Group B streptococcal infective endocarditis

From 1970 to 1983, five patients with group B streptococcal endocarditis were treated at the Mayo Clinic, Rochester, Minn. The minimal inhibitory concentration and the minimal bactericidal concentration of penicillin were 0.09 microgram/mL or less and 1.56 micrograms/mL or less, respectively. The in vitro activity of cefazolin against group B streptococci was similar to that of penicillin. In three of the five cases, penicillin and streptomycin acted synergistically in vitro against group B streptococci. Four of the five patients were cured, three by use of an aminoglycoside combined with penicillin, ampicillin, or vancomycin. Three of the five patients had multiple large systemic emboli, and one of the three died of brain-stem infarct. Penicillin alone or in combination with an aminoglycoside is effective therapy for group B streptococcal endocarditis. Patients unable to tolerate penicillin may be treated with cefazolin or vancomycin. Clindamycin therapy should be avoided in patients with endocarditis caused by strains that are tolerant in vitro to clindamycin.     

抗乙肝胎盘转移因子治疗慢性乙型肝炎的临床研究

目的验证抗乙肝胎盘转移因子（ＰＳＴＦ）的临床疗效和不良反应。方法以胎盘转移因子（ＰＴＦ）及猪苓多糖加乙肝疫苗为对照,进行“多中心”临床研究。采用随机分组,双盲对照治疗慢性乙型肝炎共３４６例,疗程均为 ３个月。结果 ＰＳＴＦ改善症状和体征、恢复肝功能均优于猪苓多糖加乙肝疫苗。 ＰＳＴＦ组 ＨＢｓＡｇ、 ＨＢｅＡｇ及 ＨＢＶ ＤＮＡ的阴转率分别达４．３％、 ５３．０％及 ５３．３％; ＰＴＦ组分别为０、 ２２．５％及 ２６．５％;猪苓多糖组分别为 ０、２７．６％及２７．０％,差异显著。随访结果与治疗结束时相似,未观察到ＰＳＴＦ有任何不良反应。结论ＰＳＴＦ是治疗慢性乙型肝炎、抗乙型肝炎病毒的安全有效药物。     

Hepatitis C and B viruses in hepatitis B surface antigen-negative hepatocellular carcinoma.

The relative role of hepatitis C virus and hepatitis B virus in hepatitis B surface antigen-negative hepatocellular carcinoma was evaluated by polymerase chain reaction in 31 patients from Taiwan. Twenty-one were positive for antibody to hepatitis C virus (group 1) and 10 were negative (group 2). Of the group 1 patients, hepatitis C viral RNA was detected in the serum by polymerase chain reaction in 16 and in the liver tissue in 17, whereas hepatitis B viral DNA was found in the liver tissue in only 4, and none were found in the serum. In group 2 patients, hepatitis C viral RNA was detected in the serum of 1 and in the liver tissue of another. In contrast, hepatitis B viral DNA was found in the serum of 4 patients and in the liver tissues of 5. It was concluded that hepatitis C virus plays an important role in hepatocarcinogenesis in hepatitis B surface antigen-negative patients in Taiwan, especially in those who had antibody to hepatitis C virus; in those without antibody to hepatitis C virus, hepatitis B virus might still be associated with the development of hepatocellular carcinoma in a significant proportion of such patients.     

乙型肝炎患者外周血淋巴细胞中核因子-κB活性的初步研究

目的 研究乙型肝炎患者外周血淋巴细胞中核因子(NF)-κB的活性表达。方法 抽取急慢性乙型肝炎、慢性重型肝炎患者以及正常对照者静脉血,分离外周血淋巴细胞(PBL)并提取核蛋白,地高辛标记NF-κB寡核苷酸探针,电泳迁移率变动法检测NF-κB活性。结果 电泳迁移率变动法结果经影像分析仪扫描所得平均吸光度(A)值为:正常对照组20.18±2.16,急性乙型肝炎组27.75±4.11,慢性乙型肝炎组13.90±3.20,慢性重型肝炎组8.02±2.65(F=26.112,P<0.01)。组间两两比较,正常对照组与慢性重型肝炎组、急性乙型肝炎组与慢性乙型肝炎组及慢性重型肝炎组之间差异均有显著性(P值分别为0.014、0.009和0.003)。结论 乙型肝炎患者PBL中NF-κB的活性表达与乙型肝炎病毒感染的不同结局有关。慢性乙型肝炎患者PBL中NF-κB活性降低,可能是患者淋巴细胞功能缺陷的重要原因。     

