Detection of IgA class antibody to hepatitis E virus in serum samples from patients with hepatitis E virus infection

A newly developed assay for IgA class antibody to hepatitis E virus (IgA anti-HEV) was used to study 145 serum samples collected during an outbreak of an enterically transmitted hepatitis that occurred in 3 villages in the lower Shebeli region of Southern Somalia between January, 1988 and November, 1989. A total of 52.4% of the afflicted patients were found positive for IgA anti-HEV, and 73.1% of these were also positive for IgM. Both antibodies disappeared during the convalescence period. Similar results were also seen in serum obtained from sporadic cases of acute waterborne hepatitis in Pakistan. © 1993 Wiley-Liss, Inc.     

Response to immunization against polio after allogeneic marrow transplantation.

Long-term immunity to poliovirus and immunization response to inactivated poliovirus vaccine (IPV) were studied in 55 patients who underwent allogeneic bone marrow transplantation (BMT). Antibodies were determined by neutralization assays. Patients were studied before, at 12 months after BMT and at 12 months after immunization with IPV. Thirty-seven patients were seropositive to all poliovirus types at 12 months after BMT. At least a four-fold decrease in antibody level was recorded between BMT and 12 months later in 55%, 41%, and in 45% of the patients to poliovirus types 1, 2, and 3, respectively. Nineteen patients were immunized with one dose of trivalent IPV. Eight patients (42%), seven patients (36%), and four patients (21%) responded with at least a four-fold antibody titer increase to poliovirus type 1, 2, and 3, respectively. Twenty-nine patients were primarily immunized with three IPV doses. The response rates were 52%, 48% and 48% to poliovirus types 1, 2, and 3, respectively. The immunization responses were similar in patients who did or did not have chronic GVHD. Reimmunization of allogeneic BMT recipients against poliovirus is necessary and a three dose schedule is needed to obtain an adequate immunization response.     

Comparison of class and subclass distribution of antibodies to the hepatitis B core and B e antigens in chronic hepatitis B

The IgG subclasses IgM and IgA1 of antibodies to hepatitis B core antigen (anti-HBc) and hepatitis B e antigen (anti-HBe) were assayed in sera from 82 patients with chronic hepatitis B utilising class/subclass-specific enzyme immunoassays (EIA). The solid-phase was either recombinant hepatitis B core antigen (rHBcAg) or rHBcAg converted to HBeAg by addition of 0.1% SDS with remaining HBcAg antigenicity blocked with monoclonal anti-HBc. Anti-HBc IgG1 was detected in 81 sera at a geometrical mean titre (GMT) of 296,110 x divided by 2.9. Anti-HBc IgG2 was not detected in any of the sera, and anti-HBc IgG3 and IgG4 were detected in 50 and 37 sera, respectively. Anti-HBc IgM and IgA1 were both significantly correlated to the presence of HBV DNA. The predominant antibody to HBeAg was found to be IgG1, being detected in 45 sera with a GMT of 1,035 x divided by 3.3. Anti-HBe IgG2 was not detected in any serum, while anti-HBe IgG3 and IgG4 were found in 8 and 23 sera, respectively. Anti-HBe IgG1, IgG3, and IgG4 were mainly detected in sera positive for anti-HBe in RIA (Abbott). No patient was found positive for anti-HBe IgA1 or IgM. Thus, in contrast to HBcAg, HBeAg does not trigger a persistent IgM and IgA1 response in chronic hepatitis B. The levels of anti-HBe IgG1 and IgG3 were much lower than the levels of anti-HBc IgG1 and IgG3. The presence of anti-HBe IgG4 was significantly correlated to that of anti-HBc IgG4.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute myocarditis. Serologic diagnosis, clinical findings and follow-up

In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a "routine" serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p less than 0.05).     

