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Research progress on hepatitis C virus-related cryoglobulinemia

Zhantao ZHU ; Fuying MA ; Junying ZHOU ; Xiaoshuang ZHOU

Chinese Journal of Clinical Infectious Diseases.2015;12(3):283-286. doi:10.3760/cma.j.issn.1674-2397.2015.03.025

Chronic hepatitis C virus ( HCV) infection has been reported in association with several extrahepatic complications, among which mixed cryoglobulinemia is the most documented. Clinical manifestations of HCV related cryoglobulinemia include skin lesions, glomerulonephritis, peripheral neuropathy, and widespread vasculitis.The therapy may be directed to eradicate HCV infections, suppress B-cell clonal expansion and cryoglobulin production, and ameliorate symptoms.This paper reviews the research progress on pathogenesis, clinical manifestations, diagnosis and treatment of HCV related cryoglobulinemia.

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Expression of Th17, CD4 +CD25 +Treg, HLA-DR mRNA in peripheral blood of children with hand, foot and mouth diseases

Jingjing LIU ; Qingyan LI ; Qingfang LI ; Chunhua LIU ; Yukai HE ; Changming TAO

Chinese Journal of Clinical Infectious Diseases.2015;12(3):263-268. doi:10.3760/cma.j.issn.1674-2397.2015.03.018

Objective To investigate the expressions of Th17, CD4 +CD25 +Treg, HLA-DR mRNA in peripheral blood of children with EV71-induced hand, foot and mouth diseases ( HFMD ) and their clinical significance.Methods Stratified random sampling was used to select 60 children with HFMDs from Liaocheng People’s Hospital from February to October, 2014, including 20 mild, 20 severe and 20 critically ill cases.Twenty healthy children were also enrolled as the control group.All the children with HFMDs were given ribavirin (10 mg/kg) for the treatment.The percentages of Th17 and CD4 +CD25 +Treg cells in CD4 +T cells of peripheral blood were determined by flow cytometry, and the expression of HLA-DR mRNA in peripheral blood mononuclear cells was detected by reverse transcription polymerase chain reaction ( RT-PCR).Analysis of variance and SNK-q test were used to compare the expressions of Th17, CD4 +CD25 +Treg and HLA-DR mRNA among groups, and Pearson correlation analysis was performed to reveal the correlations between HLA-DR mRNA and Th17, CD4 +CD25 +Treg.Results Compared with the control group, the expression of Th17 was increased, while CD4 +CD25+Treg and HLA-DR mRNA expressions were decreased in children with HFMDs on d1 of treatment (F=310.4, 81.5 and 545.4, P<0.01).After treatment, Th17 levels in mild group, severe group and surviving children of critically ill group were decreased, CD4 +CD25 +Treg and HLA-DR mRNA expressions were increased, while in fatal cases, Th17 level was still on the rise, and CD4 +CD25+Treg and HLA-DR mRNA expressions were still decreasing. After 10 d of treatment, the difference in Th17 and CD4 +CD25 +Treg levels among mild group, severe group, surviving children of critically ill group and control group was of no statistical significance ( P >0.05), but Th17 level in fatal was still higher and CD4 +CD25 +Treg level was still lower than those in control group (t=16.4 and 12.0, P<0.05).After 10 d of treatment, HLA-DR mRNA expressions in mild group and severe group were increased to the normal level.HLA-DR mRNA expression in surviving patients of critical ill group was still lower than that in mild group and severe group (P<0.05), but was higher than that in fatal patients (t=7.8, P<0.05).Pearson correlation analysis showed that, HLA-DR mRNA was negatively correlated with Th17 level (r=-0.770, P<0.01), and positively correlated with CD4 +CD25 +Treg level (r=0.883, P<0.01).Conclusion The expressions of Th17, CD4 +CD25 +Treg cells, and HLA-DR mRNA are correlated with the severity of HFMD, and may be used for evaluation of disease severity and prediction of disease outcomes.