Hepatitis B vaccination

Alcoholics are at risk to develop hepatitis B infections, chronic active hepatitis, and even hepatoma. Hence, immunization with hepatitis B vaccine is recommended. However, immune abnormalities may coexist which alter their responsiveness to vaccination. This study compares the immune response to this vaccine in controls (group I), alcoholics without overt liver disease (group II), and alcoholics with clinical liver disease (group III). By the seventh month after the initial vaccination, 89% in group I, 70% in group II, and 18% in group III had a response >36 RIA units. The magnitude of the response was significantly different in groups I, II, and III (19,456 vs 8,326 vs 153 RIA units, respectively; P <0.05, group I vs III). In those who did not respond, a significant (P < 0.02) lower helper/inducer (T ₄)class of lymphocytes was observed as compared to patients who exhibited an adequate response. These observations suggest: (1) that the response to hepatitis B vaccine is a T-cell-dependent event and (2) that in this population, using the existing vaccine, postvaccination evaluations of antibody concentrations are needed before protection against hepatitis B infection can be assumed.This research was funded by the Veterans Administration, Cincinnati, Ohio; and Merck, Sharp and Dohme Laboratories.     

Evolution of acute hepatitis B in homosexual men to chronic hepatitis B. Prospective study of placebo recipients in a hepatitis B vaccine trial

To determine whether the frequency of chronic hepatitis B in homosexual men reflects the high rate of acute hepatitis B or an altered response to hepatitis B, 236 homosexual men were prospectively followed up after entry into the placebo group of a hepatitis B vaccine trial. Sixty-six participants (28.0%) developed hepatitis B ten to 18 months after entering the study. Only four (6.1%) of the 66 had persistence of hepatitis B beyond six months, similar to reports in nonhomosexual subjects. This study suggests that the high rate of acute hepatitis B is the major factor contributing to the high prevalence of chronic hepatitis B in homosexual men, rather than an altered host response. Clinical features of the acute illness could not be used to identify patients who developed chronic hepatitis B.     

Prevention of group B streptococcal infection.

Group B streptococci continue to be major perinatal pathogens, both for mothers and their infants, and are associated with significant morbidity, mortality, and its attendant cost to society. Approaches to prevention are directed toward either eliminating exposure to the organism or enhancing host resistance, that is, chemoprophylaxis and immunoprophylaxis. Intrapartum chemoprophylaxis has been shown to effectively interrupt vertical transmission of group B streptococci from the genitally colonized mother to the infant and to decrease the incidence of both maternal and early-onset neonatal group B streptococcal disease. To avoid unnecessarily exposing large numbers of colonized women to antibiotics, only those with defined risk factors should be selected for intrapartum chemoprophylaxis. This regimen is ampicillin given intravenously, 2 g initially at onset of labor or rupture of membranes, followed by 1 g every 4 hours until delivery. Risk factors include premature onset of labor or rupture of membranes before 37 weeks' gestation, rupture of membranes of more than 12 hours, intrapartum fever, group B streptococcal bacteriuria, or having previously delivered an infant with group B streptococcal disease. Detection of anogenital colonization is accomplished either by culture late in the second or early in the third trimester or by intrapartum group B streptococcal antigen testing of vaginal swabs from those previously culture-negative or not cultured. Although this approach combines the advantages of several proposed strategies, it will still miss those cases of group B streptococcal disease developing in the absence of discernible risk factors. Intrapartum prophylaxis does not prevent late-onset group B streptococcal disease. Prenatal and postnatal chemoprophylaxis have not been shown to be effective. Symptomatic infants born to mothers given chemoprophylaxis should be evaluated for neonatal sepsis and treated accordingly. This approach is also suggested for asymptomatic premature infants, those whose mothers have not received adequate prophylaxis or have previously delivered infants with group B streptococcal disease, and for twin siblings of infants developing group B streptococcal disease. Successful implementation of this approach may be limited by the availability and sensitivity of the rapid antigen test used. Immunoprophylaxis, and active immunization in particular, is the most promising method of preventing perinatal group B streptococcal disease in mothers and their infants, including late-onset disease. Immunization of pregnant women with type III polysaccharide vaccine has resulted in adequate provision of functional antibody to the infants born to responders.(ABSTRACT TRUNCATED AT 400 WORDS)     

Immune response to hepatitis B vaccine of subjects with isolated antibody to hepatitis B core antigen

