1/13. Molecular evolutionary analysis of the complete nucleotide sequence of hepatitis B virus (HBV) in a case of HBV infection acquired through a needlestick accident.To elucidate needlestick transmission of hepatitis b virus (HBV), strains isolated from 1 physician who acquired HBV infection through a needlestick accident and 3 patients with chronic hepatitis B (donor patients A, B, and C) were tested using molecular evolutionary analysis based on full-length HBV genomic sequences. Nucleotide sequences of these isolates were aligned with 55 previously reported full-length genomic sequences. Genetic distances were estimated using the 6-parameter method, and phylogenetic trees were constructed using the neighbor-joining method. Strains isolated from patient A and the recipient pair were clustered within a closer range of evolutionary distances than were strains recovered from the recipient pair and patients B and C. Furthermore, strains from patient A and the recipient were also clustered on the S gene sequences of HBV. These results demonstrated that patient A alone was the source of direct transmission to the recipient. This approach can be used to investigate the transmission route of HBV.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Fetal meconium peritonitis in the infant of a woman with fulminant hepatitis B. A case report.BACKGROUND: Simultaneous fulminant maternal hepatitis B infection and fetal meconium peritonitis has never been reported before in the English-language literature. CASE REPORT: Fetal meconium peritonitis was detected at 32 weeks' gestation in a 21-year-old woman suffering from fulminant hepatitis. Fulminant hepatitis B was confirmed by clinical observation and serologic examination results. The course was also complicated with preterm labor. The fetus was diagnosed with meconium peritonitis prenatally. Because of failed tocolytic treatment, the fetus was delivered vaginally. Both the mother and fetus received intensive care, and the mother recovered. In contrast, the fetus's course worsened due to progressive abdominal distension. Although exploratory laparotomy was attempted, the operation was not successful. The infant died five days after birth. CONCLUSION: Recognition of the predisposing factors in fetal meconium peritonitis and immediate referral to a tertiary medical center, where specialists are available, could help physicians determine an accurate diagnosis and might improve prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Treatment of hepatitis b virus-related polyarteritis nodosa: two case reports and a review of the literature.A substantial number of cases of polyarteritis nodosa (PAN) are related to hepatitis b virus (HBV) infection. Different treatment strategies are reported in the literature. The aim of this study was to review 15 years of literature (1988-2002) to determine the optimal treatment for HBV-related PAN at present, and to discuss the indications and mechanism of action of corticosteroids in HBV-related PAN, as many physicians are reluctant to use these in the presence of HBV infection. The first patient stopped his initial treatment, relapsed and died of cerebral infarction. The second case illustrates the favorable outcome with the standard treatment: corticosteroids, lamivudine and plasma exchanges. If adequate follow-up is possible, antiviral agents as well as corticosteroids are indicated in HBV-related PAN. Corticosteroids diminish inflammation and corticosteroid withdrawal induces an alanine aminotransferase (ALT) rebound in patients with a low baseline ALT level. antiviral agents are essential, as they reduce the production of HBV antigens and help to achieve hepatitis B early antigen (HBeAg) seroconversion. Plasma exchanges reduce the level of circulating immune complexes and are included in the treatment protocol of all recent studies. However, their effect has not been evaluated in controlled trials. We concluded that if adequate follow-up is possible, antiviral agents as well as corticosteroids are indicated in HBV-related PAN.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Hepatic failure due to fibrosing cholestatic hepatitis in a patient with pre-surface mutant hepatitis b virus and mixed connective tissue disease treated with prednisolone and chloroquine.Fibrosing cholestatic hepatitis (FCH) is a severe variant of hepatitis B infection that has until recently been described almost exclusively in the setting of organ transplantation and hiv infection. This case report describes a patient with pre-surface (pre-S) mutant hepatitis b virus (HBV) infection who developed a fatal form of FCH after high dose prednisolone for mixed connective tissue disease (MCTD). The role of corticosteroids and pre-S viral mutation in the pathogenesis of the disease is discussed, and the importance of early diagnosis is emphasised. This report alerts the physician to the need for close monitoring of LFTs and HBV dna of hepatitis B carriers during immunosuppressive therapy regardless of the indication. As in the transplantation setting, viral dna levels should be kept to undetectable if viral replication or recurrence is to be prevented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. Living related liver transplantation for acute fulminant hepatitis B: experience from two possible hyper-acute cases.Fulminant hepatic failure, which is represented by fulminant hepatitis, is fatal in most cases unless prompt liver transplantation is performed. Even if liver transplantation is performed, irreversible neurological damage is often complicated. In this case report, we describe two cases of fulminant hepatitis induced by acute hepatitis b virus infection, both of which were successfully rescued by living related liver transplantation without significant complications. The case 1 was a 45-year-old Japanese male. He complained general malaise and anorexia. His local physician diagnosed him as acute hepatitis B, and referred to our hospital. Due to severe coagulopathy, plasma exchange was