Serological and histological follow up of chronic hepatitis B infection.

In order to study the clinical, serological, and morphological evolution of chronic hepatitis B virus infection in childhood, a prospective study has been carried out. A total of 90 children with a chronic infection were followed up for a mean (SD) of 3 (1.8) years. At the beginning of the study, 61 children were asymptomatic and 77 were household contacts of chronic carriers. Serologically 77 were hepatitis B e antigen (HBeAg) positive and 71 of them were positive to hepatitis B virus DNA. The mean alanine aminotransferase activities were higher among HBeAg positive patients than in antihepatitis B e (anti-HBe) positive ones. The most severe histological damage was also found among HBeAg positive patients. The annual seroconversion rate was 14%. A significant increase in the alanine aminotransferase activity was observed 13 (5.6) months before appearance of anti-HBe in the 85% of cases. Among anti-HBe positive patients, the alanine aminotransferase activities were normal in all except three (19%), two of whom had intrahepatic delta antigen. An increase in the histological activity was observed among patients who maintained HBeAg presence while an amelioration of liver damage was observed in anti-HBe carriers.     

病毒性心肌炎患儿微小病毒B19感染的研究

目的探讨病毒性心肌炎患儿微小病毒B19（HPV B19）感染的状况及其相关性。方法应用巢式聚合酶链反应法对60例病毒性心肌炎患儿（观察组）及30例健康体检儿童（对照组）血浆中微小病毒B19-DNA进行检测,并对观察组中HPV B19-DNA检测阳性与阴性两组中血CK、CK-MB及心功能指标进行比较。结果观察组B19-DNA检测阳性率为26．7％（16／60例）,对照组B19-DNA检测均为阴性,两组比较差异有显著性（P〈0．01）。观察组中HPV B19-DNA检测阳性与阴性的两组中血CK、CK—MB值差异无显著性（P〉0．05）。心功能指标LVSF比较差异有显著性（P〈0．01）,SV比较差异亦有显著性（P〈0．05）。结论小儿病毒性心肌炎与HPV B19感染有关,HPV B19可能是小儿病毒性心肌炎主要病原之一;HPV B19感染所致小儿病毒性心肌炎的心功能改变中左室功能受累程度较重。     

81例不同疾病患儿人细小病毒B19特异性抗体检测

目的　调查细小病毒B19(humanparvovirusB19,HPVB19)在新疆地区不同疾病患儿中的感染情 况。方法　用ELISA法对2001年8月至2002年12月该院儿科81例住院患儿和来自儿保体检门诊16例健康儿 童(对照组)的血清标本进行了B19 IgM和B19 IgG检测。结果　B19 IgM阳性检出率在特发性血小板减少性紫癜 和再生障碍性贫血最高,分别为44.4%(4/9)和41.2%(7/17)。与对照组相比较差异有显著性(P<0.05),其它 疾病组与对照组相比差异无显著性(P>0.05)。而B19 IgG的检测结果,疾病组与对照组相比差异无显著性 (P>0.05)。结论　新疆地区特发性血小板减少性紫癜和再生障碍性贫血患儿中有较高的HBVB19感染率。特 发性血小板减少性紫癜和再生障碍性贫血与B19感染关系较为密切。     

Suspected SIDS and diagnosis of myocarditis

BACKGROUND: During the last years immunohistochemical techniques have improved the diagnosis of myocarditis using specific markers for quantification of leucocytes and characterization of T-lymphocytes together with the definition of MHC class II Antigens (HLA-DP, DQ, DR), known to be enhanced in cases of myocarditis. These techniques allow the diagnosis of myocarditis in an early stage of the inflammatory process in contrast to the conventional diagnostic with hematoxylin-eosin. MATERIALS AND METHODS: 20 autopsy cases were examined in a retrospective study with conventional histological and immunohistological methods. After routine investigations including toxicological and histological examination of internal organs all cases were considered as cases of Sudden Infant Death Syndrome (SIDS). RESULTS: Increased number of LCA-positive leucocytes and CD-3-positive T-lymphocytes together with enhanced expression of inflammatory marker leads to the diagnosis of a lymphomonocytic myocarditis in three cases, in one case myocarditis could be diagnosed by conventional hematoxylin-eosin staining. In one of these four cases of myocarditis a positive immunohistochemical reaction was found using a new antibody against enteroviruses. CONCLUSION: Immunohistochemical techniques improve diagnosis of myocarditis in cases of suspected sudden infant death syndrome. Further studies using immunohistochemical inflammatory markers to control the incidence of acute myocarditis are necessary.     