BACKGROUND/AIMS: For subjects with isolated antibody to hepatitis B core antigen, vaccination can help discriminate various diagnostic possibilities. The aim of this study was to evaluate the clinical significance of isolated antibody to hepatitis B core antigen. METHODOLOGY: A total of 1403 hospital personnel were screened for hepatitis B surface antigen, antibody to hepatitis B surface antigen and antibody to hepatitis B core antigen by radioimmunoassay. Thirty subjects were confirmed to have isolated antibody to hepatitis B core antigen, and 278 subjects lacked all hepatitis B virus markers. Twenty-five of the 30 subjects (group I) and 136 of the 278 subjects (group II) were vaccinated by hepatitis B vaccine at months 0, 1, 6; followed by checking antibody to hepatitis B surface antigen in geometric mean titres at months 1, 2, and 7. RESULTS: The geometric mean titres of antibody to hepatitis B surface antigen were higher in group I than in group II at month 1 (9.1 +/- 8.6 vs. 3.2 +/- 6.0, p < 0.05), and were lower in group I than group II at month 7 (267.2 +/- 17.2 vs. 2315.3 +/- 5.1, p < 0.05). Furthermore, primary response was higher in group II than group I (73.3% vs. 35.7%, p < 0.05), but anamnestic response and non-response were higher in group I than group II (50% vs 26.7%, p = 0.116 with a trend; 14.3% vs. 0%, p < 0.01, respectively). CONCLUSIONS: For subjects with isolated antibody to hepatitis B core antigen, a strategy concerning sequential vaccination followed by checking antibody to hepatitis B surface antigen might be adopted to avoid two extra vaccine dosages and ineffective vaccination.     

Passive/active immunization against hepatitis B

No differences in eventual immune-response rates were found between 325 subjects immunized passively/actively against hepatitis B and a control group of 108 subjects vaccinated only actively. The geometric mean titers of antibodies to hepatitis B surface antigen were nearly identical in controls and in a group of 87 individuals immunized passively/actively with the same vaccine lot. Lower geometric mean titers of antibodies to hepatitis B surface antigen were seen in 238 individuals who were vaccinated passively/actively with a different vaccine lot, a difference that may be explained by a somewhat lower immunogenicity in this particular lot. The mean half-life of hepatitis B immunoglobulin was calculated as 24.8 days, and in approximately 90% of vaccines 300,000 mIU of hepatitis B immunoglobulin provided protection until an active immune response had developed.     

Detection of pre-S/S gene mutants in chronic hepatitis B carriers with concurrent hepatitis B surface antibody and hepatitis B surface antigen

Hepatitis B virus (HBV) with various mutations has been reported. The frequency of the natural occurrence of such variants and whether the heterogeneity of these genomic regions correlates with a specific serologic pattern of concurrent hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were investigated. We analyzed the perS/S regions of HBV in six asymptomatic HBV carriers who were seropositive for both HBsAg and anti-HBs (group A), four hepatocellular carcinoma (HCC) patients with concurrent HBsAg and anti-HBs (group B), and five asymptomatic HBV carriers without anti-HBs as controls (group C). PreS/S regions of HBV-DNA were amplified by polymerase chain reaction (PCR), cloned, and sequenced. The results showed that, in some of the samples, a few deletions and numerous point mutations were presented in preS/S regions. One of the HBV carriers with anti-HBs (group A) and an HCC patient with anti-HBs (group B) had point mutations in the "a" determinant, resulting in conversion from Ile-126 of wild-type to Asn-126. The patients with anti-HBs (groups A and B) had a significantly greater divergence rate of amino acid for the preS/S gene compared with controls. Our results suggested that the HBV mutants observed in the preS/S gene may have led to changes in the immunogenicity of the viral particles, and thus influence the viral behavior and clinical course. Therefore, some HBV patients with concurrent HBsAg and anti-HBs may be HBV S mutants. Received: October 12, 1998 / Accepted: March 26, 1999     

康氏乙肝合剂联合干扰素治疗慢性乙型肝炎41例

目的：研究康氏乙肝合剂联合干扰素治疗慢性乙型肝炎的临床疗效。方法：选择慢性乙型肝炎的病例，应用康氏乙肝合剂联合干扰素进行治疗，以单独应用康氏乙肝合剂和单独应用干扰素治疗的患者进行对比观察，疗程均为6个月。观察患者治疗前后肝功能、乙肝病毒标志物的变化情况。结果：在肝功能复常方面，治疗组优于两对照组，但无统计学差异，P＞0．05：在HBeAg、HBVDNA阴转方面，治疗组明显优于对照组，统计学处理差异有显著性意义，P＜0．01或0．05。结论：康氏乙肝合剂联合干扰素治疗慢性乙型肝炎具有较好疗效，康氏乙肝合剂能明显提高干扰素的抗乙肝病毒效果。     