IgG subclasses in circulating immune complexes with hepatitis B e antigen in chronic hepatitis B

IgG subclasses of antibodies to hepatitis B e antigen (anti-HBe) complexed to HBeAg were determined in 126 HBsAg-positive sera. In the assay HBeAg complexes were bound to microtitre plates by monoclonal anti-HBe and indicated by biotinylated monoclonals to each of the four human IgG subclasses. To evaluate the specificity of the complexed IgG, serum dilutions were also tested for HBeAg and for subclasses of anti-HBe IgG. Two groups of sera were investigated: (i) 64 sera from 64 HBsAg carriers; and (ii) 62 sera from 13 HBeAg-positive patients, of whom five seroconverted to anti-HBe. At least four sera were available from each of these patients. Complexed anti-HBe IgG was detected in 22 of 30 HBeAg-positive, and in three of HBeAg-negative carrier sera. There was no significant association between presence of complexed anti-HBe and levels of HBeAg in these sera. Complexes with multiple subclass composition were found in 13 of the 25 sera with complexed anti-HBe. The most common IgG subclasses found complexed to HBeAg were IgG1 (75%) and IgG4 (67%). A significant association (P less than 0.05) was found between the presence of free and complexed anti-HBe IgG1 in the carrier sera, indicating that the IgG1 antibodies, complexed to HBeAg, were specific for HBeAg. In the five patients who seroconverted to anti-HBe, anti-HBe IgG1 was detected in the HBeAg-positive phase before seroconversion. In the eight patients with persistent HBeAg antigenemia, free anti-HBe IgG1 was detected in only two sera from two different patients. In one patient, complexed anti-HBe IgG1/IgG4 was detected in all serum samples drawn during a period of 111 months. In conclusion, complexed anti-HBe might be detected several years before apparent seroconversion to anti-HBe in conventional anti-HBe assays. In contrast 'free' anti-HBe IgG1, when detected in HBeAg-positive sera with our anti-HBe subclass assay, seemed to signal ensuing apparent seroconversion to anti-HBe.     

Typing of hepatitis B virus genomes by a simplified polymerase chain reaction

The amplification of hepatitis B virus (HBV) DNA sequences in sera for molecular epidemiology of HBV is an important application of the polymerase chain reaction (PCR) with regard to HBV. To simplify the PCR for this purpose, the optimal concentrations of SDS and detergents for carrying out the proteinase K digestion and the amplification of DNA by Taq polymerase were evaluated. It was found that by using 1% deoxycholic acid as detergent for the proteinase K step and diluting the digest 10 times before carrying out the PCR, the phenol extraction of DNA became superfluous. The sensitivity of this procedure equalled that of PCR after phenol extraction on comparable amounts of serum. Four pairs of oligonucleotide primers were compared for amplification of HBV DNA sequences in 48 sera previously subtyped with respect to hepatitis B surface antigen (HBsAg), and in eight sera with different genotypes of HBV, representing the subtypes of HBsAg P1 to P8, defined at an international meeting [Couroucé-Pauty et al.: "HBs Antigen Subtypes." Basel: Karger, 1976]. Two primer pairs, selected from conserved regions in the X and S genes of HBV, gave a positive PCR with sera harbouring all the eight different strains of HBV, resulting in DNA fragments consistent with the sizes deduced from genome sequence data. Two other primer pairs were selected in order to discriminate genotypes with regard to differences between d/y and w/r strains.(ABSTRACT TRUNCATED AT 250 WORDS)     