performed 3 times. However, his hepatic coma progressed rapidly along with rapid decrease of both his direct/indirect bilirubin (D/T) ratio and serum blood urea nitrogen (BUN) levels. Living related liver transplantation was performed under the diagnosis of acute fulminant hepatitis B. The case 2 was a 34-year-old Japanese male. His complaints were fever and skin rush. He was referred to our hospital under the diagnosis of acute hepatitis B. On the second day after admission, he developed grade II hepatic coma, which deteriorated into grade III in spite of intensive therapy including plasma exchange. He also demonstrated rapid decrease of both D/T ratio and serum BUN level. Living related liver transplantation was performed on the next day. Both cases recovered without any evidence of neurological sequelae. In general, it is extremely difficult to rescue fulminant hepatitis by conservative treatments, particularly in cases with rapid progression. Although emergency liver transplantation may be an only option to rescue in such a case, living related liver transplantation has an advantage in view of urgent organ donation over cadeveric transplantation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. pemphigus following hepatitis B vaccination--coincidence or causality?pemphigus is an autoimmune blistering disease caused by autoantibodies against epithelial intercellular components. Its etiology is unknown, and neoplasms, antecedent infections or medications are considered possible triggering factors for the disease in some cases. We describe the first case of pemphigus following a hepatitis b virus vaccination. We suggest that in some cases vaccination may be the triggering factor for pemphigus in genetically predisposed individuals and physicians should be aware of this possible association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. Fatal hepatic decompensation in a bone marrow transplant recipient with HBV-related cirrhosis following lamivudine withdrawal.lamivudine is a nucleoside analogue with a potent antiviral activity used as prophylaxis against hepatitis b virus reactivation in patients with chronic HBV infection receiving chemotherapy. No standard guidelines exist, however, for the duration of lamivudine treatment. We report a clinical case of a 56-year-old patient with HBeAg-negative cirrhosis who developed a multiple myeloma. He was treated with lamivudine for 1 year while receiving chemotherapy and a subsequent bone marrow transplant. Complete remission from multiple myeloma was achieved. Four months after lamivudine was withdrawn, he experienced HBV reactivation with jaundice, though no YMDD mutations were detected. The patient rapidly developed fatal decompensation with septicemia and renal failure. In conclusion, this case shows that physicians should avoid discontinuing nucleoside therapy in patients with HBV infection who undergo immunosuppression for concomitant neoplastic conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Passive transfer of hiv antibody by hepatitis B immune globulin.Two newborns of mothers carrying hepatitis B and at high risk for human immunodeficiency virus (hiv) infection developed hiv-positive test results by enzyme-linked immunosorbent assay and Western blot tests after birth. Both had been administered hepatitis B immune globulin within 48 hours of birth. Serological tests detected hiv antibody as long as 17 days after birth. Both newborns had received lots of hepatitis B immune globulin containing antibody to hiv. While hepatitis B immune globulin cannot transmit hiv infection to recipients, physicians should be aware that administration of older lots of this preparation may result in transiently positive tests for hiv antibody in the recipients. Lots manufactured from screened plasma do not contain antibody to hiv.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Multiple exposure of hospital employees to hepatitis B. Five case studies.Five occurrences of multiple exposure of hospital employees to presumed cases of hepatitis B were documented in urban hospitals in arizona in 1982. On each occasion employees were exposed before the patient's condition was known to be potentially infectious. In four hospitals, the exposed employees received hepatitis B immune globulin, some with no consideration for the actual extent of exposure; in the fifth hospital, hepatitis B vaccine was given. Procedures followed in the hospitals indicated problems in understanding the potential communicability of hepatitis B, transferring information between hospital units, using hospital charts to determine diagnosis, and obtaining serologic confirmation of hepatitis B. Costs to the hospital for attempted postexposure prophylaxis in these occurrences ranged from $982 to $7,998. Recommendations for overcoming the identified problems include development and dissemination of detailed procedures within hospitals, education for physicians and infection-control personnel regarding proper postexposure prophylaxis, and immunization of high-risk employees with hepatitis B vaccine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Conflicting duties to patients: the case of a sexually active hepatitis B carrier.A hemodialysis nurse who is a hepatitis B carrier insists on continuing dialysis nursing and sexual relationships but refuses to inform her lovers. The implications of her stance pose an ethical problem for her physician: whether to keep confidentiality, whereby others may be exposed to her hepatitis, or to breach confidentiality in order to limit her patient care activities and to notify her lovers. Pertinent medical and epidemiologic facts, legal opinions, and ethical considerations are discussed. We propose that the physician's responsibility to keep in immediate patient's confidences outweighs the responsibility to protect others unless there is sound evidence for very certain, severe harm to specific others.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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