HBV标志阳性者配偶婚前紧急乙型肝炎免疫的效果

目的:观察快速乙肝疫苗接种方案对HBV标志阳性者配偶婚前紧急乙肝免疫的效果.方法:健康受试者分为2组.组1按快程序(d0,7,14接种),组2按标准程序(mo 0,1,6接种)三角肌内接种20μg CHO乙肝疫苗.在首针接种后1,3,7,12和24 mo分别检测抗-HBs滴度等.结果:组1全程接种完成率(93.3%)显著高于组2(64.6%)(P<0.01).首针接种后1,3 mo组1血清抗-HBs阳转率(86.7%和93.3%)显著高于组2(22.9%和45.2%,P<0.01);7-24 mo各时段2组接近,无显著差异;抗-HBs有效保护率组1(77.8%,84.4%)显著高于组2(4.2%,26.2%,P<0.01);血清抗-HBs几何平均滴度(GMT)组1分别为109.5和112.8 IU/L,显著高于组2(19.6和40.1 IU/L,P<0.01).结论:d 0,7,14接种方案方便、全程接种完成率高、抗-HBs阳转率和GMT峰值高且出现早,对HBV标志阳性者配偶婚前紧急乙肝为理想的免疫方案.     

胸腺肽联合乙肝疫苗治疗干扰素无应答的慢性乙型肝炎疗效观察

观察胸腺肽联合乙肝疫苗对干扰素治疗后无应答的慢性乙型肝炎的疗效。分为胸腺肽加乙肝疫苗联合组４２例，胸腺肽组３０例，乙肝疫苗组２６例，护肝组２５例仅使用一般性保肝药物。疗程为６个月。结果ＨＢｅＡｇ／抗－ＨＢｅ转换率联合组４２．６％，胸腺肽组３０．０％，乙肝疫苗组１５．４％，联合组比后二者具有显著性差异（Ｐ＜０．０５）． ＨＢＶ－ＤＮＡ阴转率联合组 ５２．４％，胸腺肽组３６．７％，乙肝疫苗组 １９．２％，护肝组４．０％（Ｐ＜０．０１）。说明胸腺肽联合乙肝疫苗对干扰素治疗无应答的慢性乙型肝炎可取得较好疗效．     

Group B streptococcal bacteremia in a community teaching hospital

Group B streptococcal bacteremia outside the perinatal setting is not commonly emphasized. This report reviews all episodes of group B streptococcal bacteremia during a four and a half year period in a large community teaching hospital. Fourteen episodes occurred in neonates, four in parturient women, and 28 in other adults. Bacteremic adults were usually elderly with an average age of 68 years. Group B streptococcal bacteremia occurred in adults with various underlying diseases, including diabetes mellitus, liver disease, peripheral vascular disease, and hematologic disease, and in those receiving long-term steroid therapy. Infections causing group B streptococcal bacteremia in adults included decubitus ulcers, pneumonia, endocarditis, cellulitis, arthritis, osteomyelitis, and meningitis. Thirteen of 28 episodes of group B streptococcal bacteremia in adults were hospital-acquired. Overall mortality in adults was 70 percent. Group B streptococcal bacteremia in adults outside of the perinatal setting is associated with significant underlying diseases and has a high mortality.     

Occult hepatitis B

Worldwide, chronic hepatitis B virus (HBV) infection is the primary cause of cirrhosis and hepatocellular carcinoma and is one of the ten leading causes of death. Traditionally, people with chronic HBV infection have been identified with blood tests for HBV antigens and antibodies. Recently, another group of patients with chronic HBV infection has been identified by sensitive, molecular testing for HBV DNA. Members of this group are often referred to as having occult hepatitis B because they are HBV-DNA positive, but hepatitis B surface antigen negative. Occult hepatitis B occurs in a number of clinical settings. In this review, we examine occult hepatitis B in people co-infected with hepatitis C, in whom occult hepatitis B has been associated with advanced fibrosis and diminished response to interferon alpha. Although much more research is needed, existing reports justify a heightened awareness of the medical importance and means of testing for occult hepatitis B.     

Group B streptococcal bacteremia in an adult: a case report from India

The incidence of group B streptococcal bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However, group B still remains an unusual pathogen in adults in developing countries. We report a case of group B streptococcal bacteremia in a non-pregnant adult, the only case reported in our hospital. The organism was only isolated from the blood and responded to specific therapy.     