Efficacy of interferon-α2b treatment in children with chronic hepatitis B who have previously undergone therapy for cancer

BACKGROUND: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)-alpha2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer. METHODS: Nine children had acute leukemias and the other three children had solid tumors. The mean (+/-SD) age of the children was 8.4+/-3.8 years (range 4-16 years). All cases were hepatitis B virus (HBV)-DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti-HBe positive (mutant strain). Four cases were anti-delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon-alpha2b was given at a dose of 5 MU/m2 three times a week, subcutaneously, for 12 months. RESULTS: Elimination of serum HBV-DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV-DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti-HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P = 0.0039). CONCLUSIONS: In conclusion, a 12 month course of IFN-alpha2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer.     

Hepatocellular carcinoma in Nigerian children

Childhood primary hepatocellular carcinoma is rare and accounts for less than 1% of all abdominal malignancies in children < or = 14 years of age. A review of the records of the Cancer Registry, Ibadan, Nigeria covering the period 1960-1995 was scrutinised and 19 cases of hepatocellular carcinoma (HCC) were registered, accounting for 0.49% of all abdominal malignancies over the period of review. The mean (SD) age at presentation was 10.4 (3.0) years and the duration of illness before presentation was short. All the children presented late with abdominal distension and hepatomegaly as the major clinical features. Weight loss was evident in 80% of cases, splenomegaly occurred in 50% and jaundice was present in a third of them. The prognosis was poor; all the cases died within 2 weeks of presentation in hospital. There was evidence to suggest an association between hepatitis B virus infection and HCC in all the liver tissue stained by Shikata-Orcein. This review shows that HCC, though uncommon, is important enough to be considered a possible cause of unexplained hepatomegaly in Nigerian children and that hepatitis B virus is an important aetiological factor. Though the number of cases under review is small, universal early vaccination against hepatitis B virus is necessary in Nigerian children in order to reduce the burden of chronic hepatitis B disease and hepatocellular carcinoma.     

Natural history of hepatitis B in perinatally infected carriers

OBJECTIVES: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally infected hepatitis B carriers. METHODS: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were Afro-Caribbean, and five were white. Median follow up was 10.24 (range 2.02-20.16) years. RESULTS: Only three of the children followed up had cleared hepatitis B surface antigen during this period, and 30% of the children had seroconverted to anti-HBe. Seroconversions to anti-HBe were observed in Asian (18/50) and white (4/5) children, but not in Oriental or Afro-Caribbean children. More girls (40%) than boys (23%) had seroconverted, but the difference was not significant. All children were asymptomatic with normal physical examination, growth, and development. Almost half (48%) of the hepatitis B e antigen (HBeAg) positive children had normal hepatic transaminases and liver function. Thirty five liver biopsies were performed in children with active virus replication (HBeAg or hepatitis B virus DNA positive) who were being considered for antiviral treatment as part of a clinical trial and were scored using the Ishak method. Two thirds (62%) of the children had mild hepatitis, 60% had mild fibrosis, and 18% had moderate to severe fibrosis. There was a weak correlation between histological evidence of hepatitis and hepatic transaminase activity, implying that biochemical monitoring of hepatic disease activity may be ineffective. CONCLUSIONS: These asymptomatic hepatitis B virus carrier children remain infectious in the medium to long term with notable liver pathology. They should receive antiviral treatment to reduce infectivity and to prevent further progression of liver disease. Hepatic transaminases alone are not a reliable marker of liver pathology, and liver histology is essential before consideration for antiviral treatment.     

Enteroviral myocarditis in neonates

Enteroviruses are a leading cause of viral infections in children. While most enteroviral infections are mild and self‐limiting, severe disease such as a viral sepsis syndrome, myocarditis, hepatitis and meningoencephalitis may occur. We present two cases of neonatal enteroviral myocarditis. Cardiorespiratory failure occurred in both cases, and severe shock refractory to conventional treatment required support with extracorporeal membrane oxygenation (ECMO). One child with coxsackievirus B3 myocarditis failed to recover and died after 3 weeks on ECMO, while one child could be decannulated successfully after 9 days of ECMO and recovered completely subsequently. In conclusion, neonatal myocarditis has a very high mortality, and ECMO should be considered early in neonates with rapid clinical and echocardiographic deterioration despite adequate inotropic support.     

