Small round structured viruses and persistence of infectivity in food handlers.
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Biomedical subjects
Publications and source records attributed to J Craske.
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In a prospective study of cryoprecipitate administration to patients who had never received large pool concentrates, no evidence of hepatitis or HIV infection was detected in a follow up period of one year. Following the introduction of screening of blood donors for anti-HIV in the UK in October 1985 the use of cryoprecipitate in selected cases should be reconsidered.
At the end of 1984 a collaborative survey was carried out to determine the prevalence of infection with human T cell lymphotropic virus type III/lymphadenopathy associated virus (HTLV-III/LAV) and HTLV-I among 584 recipients of various blood products in Britain at that time. In 204 cases yearly point prevalence figures for infection were also obtained for 1978 to 1983. In 1984, 215 of 315 patients (68%) who had received commercial concentrate for haemophilia A were identified as positive for anti-HTLV-III/LAV as compared with only 18 of 166 patients (11%) given British concentrate alone for this disease. This difference was further emphasised by the yearly point prevalence rates: seroconversion began in 1980 among recipients of commercial concentrate, but not until 1983 did such an instance occur among recipients of British concentrate. Any conclusions must remain speculative, but possibly seropositivity among haemophiliacs may not carry so grave a prognosis as previously thought.
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Acute encephalopathy was associated with the appearance of antibodies to human T-lymphotropic virus (HTLV-III) in two patients. A third patient showed seroconversion for anti-HTLV-III, but the temporal association was not established so precisely. The illness was characterised by a prodromal period of up to 2 weeks, characterised by pyrexia, general malaise, and changes of mood. The encephalopathy culminated in epileptiform seizures in two of the patients. Electroencephalographic changes were compatible with viral encephalitis, and cerebrospinal-fluid pleocytosis was minimal. Neurological signs and symptoms resolved quickly in all patients, and no residual central-nervous-system sequelae were apparent.
The immune response of 198 young Nigerian children protected against malaria by chemoprophylaxis with chloroquine to immunization with triple, poliomyelitis, measles, typhoid, meningococcal and BCG vaccines was compared with the immune response to vaccination of 185 control children. Good responses to triple, measles and BCG vaccines were shown by children in both groups; poorer responses were obtained to poliomyelitis, typhoid and meningococcal vaccines. The response to immunization of protected children was similar to that observed among control children for all the vaccines tested except for meningococcal polysaccharide vaccine. Protected children showed a significantly greater antibody response to both group A and group C meningococcal polysaccharides than control children. This finding supports the results of previous studies which have shown that the immune response to meningococcal polysaccharide vaccines is adversely affected both by acute malaria and by asymptomatic malaria parasitaemia.
We present bacteriological and virological findings together with salient clinical features from a prospective study of 447 children aged under 2 years admitted to hospital with infectious gastroenteritis. Putative pathogenic micro-organisms were identified in the stools of 75% of these children. Eight identifiably distinct groups of viruses, found on electron microscopy and tissue culture were present in 67% of patients--rotavirus was detected most frequently. Pathogenic bacteria (salmonellas, shigellas, Escherichia coli, and Campylobacter jejuni--but excluding Clostridium difficile) were found in 16% only. Altogether 4 X 9% of 390 patients had gastroenteritis associated with Cl difficile toxin. The mean duration of diarrhoea was shortest in patients with identifiable virus, with rotavirus having a mean of 5 X 01 days, and was longest in patients with pathogenic bacteria in the stools (11 X 14 days). The finding of more than one type of virus did not seem to be associated with a significantly increased duration of diarrhoea. There are few clinical features which can be associated specifically with any particular micro-organism or groups of these. Multiple organism isolation was common, but the severity of the illness in those patients with at least two types of organism was not greater. Certain viruses, including the norwalk-like virus, known to be associated with outbreaks of gastroenteritis were found as frequently in a group of patients who did not have diarrhoea studied for comparison. Virus was still detectable in the stools of up to 40% of asymptomatic children on the day of discharge.
Two outbreaks of gastrointestinal illness with identical symptoms occurred in parties attending banquets on consecutive evenings at a large hotel. The illness was typical of epidemic winter vomiting disease. Small round structured viruses resembling those seen in the Norwalk Ohio outbreak were identified by electron microscopy in stools of victims from one episode. One food handler was found to be excreting the virus, and there was evidence of a poor standard of hygiene in the kitchen. A food history analysis showed the illness to be significantly associated with eating cold cooked ham.
