- Email: [email protected]
Aetiological association of a virus-like particle with enterically transmitted non-A, non-B hepatitis
70 Infectious Diseases Newsletter 7(9) September 1988
COMMENTS ON CURRENT PUBLICATIONS lspahani P, Donald FE, Aveline AID: Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated. J Infect 16:37-46, 1988. Over a 7-year period, 40 of 1984 episodes of bacteremia documented by cultures of the blood were caused by Streptococcus pyogenes (Group A beta-hemolytic streptococci). Although M- and T-typing was carried out, there was no distinct pattern. The bacteremias were community acquired in 32 (80%) episodes. Twenty-one of the patients (52.5%) were males. While the range in age was 4 months to 88 years (mean 53.6 years) 72.5% of the episodes occurred in persons I> 40 years. Fourteen (35%) patients were healthy prior to bacteremia, whereas 20 (50%) suffered from a variety of chronic, nonfatal diseases, and 6 (15%) had ultimately fatal underlying diseases. No focus of infection antecedent to the bacteremia was found in 2 (5%) patients. Bacteremia originated from skin and soft tissues in 23 (57.5%), the respiratory tract in 8 (20%), joints in 3 (7.5%), and miscellaneous sites in the remaining 4 patients. All of the S. pyogenes were susceptible to penicillin G; one isolate was resistant to erythromycin. While the mean temperature was 38.5°C at the time the blood that yielded S. pyogenes was drawn, 10 (25%) patients never had fever to 38°; of these, 5 died. Death directly associated with the streptococcal bacteremia occurred in 14 (35%) patients with 11 (27.5%) fatalities in persons/> 60 years. Shock was present in 15 patients of whom 60% died. Acute renal failure developed in 11 (27.5%) patients; 6 died, and hemodialysis was required in 3/5 survivors.
Comment Notable in this thorough report of the
clinical aspects of bacteremia caused by S. pyogenes was the apparently increasing incidence over the 7 years of the study; the authors could offer no explanation, and it would be interesting to know if the experience in other centers is the same. The speed of lethality observed in some patients calls to mind the ominous ring of the lay term for streptococcal bacteremia - - " b l o o d poisoning" PDH []
Arankalle VA, Sreenivasan MA, Popper H, et al: Aetiological association of a virus-like particle with enterically tranmnitted non-A, non,B hepatitis. Lancet 1:550-554, 1988.
transmitted NANB hepatitis encountered in several different areas of the world. It is unclear why the numbers of particles in feces are small. The canse(s) of parenterally transmitted NANB still remain obscure. RML []
Watt G, Tuazon ML, Santiago E, et al: P h ~ m - c o n i r o i ~ ~ o f lntravenom ~ for s ¢ v o r e ~ . l a t e lepto~trosis. Lancet 1:433-435, 1988.
A 27-mm virus-like particle was found in the feces of an Indian patient with acute, enterically transmitted non-A, non-B (ENANB) hepatitis. The particles lacked a distinctive appearance but had a feathery outline. They were serologically distinct from hepatitis A virus (HAV) and nucleic acid extracted from the particles did not hydridize with the cDNA probes from HAV, enteroviruses, or cardioviruses. In two chimpanzees inoculated with fecal suspensions containing the virus-like particles or feces from another case of ENANB hepatitis, mild histological and biochemical hepatitis developed and there was serologic evidence of infection with the particle. Sera from several epidemics and sporadic cases of ENANB hepatitis in India, Pakistan, USSR, and Algeria in 1956 and 1985 were positive for antibody to the virus-like particle.
Forty-two patients were enrolled in a placebo-controlled, double-blind trial of intravenous penicillin (6,000,000 units/day) for treatment of severe, advanced leptospirosis. Patients were entered into the study if either an IgM-specific dot-ELISA test or rapid microhemagglutination screening test was positive. Of 42 patients, 41:had leptospirosis confirmed by culture of leptospires in urine or blood (eight patients), or fourfold or greater in= creases in microbemaggtutination antibody titers (39 patients), or both. Twenty-six had increased serum creatinine, 22 had increased serum bilirubin, and 19 were frankly jaundiced. Penicillin treatment reduced the duration of fever from 11.6 to 4.7 days, shortened the duration of hospital stay, reduced the duration of hepatic tenderness, and reduced the period of increased serum creatinine. No patient in either group required renal dialysis. Penicillin prevented leptospiruria: Urine cultures after treatment was started were ~ i t i v e in 58 of the placebo group and only 13% of the penicillin group.
