Chlamydia trachomatis in the ascitic fluid of patients with chronic liver disease

Several recent reports suggest that Chlamydia trachomatis causes peritonitis and perihepatitis in young women. We studied nine patients with chronic liver disease and ascites to determine a possible role for C. trachomatis in the bacterial peritonitis of cirrhotic patients. C. trachomatis was isolated and identified from the peritoneal fluid in three of these patients. In these patients, the peritoneal fluid was a transudate that contained fewer than 250 white blood cells/mm3, with fewer than 10% neutrophils, except when a bacterial organism other than C. trachomatis was also present. Two of these patients developed peritonitis that was associated with other bacterial organisms. Unless specific tests for C. trachomatis was performed, its presence will not be detected, and the peritoneal fluid cell count will not suggest bacterial infection.

Detection of hepatitis B virus-specific DNA in the genomes of human hepatocellular carcinoma and liver cirrhosis tissues

Hepatitis B virus-related DNA was detected in the chromosomal DNA of three out of seven hepatocellular carcinomas and two out of five cirrhosis samples examined, by means of the blot-hybridization technique, described by Southern (1975). The integration patterns were not identical but some similarities raise the question of whether there are some preferred sites of viral integration.

[Primary liver carcinoma and markers of virus of type B hepatitis (author's transl)]

Association of primary liver carcinoma with virus of type B hepatitis has been demonstrated around the world, especially in African and Asian countries where high titles for surface antigen of B hepatitis (HBsAg) have been found. Presence of viral markers of B hepatitis has been studied in a group of 34 patients with primary liver carcinoma, in 139 cirrhotic patients, and in 100 normal individuals. Positive titles of HBsAg or of antibodies against "core" antigen (anti-HBc) without evidence of antibodies against HBsAg (anti-HBs) were considered as positive markers for virus B infection. Percentages of positive markers in the series studied were as follows: 52% in the cases of primary liver carcinoma, 38% in the cirrhotic cases, and 5% in the control subjects. There is a significant difference in relation to the incidence of viral markers between patients with liver carcinoma and normal controls. A possible role of the virus of B hepatitis in the pathogenesis of primary liver carcinoma could be suggested on the basis of these results.

Mutagenic urine in cirrhosis

Multiple samples of daytime urine from 5 non-smoking patients with cirrhosis, 12 healthy smokers, and 15 healthy non-smokers were collected and analysed for mutagens by the Ames salmonella microsome assay. All 12 samples collected from the 5 cirrhotic patients were mutagenic. 16 of the 17 samples collected from the smokers were mutagenic, while only 2 of the 24 samples from the non-smokers were mutagenic. The discovery of mutagens in the urine of non-smoking patients with cirrhosis is new.

[Septicaemia and spontaneous peritonitis in the cirrhotic (author's transl)]

During a five year period 36 episodes of septicaemia in 32 patients with hepatic cirrhosis were documented. This represents 20% of the patients hospitalized with a decompensated cirrhosis and 1.1% of the patients with non decompensated cirrhosis. In patients with decompensated cirrhosis, enteric Gram-negative organisms were most frequently isolated (91% of the cases) and ascitis was infected in one third of the cases. No primary foci of infection were documented. On the contrary patients with a non decompensated cirrhosis had infection mostly with Gram-positive organisms (82%) and foci of infection (skin, throat) were documented in 38% of the cases. Infection by enteric organisms was associated with higher mortality than infection by non enteric organisms (68% vs 28%). Five patients with inappropriate antibiotic treatment died from septic shock. Spontaneous septicaemia and peritonitis are frequent complications if cirrhosis. There are potentially treatable causes of deterioration in the cirrhotic patient, necessitating prompt recognition and treatment.

Analysis of ascitic fluid in cirrhosis

In order to determine the composition of "normal" ascitic fluid, the results of analysis of the first paracentesis on 347 consecutive cirrhotic patients with ascites at the West Haven Veterans Administration Hospital between 1955 and 1976 were examined. The ascites was considered "normal" in 259 patients. Bacterial peritonitis was present in 51, malignant ascites in 18, pancreatitic ascites in 15, and ascites of other types in 4 patients. Normal ascites is sterile, usually clear, and contains 281 +/- 25 leukocytes/mm3 (mean +/- SEM), 27 +/- 2% of which are polymorphonuclear. In spontaneous bacterial peritonitis the fluid is usually cloudy, contains 6084 +/- 858 white blood cells/mm3, 77 +/- 4% of which were PMN and culture is positive for a single bacterial species, usually enteric in origin. Malignant and pancreatitis ascites are sterile, often cloudy, and contain an average of 696 +/- 273 and 1821 +/- 833 leukocytes/mm3, respectively, about half of which are polymorphonuclear. Amylase activity is increased in pancreatitic ascites, but not in other types of ascites. Stained smears of sediment for bacteria are often positive in bacterial peritonitis, but not in the other categories. Neither the specific gravity, protein concentration, nor glucose level is useful in the differential diagnosis of ascites. Based on the critical number of leukocytes alone, (500/mm3), one can accurately differentiate infected from uninfected fluid in over 90% of ascitic patients.