Cardiac troponin‐I as a screening tool for myocarditis in children hospitalized for viral infection

Aim: The incidence of myocarditis in children is uncertain because patients with minor symptoms can remain undiagnosed. We hypothesized that screening all children who are hospitalized for an acute infection with troponin‐I (TnI) would reveal myocarditis cases and performed a prospective screening study. Methods: Between October 2005 and July 2008, a blood sample for TnI measurement was taken every time a sample for C‐reactive protein measurement was drawn. If TnI value was above the screening limit (0.06 μg/L), electrocardiogram (ECG) and cardiac ultrasound were performed. TnI measurements were repeated until at normal level. Results: Altogether, 1009 children were screened during the 33 months. TnI was above the screening limit (0.06 μg/L) in six children. None of them had any signs of myocarditis in ECG or cardiac ultrasound. Five of those six children were younger than 30 days. All had a respiratory infection as a cause for hospitalization, three of which was caused by RSV. In four children, all younger than 30 days, TnI levels remained high (>0.37 μg/L) for two months, but decreased after that to normal levels. Conclusion: The incidence of myocarditis during viral infections is low and a routine TnI screening for asymptomatic myocarditis is not useful.     

儿童再生障碍性贫血病毒病因学的初步研究

用ＰＣＲ和ＥＬＩＳＡ技术对３８例ＡＡ患儿的外周血进行了１９、ＥＢＶ、ＣＭＶ及ＨＢＶ系列检测。     

Acute human parvovirus B-19 infection in hospitalized children: A serologic and molecular survey

BACKGROUND: The extent and clinical manifestations of acute human parvovirus B19 (B19) infection were assessed in previously healthy hospitalized children admitted with clinical syndromes potentially associated the virus. PATIENTS AND METHODS: The study was prospective and was conducted between October 2002 and August 2004 in the pediatric departments of 3 hospitals in Israel. The survey included previously healthy children who were hospitalized with 1 or more of the following acute diseases: acute nonallergic exanthema, fever for >1 week, aplastic anemia or pancytopenia, acute nonbacterial arthropathy, immune thrombocytopenic purpura (ITP), Henoch-Sch?nlein purpura (HSP) and aseptic meningitis. A control group of children with a proven, non-B19 infection was also studied. Serum samples obtained from each child on admission were tested for B19 DNA by real-time PCR and B19 IgM by ELISA. Acute B19 infection was defined by the following criteria: positive serum B19-DNA and/or B19 IgM, negative serum B19 IgG, and no other proven infection. RESULTS: Overall, 167 children were included in the study. The mean age was 5.5 +/- 4.6 years (range, 0.5-17), males and females equally divided. Acute B19 infection was demonstrated in 12.6% (n = 21) of the children. Both tests were performed in 19 children and were positive in 10 (53%). In 7 and 2 children, only B19-DNA or B19 IgM, respectively, was positive. Acute B19 infection was documented in 27% (10/39) of children who presented with a variety of acute exanthema diseases; 9% (5/57) of children with acute arthropathy (all 5 had transient synovitis); 10% (2/21) of children with fever >1 week, both presented as mononucleosis syndrome; and in 44% (4/9) of children with transient pancytopenia or aplastic anemia. No acute B19 infection was demonstrated in 15 children with ITP, 9 with HSP, and 6 with aseptic meningitis and among 70 children in the control group. By logistic regression analysis, manifestations significantly associated with acute B19 infection were exanthema (OR 2.9; 95% CI = 1.1-7.5), anemia (OR 6.35; 95% CI = 2.2-18.2) and leucopenia (OR 4.14; 95% CI =1.2-14.2). CONCLUSIONS: Acute B19 infection was documented among 12.6% of children hospitalized with clinical syndrome potentially associated with the virus. Clinical and laboratory features associated with acute B19 infection were exanthema, anemia and leucopenia. Determination of both serum B19-DNA and serum B19 IgM should be performed for the accurate diagnosis of acute B19 infection.     