Thirty patients who had not previously received treatment with factor VIII concentrate or who had been treated only infrequently with factor VIII concentrate were studied after a transfusion of factor VIII. Tests of liver function were performed frequently. Four patients had evidence of chronic liver disease before transfusion. In 17 of the remaining 26 patients serum transaminase activities became raised and 10 patients developed jaundice. All of the nine patients who had not previously received factor VIII transfusion developed non-A non-B hepatitis. Four out of 10 patients followed up for a year had persisting abnormalities of liver function. The pattern of illness suggests that more than one serotype of non-A non-B hepatitis virus may be transmitted by factor VIII concentrate prepared by the National Health Service from volunteer donors in the United Kingdom.
There are reports in the literature that infection with hepatitis A virus in hepatitis B carriers can result in resolution of the carrier state. In an attempt to induce clearance of the carrier state of hepatitis B virus in two persistently infected chimpanzees, the chimpanzees were infused with documented non-A, non-B infectious material. Biochemical and histopathological evidence of hepatitis was accompanied by the unique abnormalities of endoplasmic reticulum associated with non-A, non-B hepatitis in the chimpanzees. Elevation of alanine aminotransferase was accompanied by fourfold reduction in one chimpanzee and sixfold reduction in the other in the plasma levels of HBV-associated DNA polymerase activity and simultaneously by twofold reduction in the concentration of hepatitis B surface antigen in both chimpanzees. A mediator may account for these changes in markers of hepatitis B virus infection, and this mechanism may also explain the occurrence of spontaneous regression in some persistently infected carriers. The significance of transient red cell anaemia in non-A, non-B hepatitis, which was observed in one of the chimpanzees, is yet to be established.
Successful percutaneous liver biopsy was carried out on 12 multi-transfused haemophiliacs from the Manchester area with persistently abnormal liver function tests. Only one patient showed evidence of chronic active hepatitis with progression to active micronodular cirrhosis although a further four patients showed some evidence of mild chronic active hepatitis. This represents a much lower incidence of severe histological liver damage than many previous reports and implies that liver biopsy in asymptomatic haemophiliacs may not be indicated as a routine procedure, particularly in the absence of proven therapy. Dynamic liver function tests may prove to be a useful indicator of deteriorating liver function in the otherwise asymptomatic haemophiliac.
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The results of a field trial of a joint DMRQC/Organon ELISA kit for the detection of hepatitis A IgM antibody are reported. The participating laboratories were asked to use the kit to test a panel of 360 specimens consisting of duplicate coded samples of 180 sera. The panel was also tested by MACRIA in the Virus Reference Laboratory, Colindale. The ELISA was shown to be specific and sensitive giving good discrimination between acute and late convalescent hepatitis A sera. It was proposed that the same cut-off control as is used in the RIA (equivalent to 10 RIA units) should be adopted for the ELISA also.
A field trial of an enzyme-linked immunosorbent assay (ELISA) for the detection of the hepatitis Be markers is reported. It is simple to perform, is designed to be read by eye and does not require any expensive apparatus. When compared with a commercially available RIA kit for the detection of the same markers, ELISA was shown to be as sensitive as RIA for the detection of anti-HBe but slightly less sensitive for the detection of HBeAg. However if all specimens negative for both HBeAg and anti-HBe by ELISA are considered to be potentially infectious, the ELISA should prove to be as useful as RIA for determining the "e" status of HBsAg-positive patients and, therefore, provide a reliable indication of the risk of secondary spread of hepatitis B infection to contacts by needle stick accident, close personal contact or perinatal transmission.
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A retrospective survey of transfusion hepatitis associated with a brand of commercial Factor VIII was carried out in 24 Haemophilia Centres from January 1974 until December 1975. Of 371 patients who were transfused with this product, and were followed up, 78 cases of hepatitis affecting 66 patients were found (17.7%). Two types of hepatitis were observed: hepatitis B and non-B hepatitis, the latter with an incubation period of between 8 and 60 days. Twelve patients contracted two types of hepatitis, non-B followed by hepatitis B. Only one patient died after contracting hepatitis B. Four of the suspect batches of concentrate were found to be positive for HBsAg by radioimmunoassay. There was evidence that the presence of hepatitis B surface antibody in a patient's serum prior to exposure was associated with immunity to hepatitis B. Evidence was presented suggesting that the non-B hepatitis observed was not due to hepatitis A. The factors affecting the incidence of transfusion hepatitis in haemophiliacs were discussed.
An outbreak of jaundice associated with three out of four batches of a commercial brand of freeze-dried factor-VIII concentrate occurred at the Bournemouth haemophilia centre between April and June, 1974. Seven cases of non-B hepatitis and four of hepatitis B occurred within 6 months of the first use of this product. Two patients contracted both types of hepatitis; thus nine patients became ill out of a total of twenty regularly seen at the centre, eighteen of whom received commercial factor-VIII concentrate.