Group B streptococcus arthritis

Serious infections with group B streptococcus (streptococcus agalactiae) are rare in adults. A 81-year-old patient with cirrhosis who developed a septic arthritis due to this germ, is described. Only eleven cases of group B streptococcal arthritis have been previously reported.     

茶多酚对酒精性肝病核因子-κB活性的调节作用

目的 观察茶多酚对酒精性肝病肝脏核因子-κB(NF-κB)活性调节作用.方法 将22只Wistar大鼠随机分为3组:对照组6只,普通饲料喂养;模型组7只,每天给予大鼠体积分数56%白酒8 ml/kg灌胃,每周递增2ml/kg直至总剂量达每天16ml/kg造模;茶多酚组9只,在模型组的基础上给予茶多酚0.25 g/kg加入白酒中灌胃,7周后处死大鼠.同时培养人正常肝细胞株L02,分为5组:对照组常规培养;模型组:加入0.6%乙醇;预防组:先加入200μg/ml茶多酚培养3 d后再加入0.6%乙醇培养;干预组:同时加入0.6%乙醇和200 μg/ml茶多酚培养;治疗组:先加入0.6%乙醇培养3 d后再加入200μg/ml茶多酚培养.各组细胞均以7d为周期传代,处理4周.实验重复3次.光镜观察肝细胞改变,分光光度计测各组大鼠血清丙二醛及L02细胞活性氧含量,RT-PCR测各组NF-κB和NF-κB抑制因子(I κB)表达;凝胶迁移电泳测各组NF-κB活性变化.结果 NF-κB mRNA表达:对照组为0.53±0.01、模型组为1.15±0.03、茶多酚组为0.58±0.16,模型组明显高于对照组和茶多酚组,F=2431.117,P<0.01,差异有统计学意义.大鼠肝组织NF-κB活性:模型组DNA染色:1410.78±22.19,蛋白染色:1426.08±33.15,对照组DNA染色:419.84±8.32,蛋白染色:419.99±7.06,模型组NF-κB活性比对照组强,P<0.01,差异有统计学意义.茶多酚DNA染色:669.85±41.34,蛋白染色:675.35±18.27,较模型组减弱,P<0.01,差异有统计学意义.L02细胞NF-κB mRNA表达,对照组、模型组、预防组、干预组、治疗组分别0.56±0.01、0.76±0.03,0.60±0.03、0.59±0.01、0.59±0.01,预防组、干预组、治疗组比模型组降低,F=46.353,P<0.01,差异有统计学意义.L02细胞NF-κB活性对照组、模型组、预防组,干预组、治疗组DNA染色分别为:344.42±11.37、849.94±12.45、713.07±11.91,710.79±14.99和693.45±71.69;蛋白染色分别为371.20±13.51、925.96±5.78、758.88±34.65,753.07±76.78和725.77±36.09,预防组、干预组、治疗组比模型组减弱,P<0.01,差异有统计学意义.结论 茶多酚对预防、干预和治疗酒精性肝病均有一定的作用,其作用可能是通过抑制NF-κB的活化实现.     

Group B streptococcal arthritis in adults

Group B beta-hemolytic streptococci (Streptococcus agalactiae) have been a rare cause of septic arthritis in adults. Only 18 cases have been cited in the literature, eight of which were described since 1976. Two additional cases occurring in the last year are described herein. Like other infections caused by group B streptococci, the incidence of septic arthritis due to these organisms appears to be increasing. A review of these 20 cases revealed a history of prior arthritis or trauma to the involved joints in 30 percent, and an additional 30 percent occurred in potentially immunocompromised hosts. Four of the patients had probable oligoarticular group B streptococcal arthritis. Although most deaths occurred in the pre-penicillin era, early recognition and treatment are essential to prevent joint destruction.     

丹酚酸B抗神经细胞凋亡的实验研究

目的观察丹酚酸B对大鼠局灶性脑缺血再灌注时神经细胞凋亡的影响及其可能的分子机制。方法健康雄性Wistar大鼠39只，随机分为3组，即假手术组、模型组和丹酚酸B组；线栓法制备大脑中动脉缺血再灌注模型；分别采用原位细胞凋亡检测技术和免疫组化方法，利用病理图像分析系统测定脑组织细胞凋亡指数（AI）以及bcl-2和bax蛋白表达量，应用半定量逆转录-聚合酶链反应（RT-PCR）检测各组大鼠脑组织bcl-2和bax mRNA相对表达量。结果丹酚酸B组AI较模型组降低，bcl-2表达增加，bax表达减少。结论 丹酚酸B能上调bcl-2表达同时下调bax表达，这可能是其抗神经细胞凋亡的作用机制之一。