Parvovirus B19 infection as a cause of anemia in pediatric acute lymphoblastic leukemia patients during maintenance chemotherapy

PURPOSE: Persistent parvovirus B19 tends to occur in immunocom-promised patients and manifests as pure red cell aplasia and chronic anemia. This study aimed to detect the contribution of parvovirus B19 infection to anemia in children with acute lymphoblastic leukemia (ALL) receiving chemotherapy. PATIENTS AND METHODS: Two groups of ALL patients were studied during maintenance chemotherapy: 50 patients with persistent anemia (ie, extending for >2 weeks) and 34 patients without anemia (controls). Serum parvovirus B19 IgG and IgM were investigated by an enzyme-linked immunosorbent assay, and the virus DNA was sought in bone marrow cells by a nested polymerase chain reaction assay. RESULTS: Parvovirus B19 DNA was detected in 11 of the 50 (22%) ALL children with anemia, 4 of whom were also IgM positive. In addition, IgM positivity was observed in nine (18%) other children who were negative for parvovirus B19 DNA. The children without anemia were found to be significantly different than those with anemia in terms of parvovirus B19 DNA positivity and DNA + IgM positivity (P = 0.03 and 0.01, respectively). IgG was found to be positive in a total of 19 (38%) cases, with B19 DNA present in 6 of them. CONCLUSIONS: These findings indicate the high frequency of parvovirus B19 in anemia in children with ALL and the importance of testing for its DNA in the bone marrow cells together with IgG and IgM antibodies in the serum of immunocompromised patients. It is important to consider parvovirus B19 infections as a cause of anemia and suppressed erythropoiesis in children with ALL who are receiving ongoing treatment.     

PCR测定血中柯萨奇病毒B RNA对确定病毒性心肌炎病原诊断的价值

目的 研究PCR技术测血中柯萨奇病毒B RNA(CVB-RNA)对病毒性心肌炎病毒病原诊断的价值及其阳性率与病程的关系。方法 对75只小鼠腹腔注射CVB3病毒后,做心肌病理检查和检测血液中CVB-RNA。对145例临床诊断心肌炎患儿测定血中CVB-RNA,对比病毒性心肌炎患儿病程1个月以内104例和病程1个月以上41例的阳性率。结果 75只小鼠病理检查结果有心肌炎改变占85.3%,CVB-RNA阳性率为53.3%。145例患儿CVB-RNA阳性率为46.2%。PCR CVB-RNA病程1个月以内阳性率为56.7%,显著高于病程1个月以上(阳性率为26.8%)。结论 用PCR技术检测病毒性心肌炎血中CVB-RNA的敏感性与可靠性均较高,病程1个月以内阳性率高于1个月以上。     

PCR测定血中柯萨奇病毒B RNA对确定病毒性心肌炎病原诊断的价值

目的 研究PCR技术测血中柯萨奇病毒B RNA(CVB-RNA)对病毒性心肌炎病毒病原诊断的价值及其阳性率与病程的关系。方法 对75只小鼠腹腔注射CVB3病毒后,做心肌病理检查和检测血液中CVB-RNA。对145例临床诊断心肌炎患儿测定血中CVB-RNA,对比病毒性心肌炎患儿病程1个月以内104例和病程1个月以上41例的阳性率。结果 75只小鼠病理检查结果有心肌炎改变占85.3%,CVB-RNA阳性率为53.3%。145例患儿CVB-RNA阳性率为46.2%。PCR CVB-RNA病程1个月以内阳性率为56.7%,显著高于病程1个月以上(阳性率为26.8%)。结论 用PCR技术检测病毒性心肌炎血中CVB-RNA的敏感性与可靠性均较高,病程1个月以内阳性率高于1个月以上。     

Sickle cell disease: a clinical and histopathologic study of the liver in living children

PURPOSE: To study hepatic lesions in living children with sickle cell disease. Although such lesions are well known, the possibility of chronic persistent damage to the parenchyma resulting from the disease itself or iron overload is controversial. PATIENTS AND METHODS: Sixteen children with sickle cell disease aged 15 months to 18 years were prospectively investigated out of 741 patients younger than 20 years registered at Hemominas Foundation, Brazil. Inclusion criteria for biopsy were as follows: five had positive anti-hepatitis C virus (HCV) antibody, two had positive hepatitis B virus (HBV) surface antigen and persistently increased levels of aminotransferases, and nine underwent biopsy during abdominal surgery. RESULTS: Children with B or C hepatitis were significantly older than the others and also had increased levels of both alanine and aspartate aminotransferases. Lobular architecture was preserved in all nonviral cases; mild to moderate sinusoidal dilatation was present in eight, hepatocellular regenerative activity in six, and focal necrosis and corresponding mild inflammatory infiltrate in three. No fibrosis or bile duct damage was observed. Mild to severe hemosiderosis was present in all children except one. The degree of iron overload was clearly associated with the number of previous blood transfusions. All five children with HCV had chronic hepatitis. One of the children with HBV had incomplete and the other had definite cirrhosis. CONCLUSIONS: These data indicate that chronic hepatic lesions in children with sickle cell disease may be caused by viral damage. Patients without evidence for viral etiology had reversible vascular lesions. Follow-up studies would be necessary to confirm this hypothesis but are precluded for ethical reasons. Hemosiderosis was not associated with fibrosis in any nonviral cases, but a larger number of patients would be necessary to establish valid conclusions.     