Full and empty Dane particles in chronic hepatitis B virus infection: relation to hepatitis B e antigen and presence of liver damage

Circulating complete and defective hepatitis B virus forms, as represented by full, DNA polymerase-positive and empty, DNA polymerase-negative Dane particles, respectively, were investigated in sera from patients with chronic hepatitis B virus infection and related to the presence of e antigen and antibody and to the histological findings on liver biopsy. Complete hepatitis B virus particles were detected in the serum of all patients postive for e antigen, their percentage ranging from 15 to 61% of the total Dane particle population. Although most of these cases had chronic persistent or chronic active hepatitis, complete viral particles were also found in serum of 3 healthy carriers of hepatitis B surface antigen who had e antigen. These results indicate that e antigen is a marker of active virus replication and support its association with infectivity. It is also associated with liver damage because production of complete virus is a feature of chronic hepatitis. In the presence of anti-e, detection of Dane particles in serum appeared to be related to the histological findings. Most of the healthy carriers had no Dane particles in serum, whereas 80% of the cases with chronic liver disease had circulating Dane particles. However, in contrast to the cases with e antigen, 98 to 100% of Dane particles in these cases appeared to be defective in nucleic acid material on electron microscopy after positive staining. All of the patients with chronic active hepatitis in this group had progressed to cirrhosis and it is possible that production of complete virus particles is reduced in the later stages of the illness.

Pasteurella multocida bacteremia associated with peritonitis and cirrhosis

Pasteurella multocida has been the etiologic agent in at least three cases of "spontaneous" bacterial peritonitis (SBP). We report another patient with P. multocida bacteremia and SBP and suggest that there may be more than a chance association between cirrhotic liver disease and this unusual organism which rarely causes sepsis in man.

Fulminant septicemia caused by Yersinia enterocolitica

A lethal case of septicemia caused by Yershia enterocolitica serotype 3 is described. A 59-year-old male, previously healthy, presented with 6 weeks of fever, abdominal pains and gradual prostration ending in overhelming septicemia and death before a conclusive diagnosis was established. Necropsy showed cirrhosis, haemochromatosis and numerous abscesses in the liver.

[Significance of the AgHB and of the immune reaction in chronic hepatitis]

The authors studied 496 patients with chronic persistent or aggressive hepatitis, and active or non-active hepatic cirrhosis, and 396 non-hepatic patients. AgHB was detected in the serum by immuno-electrophoresis and by immuno-diffusion and, in the liver, by needle biopsy, using immuno-fluorescence. The liver diagnosis was made histologically. AgHB was found in 34.2% of patients, more often in chronic active hepatitis (53.7%) than in inactive forms (23.2%). This finding may be interpreted as a sign of severity, chronic aggressive hepatitis is more frequently caused by B virus and by its persistence in the liver. In all cases of chronic, aggressive hepatitis studied with AgHB in the serum, AgHB was detected in the nuclei of the liver parenchyma cells. It should be emphasized that there is no significant difference from the immunological point of view, between patients with AgHB and the others, the levels of gamma-globulin and immunoglobulin were higher in the former. The increased frequency of AgHB in the active forms of the disease compared with stabilised forms, reinforces its physiopathological, diagnostic and prognostic significance.

[Immunopathological aspects of liver cirrhosis]

After a short historical retrospect and a comment on the nomenclature and on the notion of chronic hepatitis and liver cirrhosis the diagnostic criteria and immunopathological peculiarities of virus-induced HBsAg-positive, non-virus-induced autoimmune, drug-induced and finally cryptogenic chronically progressing liver diseases are discussed. Immunoserology and immunohistology are nowadays to be regarded as the most important enrichments in the diagnostic spectre for the differentiation of chronic inflammatory liver diseases. In order to complete the diagnostic programme and to understand the pathogenesis of cryptogenic chronic hepatitides as soon as possible an establishment of the hepatitis-A- and C-serology is necessary. Apart from a further analysis of the group of the non-B-hepatitides the diagnostic use of other markers of virus hepatitides will be able to adopt a definite attitude to the unclarified question of virus-induced autoimmunopathies in liver diseases. The primary biliary cirrhosis with the morphologic findings of a chronically destructing, non-purulent cholangitis is an immunologically conditioned liver diseases of unknown etiology, which in contrast to the autoimmune chronic active hepatitides and liver cirrhoses is not to be influenced in the course by therapeutic measures.