A solid-phase reverse immunosorbent test for the detection of enterovirus IgM

IgM antibodies against enterovirus antigen were determined by solid-phase reverse immunosorbent test (SPRIST). The 145 sera studied were sampled from cases of enterovirus infections diagnosed by virus isolation and/or complement fixation. In 91 sera from enterovirus infections diagnosed by virus isolation 11/40, 16/28 and 9/23 were positive in SPRIST against ECHO 3 and/or Coxsackie B3 antigen during the first, during the second and third, and after 3 weeks of illness, respectively. The corresponding figures for 85 sera from enterovirus infections diagnosed by a greater than or equal to 4-fold rise in complement fixing (CF) antibody titre against antigen from ECHO 18 and/or Coxsackie B5 antigen were 10/39, 12/20 and 9/26. None out of 22 sera with rheumatoid factor reacted in SPRIST, but 1/92 and 1/154 sera from blood donors was positive in SPRIST with Coxsackie B3 and ECHO 3 antigen, respectively. IgM antibodies against ECHO 3 antigen as determined by SPRIST were found to be cross-reactive over a broad range of enterovirus types and positive results were recorded with sera from infections with Coxsackie A9, B3, B4, B5, ECHO 3, 9, 17, 18, 25 and 30. Heterotypic titres in SPRIST were of the same magnitude (up to 25,600) as recorded against the homotypic virus, 12,800 and 1,600, in two sera from one patient with an ECHO 3 infection. SPRIST was found to be a rapid convenient, cross-reactive and a cheap mu-capture assay for enteroviruses with more than 50% sensitivity during the second and third weeks after onset of illness.     

Genetic diversity of hepatitis B virus strains derived worldwide: genotypes, subgenotypes, and HBsAg subtypes

Sequences of 234 complete genomes and 631 hepatitis B surface antigen genes were used to assess the worldwide diversity of hepatitis B virus (HBV). Apart from the described two subgenotypes each for A and F, also B, C, and D divided into four subgenotypes each in the analysis of complete genomes supported by significant bootstrap values. The subgenotypes of B and C differed in their geographical distribution, with B1 dominating in Japan, B2 in China and Vietnam, B3 confined to Indonesia, and B4 confined to Vietnam, all strains specifying subtype ayw1. Subgenotype C1 was common in Japan, Korea, and China; C2 in China, South-East Asia, and Bangladesh, and C3 in the Oceania comprising strains specifying adrq-, and C4 specifying ayw3 is encountered in Aborigines from Australia. This pattern of defined geographical distribution was less evident for D1-D4, where the subgenotypes were widely spread in Europe, Africa, and Asia, possibly due to their divergence having occurred a longer time ago than for genotypes B and C, with D4 being the first split and still the dominating subgenotype of D in the Oceania. The genetic diversity of HBV and the geographical distribution of its subgenotypes provide a tool to reconstruct the evolutionary history of HBV and may help to complement genetic data in the understanding of the evolution and past migrations of man.     

Genetic characterization of hepatitis C virus strains in Estonia: fluctuations in the predominating subtype with time

During the last decade, there has been a dramatic increase in intravenous drug use in young adults in Estonia with an increased incidence of both hepatitis B and C as a consequence. Since genetic data are limited regarding hepatitis C virus (HCV) strains in Estonia, the aim of the study was to characterize HCV strains in different risk groups to determine their relatedness to strains from other geographical regions. Three hundred fifty-three anti-HCV positive sera collected during 1994-2004 from hospitalized patients, blood donors and health care workers were used as source of HCV RNA. Two hundred nine (59%) of the sera were positive for HCV RNA by PCR directed to the 5'-UTR region. For 174 strains the HCV subtype was determined by analyses of the NS5B and/or the 5'UTR-core regions. 1b (71%) was the most common subtype followed by 3a (24%), 2c (2%), 1a (1%), and 2a (1%). The 1b and 3a strains were similar to strains from other regions of the former USSR. Within genotype 1b there were several HCV lineages. However, for 3a there seemed to be two separate introductions into Estonia. There was a relative shift from subtype 1b to 3a in 1999-2000 with a further replacement of 3a with 1b in intravenous drug users in 2001 and onwards (P < 0.05). However, both subtypes were found to co-circulate in the community independent of risk factors. One patient was infected with the 2k/1b recombinant presumed to originate from St. Petersburg being the first isolate of this recombinant recovered outside Russia.