Comment The virus-like particle described by Arankalle, et al., appears to be the etiological agent for the enterically
Comment The present study appears to bethe first adequately controlled, randomized study of the effects of treatment
© 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/$0.00 + 2,20
COMMENTS ON CURRENT PUBLICATIONS lspahani P, Donald FE, Aveline AID: Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated. J Infect 16:37-46, 1988. Over a 7-year period, 40 of 1984 episodes of bacteremia documented by cultures of the blood were caused by Streptococcus pyogenes (Group A beta-hemolytic streptococci). Although M- and T-typing was carried out, there was no distinct pattern. The bacteremias were community acquired in 32 (80%) episodes. Twenty-one of the patients (52.5%) were males. While the range in age was 4 months to 88 years (mean 53.6 years) 72.5% of the episodes occurred in persons I> 40 years. Fourteen (35%) patients were healthy prior to bacteremia, whereas 20 (50%) suffered from a variety of chronic, nonfatal diseases, and 6 (15%) had ultimately fatal underlying diseases. No focus of infection antecedent to the bacteremia was found in 2 (5%) patients. Bacteremia originated from skin and soft tissues in 23 (57.5%), the respiratory tract in 8 (20%), joints in 3 (7.5%), and miscellaneous sites in the remaining 4 patients. All of the S. pyogenes were susceptible to penicillin G; one isolate was resistant to erythromycin. While the mean temperature was 38.5°C at the time the blood that yielded S. pyogenes was drawn, 10 (25%) patients never had fever to 38°; of these, 5 died. Death directly associated with the streptococcal bacteremia occurred in 14 (35%) patients with 11 (27.5%) fatalities in persons/> 60 years. Shock was present in 15 patients of whom 60% died. Acute renal failure developed in 11 (27.5%) patients; 6 died, and hemodialysis was required in 3/5 survivors.
Comment Notable in this thorough report of the
clinical aspects of bacteremia caused by S. pyogenes was the apparently increasing incidence over the 7 years of the study; the authors could offer no explanation, and it would be interesting to know if the experience in other centers is the same. The speed of lethality observed in some patients calls to mind the ominous ring of the lay term for streptococcal bacteremia - - " b l o o d poisoning" PDH []
Arankalle VA, Sreenivasan MA, Popper H, et al: Aetiological association of a virus-like particle with enterically tranmnitted non-A, non,B hepatitis. Lancet 1:550-554, 1988.
transmitted NANB hepatitis encountered in several different areas of the world. It is unclear why the numbers of particles in feces are small. The canse(s) of parenterally transmitted NANB still remain obscure. RML []
Watt G, Tuazon ML, Santiago E, et al: P h ~ m - c o n i r o i ~ ~ o f lntravenom ~ for s ¢ v o r e ~ . l a t e lepto~trosis. Lancet 1:433-435, 1988.
A 27-mm virus-like particle was found in the feces of an Indian patient with acute, enterically transmitted non-A, non-B (ENANB) hepatitis. The particles lacked a distinctive appearance but had a feathery outline. They were serologically distinct from hepatitis A virus (HAV) and nucleic acid extracted from the particles did not hydridize with the cDNA probes from HAV, enteroviruses, or cardioviruses. In two chimpanzees inoculated with fecal suspensions containing the virus-like particles or feces from another case of ENANB hepatitis, mild histological and biochemical hepatitis developed and there was serologic evidence of infection with the particle. Sera from several epidemics and sporadic cases of ENANB hepatitis in India, Pakistan, USSR, and Algeria in 1956 and 1985 were positive for antibody to the virus-like particle.
Forty-two patients were enrolled in a placebo-controlled, double-blind trial of intravenous penicillin (6,000,000 units/day) for treatment of severe, advanced leptospirosis. Patients were entered into the study if either an IgM-specific dot-ELISA test or rapid microhemagglutination screening test was positive. Of 42 patients, 41:had leptospirosis confirmed by culture of leptospires in urine or blood (eight patients), or fourfold or greater in= creases in microbemaggtutination antibody titers (39 patients), or both. Twenty-six had increased serum creatinine, 22 had increased serum bilirubin, and 19 were frankly jaundiced. Penicillin treatment reduced the duration of fever from 11.6 to 4.7 days, shortened the duration of hospital stay, reduced the duration of hepatic tenderness, and reduced the period of increased serum creatinine. No patient in either group required renal dialysis. Penicillin prevented leptospiruria: Urine cultures after treatment was started were ~ i t i v e in 58 of the placebo group and only 13% of the penicillin group.
Comment The virus-like particle described by Arankalle, et al., appears to be the etiological agent for the enterically
Comment The present study appears to bethe first adequately controlled, randomized study of the effects of treatment
© 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/$0.00 + 2,20