Hepatitis B virus, cirrhosis and primary carcinoma of the liver. An electron microscopic study

The core and coat of hepatitis B virus were found by electron microscopy in parenchymal cells of a liver biopsy from a 61 year old man with chronic active hepatitis and cirrhosis of the liver. Laparoscopy, 35 days after liver biopsy, and autopsy 42 days later confirmed the cirrhosis and showed in addition a well differentiated hepatoma. The possibility of a viral aetiology for the cirrhosis and primary carcinoma of the liver is considered.

Detection of e antigen and antibody: correlations with hapatitis B surface and hepatitis B core antigens, liver disease, and outcome in hepatitis B infections

Testing for e antigen and antibody (anti-e) was performed by immunodiffusion and counterelectrophoresis in patients with polyarteritis nodosa fulminant hepatitis, and chronic active hepatitis (CAH), in 59 asymptomatic carriers of hepatitis B surface antigen (HBsAg) who underwent liver biopsy, and in 150 carriers followed with sequential SGPT determinations. Counterelectrophoresis was more sensitive that immunodiffusion. Neither e antigen nor anti-e was found in the absence of HBsAg. Among HCsAg-positive patients with polyarteritis nodosa and CAH, e antigen was found in 16 of 18 and 13 of 22, respectively. It was not found in any of 43 patients with fulminant hepatitis, of whom 24 were HBsAg-positive. The e antigen was detected in none of 13 biopsied carriers with normal histology, 4 of 28 with nonspecific changes of 11 of 18 with CAH or chronic persistent hepatitis. Conversely, anti-e was present in 9 of 13 with normal biopsy, 7 of 28 with nonspecific changes, and none of 18 with CAH or chronic persistent hepatitis. The e antigen was found more commonly in nonbiopsied carriers with elevated SGPT, and anti-e in those with normal SGPT. Six carriers whose antigenemia terminated spontaneously had anti-e. The presence of e antigen correlated with a high titer of HBsAg, and with immunofluorescent detection of hepatitis B core antigen in the nuclei of hepatocytes. Conversely, anti-e was associated with significantly lower titers of serum HBsAg (P less than 0.001) and lack of detectable hepatitis B core antigen in the liver.

Distribution patterns of hepatitis B surface antigen (HBsAg) in the liver of hepatitis patients

One hundred liver biopsies from 100 hepatitis patients were examined by the indirect immunofluorescent technique for the detection of HBsAg. Of the 60 positive specimens 52 were diagnosed as various types of chronic hepatitis and 8 were acute hepatitis. Four main distribution patterns of HBsAg were obtained: full cytoplasmic fluorescence with diffuse lobular distribution; cytoplasmic fluorescence with spotty distribution; peripheral fluorescence in the cell membrane and/or cell peripheries; and focal cytoplasmic positivity. There was an inverse relationship between the number of positive hepatocytes and the extent of liver cell necrosis. The distribution patterns of HBsAg were distinctive in each type of chronic hepatitis and in acute hepatitis. Homogeneous full cytoplasmic fluorescence, distributed diffusely in the whole liver lobule, was observed in chronic persistent hepatitis and in cirrhosis with little activity whereas peripheral liver cell membrane and/or peripheral cytoplasmic fluorescence associated with cytoplasmic positivity in a smaller number of hepatocytes was a characteristic finding in chronic aggressive hepatitis, active cirrhosis, and acute hepatitis with possible transition to chronicity. Focal cytoplasmic fluorescence was observed in acute hepatitis and a group of biopsies in chronic hepatitis in which HBsAg was detected in the liver but no antigen was detectable in the serum. The results show that the different patterns of distribution of HBsAg in the liver biopsy are helpful for the histological diagnosis of different types of HBAg positive viral hepatitis and are consistent with the hypothesis of the role of specific immune response in the pathogenesis of type B viral hepatitis.

Hepatitis B surface antigen (HBsAg) in the liver of patients with hepatitis; a comparison with serological detection

Chronic hepatitis was diagnosed on liver biopsy of 76 patients; 52 (68%)had HBsAg. Of the 52 patients with HBsAg, 23% had HBsAg shown by immunofluorescence on the liver, while it could not be detected with radioimmunoassay on the serum; 77% had HBsAg detectable in liver and in serum, and none had HBsAg in serum only. HBsAg was detected more frequently in chronic aggressive hepatitis and active cirrhosis than in chronic persistent hepatitis and cirrhosis with little activity. No correlation was found in the different forms of chronic hepatitis between the HBsAg status on the one hand, and levels of transaminases, gammaglobulins, and auto-antibodies on the other. Acute hepatitis was diagnosed on liver biopsy of 24 patients; 50% had HBsAg. Liver tissue positivity was very low in the fully developed stage compared to serum positivity. In 146 patients with other liver ailments, both liver and serum were negative for HBsAg.

