Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure

e-Antigen and anti-e in two categories of chronic carriers of hepatitis B surface antigen

Screening for e antigen and anti-e was performed in 517 HBs antigen chronic carriers, 329 blood donors and 188 hemodialyzed patients. e antigen was detected in 35 blood donors (10.6 percent): 88 percent had a high titre of HBsAg, and 80 percent had a distrubed liver function. No difference was noted regarding sex and age of the carrier. Anti-e was detected in 33.7 percent of the bood donors. A significant difference (p less than 0.01) was noted between males (29 percent) and females (46.6 percent). Anti-e was found more prevalent in young people between 21 and 34 than in older people (p less than 0.05). Anti-e was rarely found when the titre of HBsAg was low or high. 88 percent of the anti-e carriers had an intermediate titre from 1/1 to 1/32 by CEP. Both e Ag and anti-e were more prevalent in ad subtype than in ay subtype (p less than 0.02 for both). Inside the ad subtype, anti-e is less frequent in adr (6 percent) than in adw2 (42 percent) and in adw4 (57 percent); p less than 0.01. The difference between the prevalence of e Ag in adr (31 percent) and in adw2 (17 percent) is not significant but the healthy carriers with e antigen are more numerous in adr than in adw2 subtype. e antigen was detected in 53.7 percent of HBs Ag-hemodialyzed patients and anti-e in 3.7 percent of these patients. These results are neither correlated with the liver function nor with the state of chronic carrier (27 percent of e Ag in transient HBs Ag carrier).

Anti-HBc, HBeAg and DNApolymerase activity in healthy HBsAg carriers and patients with inflammatory liver diseases

In this paper we report on anti-HBc-titers, HBcAg, DNApolymerase activity in the serum and intracellular HBsAg in healthy HBsAg-carriers and patients with HBsAg-positive inflammatory liver diseases. 32/44 patients with acure virus-B-hepatitis were negative for anti-HBc in the first week of the disease. Anti-HBc-titers in healthy HBsAg-carriers varied between 1:10 and 1:32,000 (medium titer 1:4,000). In HBsAg-positive CAH we found a medium titer between 1:32,000 and 1:64,000, in cases with CPH of about 1:16,000. All autoimmune type CAH showed anti-HBc-titers less than 1:10. By immunofluorescence we could demonstrate in a group of 71 asymptomatic HBsAg-carriers in none of the healthy HBsAg-carriers HBcAg in the liver cell nuclei. In contrast HBcAg could only be found in 4/5 HBsAg positive CAH- and 6/9 CPH patients. No elevated DNApolymerase activity could be demonstrated in healthy HBsAg-carriers. Out of 44 patients with virus-B-hepatitis only 3 showed elevated DNApolymerase activity. On the other hand DNApolymerase elevation was demonstrable in 17/37 cases with CAH and 9/15 with CPH. The investigations showed a strong correlation between the demonstration of HBcAg in the serum and the DNApolymerase activity. The characteristic findings enabled us to differentiate between "healthy" HBsAg-carriers and HBsAg-carriers with inflammatory liver diseases.

Detection of HBeAg and anti-HBe in acute hepatitis B by a sensitive radioimmunoassay

A solid-phase radioimmunoassay using anti-HBe-coated polysterence beads and iodine-125-labeled anti-HBe of human origin was developed for the detection of HBeAg. Anti-HBe could be determined by a blocking test. Both assays were about 500-fold more sensitive than immunodiffusion. Few nonspecific positive results for HBeAg could be recognized in the anti-HBe test by increase in cpm over that of the negative control. HBeAg was not found in acute hepatitis A and non A-non B hepatitis or in a control group of accident patients. On admission to the hospital 12 of 48 (25%) acute hepatitis B patients from Greece and 17 of 20 (85%) acute hepatitis B patients from Germany were HBeAg-positive. All 39 initially HBeAg negative sera were already anti-HBe positive. Tests of the acute stage and follow-up sera of the 20 German patients indicated that HBeAg is regularly present in the incubation period and early acute phase of hepatitis B. After onset of disease the antigen is cleared from the serum very rapidly in uncomplicated cases and is usually followed by the appearance of anti-HBe. Like anti-HBc, anti-HBe can serve as a tool for the diagnosis of hepatitis B after the disappearance of HBsAg.

Liver disease in renal transplant recipients

Liver disease is a common complication in renal transplant recipients. Several types of liver disease can occur. The most common are acute and chronic hepatitis. The variety of acute hepatitis include hepatitis A, hepatitis B, cytomegalovirus hepatitis, herpes simplex hepatitis and azathioprine hepatitis. The incidence of azathioprine hepatitis may not be as high as initially suggested. Chronic hepatitis is a serious problem because the disease seems to be progressive despite prednisone therapy. The causes of this chronic hepatitis are not fully known, although hepatitis B, cytomegalovirus and herpes simplex virus have been implicated. Discontinuation of azathioprine therapy has no appreciable effect on the course of chronic hepatitis.