北京地区住院急性呼吸道感染患儿的病毒病原检测分析

目的了解北京地区住院急性呼吸道感染(ARI)患儿的病毒病原情况。方法取1260例年龄14岁以下住院ARI患儿的鼻咽深部分泌物,用间接免疫荧光及病毒分离法检测呼吸道合胞病毒(RSV)、流感病毒A、B型、副流感病毒1、2、3型及腺病毒等7种常见呼吸道病毒。用逆转录聚合酶链反应(RT-PCR)法对其中490例患儿标本进行肠道病毒(EV)检测。结果1.ARI1260例中,43.33%检测到了病毒病原,7种常见呼吸道病毒检出率36.19%,RSV阳性率最高(23.97%),以冬春季为著,88.08%的RSV阳性为3岁以下小儿。2.EV阳性率16.33%。3.19例存在2种病毒混合感染,均出现在冬春季,16例为RSV并EV感染。4.入选的510例急性呼气性喘息患儿中,3岁以下RSV阳性率最高(43.20%),3岁以上EV阳性率最高(36.11%)。结论1.RSV是北京地区冬春季婴幼儿ARI的主要病原。2.冬春季EV可并RSV等其他呼吸道病毒感染。3.RSV及EV是引起小儿急性喘息性疾病的主要病毒病原。     

用PCR检测微小病毒B19对儿童急性白血病发病的影响

应用１％ＮＰ－４０处理骨髓涂片，套式ＰＣＲ扩增技术对２８例儿童急性白血病者进行微小病毒Ｂ１９ＤＮＡ检测，其中ＡＬＬ１５例，ＡＭＬ１３例。并对阳性者同时采用免疫表型检测，结果显示５例阳性，且均为ＡＬＬ患者。     

Role of parvovirus B19 infection in childhood idiopathic thrombocytopenic purpura

Although parvovirus B19 exhibits a strong tissue-tropism for erythroid progenitor cells leading to anaemia, several case reports indicate that parvovirus B19 infection may also cause the development of thrombocytopenia. Despite recent studies, the frequency and clinical relevance of this association have remained questionable. Consequently, and in view of the paucity of evidence regarding a viral aetiology for idiopathic thrombocytopenic purpura (ITP), we examined the role of parvovirus B19 in 47 children with newly diagnosed ITP. Specific viral DNA indicating a current or recent parvovirus B19 infection was demonstrated in 6 of 47 patients (13%) employing the polymerase chain reaction technique. Our study suggests that children with ITP and associated parvovirus B19 infection are characterized by acute onset of profound thrombocytopenia. Among the parvovirus B19 positive children, duration of disease was brief in three children treated with immunoglobulin but chronic in the remaining three patients given high-dose steroids. Prospective studies are needed to confirm these initial observations. This virus should be considered as a possible aetiologic agent in some children with ITP.     

幼年类风湿性关节炎与人细小病毒B19感染的关系及其临床特征

目的 探讨幼年类风湿性关节炎（ＪＲＡ）与人细小病毒Ｂ１９（Ｂ１９）感染的关系及其临床特征。方法 采用巢式ＰＣＲ方法对３０例ＪＢＡ患儿血清、２６例ＪＲＡ患儿骨髓、４例ＪＲＡ患儿关节液标本进行Ｂ１９－ＤＮＡ检测。结果 ⑴３０例ＪＲＡ患儿血清Ｂ１９－ＤＮＡ阳性１２例（４０％）,１０例对照组阳性１例（１／１０）,两组差异无显著性（Ｐ〉０．０１）。⑵２６例骨髓Ｂ１９－ＤＮＡ阳性１２例（４６％）,２５例对照组     

小儿急性间质性肺炎三例并文献复习

目的 提高对小儿急性间质性肺炎的认识.方法 3例急性间质性肺炎均为首都医科大学附属北京儿童医院2008年3月至2009年11月收治的病例,女1例(例1,2岁),男2例(例2,10岁;例3,1岁4个月).分析其病史、发病后临床特点、血气、肺功能、肺高分辨CT、病原学、自身抗体和抗中性粒细胞胞浆抗体的测定以及肺组织病理.结...