Hepatitis B surface antigenaemia in Kenyans with chronic liver disease

Fifty Kenyan patients with chronic liver disease or hepatocellular carcinoma were tested for hepatitis B surface antigenaemia by radioimmunoassay. The hepatitis B surface antigen was detected in 77% of the patients with chronic persistent or chronic aggressive hepatitis, or cirrhosis confirmed by liver biopsy, compared with 15% in a control group. All six patients with hepatocellular carcinoma had detectable hepatitis B surface antigen or antibody. 50% of the controls had hepatitis B surface antibody in their plasma detectable by haemagglutination. Auto-immune associated liver disease appeared infrequent. The possibility that the hepatitis B virus is an important cause of cirrhosis in Kenya is discussed.

[Australia antigen and liver diseases. Report on personal cases and review of the literature]

The AA. relate the results of HBsAg and homologous antibody research by count-electrophoresis obtained in 274 patients with several chronic and acute liver-diseases. Moreover, the most important data of literature are discussed trying to relate the different results of the various AA. to the different sensitivity of the detection techniques and to the difficulties of classifying some disease (chronic hepatitis) and also to the factors related to the geographic distribution of Australia antigen. On the basis of this discussion the AA. make some general consideration on the meaning of HBsAg in the liver disease especially in the chronic diseases and in the primary liver cell carcinoma.

Hepatitis B virus antigen quantitation by radioimmunoassay (RIA) in viral hepatitis and in chronic liver diseases

The incidence of HBAg in viral hepatitis, in chronic active hepatitis and in cirrhosis has been investigated by using immunological methods and a solid-phase radioimmunoassay. RIA demonstrated as positive: 90% of 20 patients with posttransfusion hepatitis; 88% of 50 patients with acute viral hepatitis; 100% of 13 patients with chronic active hepatitis and 35% of 20 patients with cirrhosis; whereas the frequency of HBAg in the same patients appeared to be lower by AGD, CIEP and CF. The measure of antigenaemia has been obtained by use of HBAg (ad) dose response standard curve. The quantitative HBAg data of an eight-week follow-up of fully recovered 15 patients with acute hepatitis are reported. In the first week it appeared a distribution of the HBAg levels into three classes of values. The concentration of HBAg in the serum became lower week by week and in 8th week the antigen was no longer detectable. The radioimmunoquantitation of HBAg in the serum of patients suffering from chronic acitve hepatitis and cirrhosis showed wide levels of antigenaemia ranging between 17 and 5100 ng ad equivalent/ml. The use of a dose response standard curve in order to quantify HBAg in the serum represents a further increased sensitivity of RIA.

Hepatitis B antigen (HB-Ag, Australia antigen) in mixed saliva of patients with HB antigenemia

Hepatitis B antigen was detected by both immunodiffusion and electron microscopy in mixed saliva concentrates from 5 out of 12 HB antigenemic patients who suffered from acute or chronic hepatitis, or liver cirrhosis. The antigen was also present in the saliva of two HB antigenemic kidney-transplant recipients.

Isolation of Aeromonas species from clinical sources

In a period of one year, in a general hospital, Aeromonas hydrophila was isolated from 13 patients and Aeromonas shigelloides from one patient. Eight of the patients had superficial infections, two had urinary tract infections, and four had bacteriaemia. The association of Aeromonas bacteriaemia with cirrhosis of the liver and malignant disease, which has been previously reported, was observed in three of the four bacteriaemic patients. The key to laboratory diagnosis of this genus is the routine performance of the oxidase test in bacteriological procedures for the identification of Gram-negative bacilli.

Herpesvirus hominis: isolation from human trigeminal ganglion

Herpesvirus hominis was isolated from the trigeminal ganglion obtained at autopsy from 1 of 22 patients with no clinical evidence of active herpetic disease, and from one patient with malignant lymphoma who died with herpes zoster on the abdomen, pulmonary cytomegalic inclusion disease, and possible oral herpes simplex. Virus was isolated by cocultivation of explants of ganglion with monolayers of Vero green monkey kidney cells and required 3 weeks of culture before viral cytopathic effects were evident. These observations support the concept that latent infection of sensory ganglia may be the source of virus in recurrent herpetic disease in man.