Hepatitis B. Cytologic localization of virus antigens and the role of the immune response

Antigens of the hepatitis B virus have been localized within liver tissue by various immunologic, histochemical, and electron microscopic methods. The abundance and distribution of these virus antigens are in part determined by the host immune response. This interaction of immune mechanisms with the hepatitis B virus may be related to the pathogenesis and natural history of human hepatitis B virus infection.

Enzyme-immunoassay in diagnosis of hepatitis with emphasis on the detection of "e" antigen (HBeAg)

A brief survey of the application of enzyme-immunoassay (EIA) for the detection of hepatitis B surface antigen (HBsAg), hepatitis A, and their corresponding antibodies is given. The preliminary results of a similar EIA for detection of hepatitis B-related "e" antigen (HBeAg) and its antibody (anti-HBe) are reported. This EIA is much more sensitive than immunodiffusion: at least 128 times for HBeAg and at least 512 times for anti-HBe. HBsAg and its antibody do not interfere with the test. Only a few sera strongly positive for rheumatoid factor gave rise to false-positive results, as was demonstrated by a confirmatory test.

Prevalence of hepatitis B e antigen and its antibody as detected by radioimmunoassays

A solid-phase radioimmunoassay (RIA) for the detection of hepatitis B e antigen (HBeAg) and antibody (anti-HBe) was developed. The RIA was approximately 1,000-fold more sensitive than rheophoresis for HBeAg, and approximately 6,000-fold more sensitive than rheophoresis for anti-HBe. Generally, less than one-fifth of hepatitis B antigen (HBsAg)-positive sera from blood donors were positive for either HBeAg or anti-HBe by rheophoresis; in contrast, more than 90% of the samples were positive by the RIA method. The ratio of HBeAg to anti-HBe among HBsAg carriers varied in different geographic localities. Also, the presence of HBeAg correlated directly with the titer of HBsAg and the presence of Dane core particles. Anti-HBe was associated with lower titers of serum HBsAg.

Diagnosis of hepatitis B by Dane particle associated DNA polymerase assay

We have studied prospectively 478 subjects exposed to hepatitis B virus and 20 pregnant women who developed HBs antigen during the last trimester of pregnancy. The results suggest that the DNA polymerase assay might be useful for the diagnosis of hepatitis B infection and that in confirmed cases of hepatitis, the enzyme might be detected in the absence of HBs antigen. HBe antigen appeared in 19% of those subjects who developed HBs and a positive correlation between HBe antigen and DNA polymerase was found in 40% of the cases positive for this antigen. The data presented also suggest that HBe antigenemia in pregnant women is not consistently associated with HBs infection in the babies born to them. However the children born to HBe positive mothers are at higher risk than those born to HBe negative mothers.

Hepatitis B "e" antigen: an apparent association with lactate dehydrogenase isozyme-5

Serums containing the "e" antigen of hepatitis B virus were subjected to electrophoresis in polyacrylamide gel. An extra band appeared in the lactate dehydrogenase isozyme pattern, but this band was undetectable in serums containing antibodies to the e antigenic determinant. Prior separation of the lactate dehydrogenase isozyme-5 fraction by chromatography of serum on minicolumns of diethylaminoethyl-Sephadex-A50 improved electrophoretic identification of the extra band. Neutralization with antibodies to the e antigen as well as by antibodies to the homologous d or y component of the hepatitis B surface antigen removed the extra band; antibodies to the lactate dehydrogenase isozyme-5 removed both the normal and the extra enzymatic band of isozyme-5. This feature of the e antigen provides an assay system for laboratory diagnosis of potential clinical usefulness and suggests its possible role in pathogenesis of hepatocellular injury.

Hepatitis B e antigen and antibody activity in hepatitis B virus infection

Groups of institutionalized subjects, volunteer blood donors with serologic evidence of asymptomatic hepatitis B virus infection, and patients with acute type B viral hepatitis were studied for the presence of hepatitis B e antigen and antibody in a sequential manner over a period of two to three years. HBeAg was detected in 9.5% of institutionalized residents and volunteer blood donors and in 24% of patients with acute type B viral hepatitis. HBeAg positive subjects frequently had persistently elevated pyruvic glutamic transaminase levels in the serum. Anti HBe activity was observed in 26 to 32% of subjects positive for hepatitis B surface antigen. Long-term follow-up indicated that HBsAg positive subjects with anti HBe did not eventually become seronegative for HBsAg.

The lack of nurse-infant transmission of type B hepatitis in a special care nursery

Twenty-four infants cared for by a nurse who developed acute B hepatitis with HBsAg present in her serum and saliva were examined for serologic evidence of hepatitis B virus transmission. None of the infants had HBsAg by radioimmunoassay or anti-HBc by complement fixation. One infant had anti-HBs whose transient presence was consistent with passive acquisition. Using sensitive serologic tests, no identifiable risk to newborn infants in a special care nursery could be documented as a result of exposure to a nurse who developed acute type B hepatitis during their period of care.