Non-A, non-B hepatitis: dead ends or new horizons?

Development of antibody to hepatitis C virus (HCV) in acute and chronic non-A, non-B post-transfusion hepatitis

The antibody to hepatitis C virus (anti-HCV) was measured by an immunoassay in 507 serum samples from 94 patients with acute and chronic post-transfusion non-A, non-B hepatitis (NANB) and in 436 healthy blood donors. Anti-HCV was found in 70.8 of patients with acute hepatitis, in 78.2 with chronic hepatitis, and in 1.4 of healthy blood donors. In acute hepatitis, anti-HCV appeared in the serum from 4 to 34 weeks after transfusion and from 1 to 30 weeks after the onset of the overt disease. Three patients with resolving hepatitis (21%) and 2 who developed chronic hepatitis (10%) lost anti-HCV during a mean follow-up period of 28 months. Among the 36 patients with chronic hepatitis, 2 (6%) lost anti-HCV after 12 months and 8 years respectively. These data indicate that in recent years HCV has been the major etiologic agent of acute and chronic transfusion-associated hepatitis (TAH) in our geographical area. The late appearance of anti-HCV from the onset of clinical and biochemical signs of acute hepatitis in more than 70% of patients limits the diagnostic utility of this assay for an earlier serological diagnosis of acute NANB hepatitis. Additional studies are required to determine the diagnostic significance of this antibody in chronic NANB hepatitis.

A follow-up study of an outbreak of non-A, non-B hepatitis in a plasmapheresis unit

A cluster of acute non-A, non-B hepatitis comprising 12 blood donors was diagnosed in a plasmapheresis unit. Nine cases were followed-up for 2-5.5 years and seven out of them progressed to chronicity, as judged by biochemical abnormalities. In six, liver biopsy was performed 1 year after the acute disease revealing chronic active hepatitis in two, chronic persistent hepatitis in two, chronic lobular hepatitis in one and normal liver in one. Repeated biopsies showed progression to cirrhosis in one case of chronic active hepatitis, and resolution of the disease in another one, while in the remaining patients liver morphology remained unchanged. Circumstantial epidemiologic evidence suggests a single agent being the cause of the outbreak, which resulted in a broad spectrum of liver disease.

Serial passage of west-European sporadic non-A non-B hepatitis in rhesus monkeys by inoculation with fecal extracts

An experimental model of sporadic non-A non-B hepatitis involving a Fab nonimmune binding activity in stools was established in the rhesus monkey. The first animal was inoculated intravenously with a stool extract from a French patient who had never left the country and in whom post-transfusion hepatitis was excluded. Four passages were performed, and the infection was transmitted by parenteral as well as the oral routes by inoculation of stools or liver extracts. Infection led in three monkeys to reversible hepatocyte injury manifested by a transitory increase in serum aminotransferases. The other three animals, in which persistently high levels of aminotransferases was observed, were sacrificed on day 60 after inoculation. The incubation period, as evidenced by elevation of aminotransferases was about 3 to 4 weeks. The infectious agent was transitorily present in the stools before aminotransferase elevation. The presence of the infectious agent in the stools was correlated with the nonimmune Fab binding activity.

Acute viral hepatitis: an aetiological study of 253 patients

Two hundred and fifty-three cases of acute viral hepatitis admitted to Ibn Al-Khateeb Infectious Disease Hospital, Baghdad, were studied prospectively regarding the viral aetiological agent. The most common cause was infection with one of the non-A, non-B viruses (51%). The second most common cause was infection with the hepatitis B virus (32%); two of these patients had hepatitis delta-co-infection. Hepatitis A virus was responsible for 15% of the cases, and hepatitis delta-virus superinfection in 2% of the cases.