCV antibody tests have been developed, namely enzyme-linked immunosorbent assays (ELISA) for screening and recombinant immunoblot assay (RIBA) for confirmative testing of ELISA positive results. Since May 1991 all Danish blood donations have been tested for anti-HCV antibodies. Approximately 0.04% of Danish blood donors are 4-RIBA positive and have signs of chronic HCV infection based on ALT, HCV-RNA or histological findings. High-risk groups are intravenous drug abusers, haemophiliacs, haemodialysis patients and recipients of multiple blood transfusions. Approximately one third of the cases are sporadic, i.e. without obvious risk factors. Sexual transmission of HCV may occur, but this route is uncommon. More than half of the patients with acute HCV infection progress to chronic hepatitis C. Of these a considerable proportion develops cirrhosis and some eventually hepatocellular carcinoma. At present interferon (IFN) is the only registered therapy against chronic hepatitis C. Approximately half of the patients respond to treatment. The majority, however, relapse after stopping IFN treatment and only 20% maintain their response.

Hepacivirus↗
PubMed1992

Diagnostic problems with meningococcal disease in general practice.

Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. The analysis concerned diagnostic problems in general practice, prognosis, pre-hospital antibiotic treatment and its effect on subsequent cultures, and degree of obligatory notification. The referring doctor suspected meningococcal disease/central nervous infection in 123 patients (69.5%). Neck stiffness and petechiae were related to a correct referral diagnosis, in contrast to the occurrence of a non-petechial rash. The presence of disseminated intravascular coagulation was associated with the mortality rate, which was 0.062. The therapeutic recommendations of the Danish Health Authorities were followed in only 25 of the 98 patients who fulfilled the criteria for pre-hospital parenteral antibiotic treatment. Pre-hospital antibiotic treatment was related to negative culture of spinal fluid or blood. Seven of the 177 patients were not notified according to the rules. Difficulties in pre-hospital diagnosis seem not to influence the lethal course of the disease.

Adolescent↗