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Growth and nutritional status of children with Helicobacter pylori infections

Xiaobing LI ; Yunguang BAO ; Panjian LAI ; Mingxing DING

Chinese Journal of Clinical Infectious Diseases.2015;12(3):258-262. doi:10.3760/cma.j.issn.1674-2397.2015.03.017

Objective To investigate the effect of Helicobacter pylori ( Hp) infection on the growth and nutritional status in children.Methods A total of 174 children with Hp infections were collected from Jinhua Hospital of Zhejiang University during March 2010 to September 2012, and 100 healthy children were also enrolled as the controls.The differences in age and gender between Hp-infected group and control group were not significant.All Hp-infected children were given first-line anti-Hp therapy and followed-up for two years.t test, repeated measure ANOVA and LSD test were used to analyze the growth and nutritional status between Hp infected children and healthy controls, as well as between HP-infection eradication group and relapse group.Results Among 174 Hp-infected children, 2 were diagnosed as true precocious puberty, 6 abandoned treatment and 8 were lost to follow-up.Among 158 children who completed the study, Hp infection was eradicated in 128 (eradication group), and relapsed in 30 (relapse group).The height, weight, peripheral levels of hematoglobin ( Hb) , Albumin ( Alb) , blood urea nitrogen ( BUN) , Fe and Zn in 158 Hp-infected children at the baseline were significantly lower than those in the healthy control group (t=2.674, 1.657, 12.709, 3.662, 4.227, 4.210 and 14.820, all P <0.05).The height, weight, peripheral levels of Hb, Alb, BUN, Fe and Zn in eradication group were increased in 1-and 2-year of the follow-up (F=8.350, 14.998, 50.875, 37.584, 22.701, 8.295 and 41.791, all P<0.01), while there were no significant increase in the levels of Hb, Alb, BUN and Fe in the relapse group (F=1.826, 1.659, 2.613 and 2.495, all P>0.05).In the second year of the follow-up, the increases of Alb, BUN, Fe and Zn in eradication group were significantly higher than those in the relapse group ( t=7.86, 5.17, 8.80, 5.92, 2.17 and 7.28, all P <0.05).Conclusion Hp infection may affect the growth and nutritional status of children, and the eradication of Hp infection may help to improve the development and nutritional status of the children.

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Antibiotic resistance and bro genotyping of Branhemella catarrhalis isolated from patients with lower respiratory tract infections in Linyi, Shandong province

Shuhong SUN ; Wei ZHANG ; Xiaofeng HU ; Zongxin LING ; Dequan ZHU

Chinese Journal of Clinical Infectious Diseases.2015;12(3):253-257. doi:10.3760/cma.j.issn.1674-2397.2015.03.016

Objective To analyze the antibiotic resistance of Branhemella catarrhalis strains isolated from sputum specimens of patients with lower respiratory tract infections from Linyi, Shandong Province, and to explore the relationship between bro genotypes of the strains and their resistance to antibiotic agents.Methods Sputum specimens were colleted from the patients with lower respiratory tract infections in Linyi People ’ s Hospital from the January 2010 to December 2014.The specimens were inoculated into 4 different disks for bacterial isolation and cultivation.β-lactamase detection and drug sensitivity tests were performed, and PCR coupled with restriction endonuclease analysis was employed for bro genotyping.χ2 test was used to compare drug resistance of strains with different bro genotypes.Results A total of 497 Branhemella catarrhalis strains were isolated in five years, among which 221 strains were isolated in winter.All strains were sensitive to ertapenem and chloramphenicol, and the resistance rates to amoxicillin/clavulanate and cefaclor were low (≤2.8%).The strains were highly resistant to compound sulfamethoxazole, erythromycin and ampicillin (47.6%-89.8%), and there was a trend of increasing resistance rates with the year, but no statistically significant difference was observed ( P >0.05 ) .β-lactamases was positive in 412 strains (82.9%), and all of these strains were positive for bro gene, and the resistances to erythromycin, compound sulfamethoxazole, levofloxacin and ampicillin were higher in bro positive strains than those in bro negative strains (χ2 =12.16, 16.18, 8.41 and 200.00,P<0.05).Among bro positive strains, 391 (94.9%) were of genotype bro-1, 21 (5.1%) were of genotype bro-2, and their resistance to antibiotic agents was not of statistical difference ( P >0.05 ).Conclusions Most of Branhemella catarrhalis clinical isolates are β-lactamase producing strains, and bro-1 is the most common genotype.Strains are highly sensitive to carbapenems, cephalosporins andβ-Lactamaseinhibitors, which can be recommended for the treatment of Branhemella catarrhalis-related respiratory tract infections.

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Risk factors and antimicrobial susceptibilities of severe community-acquired Staphylococcus aureus infections in Ningbo

Yanzi CHANG ; Lipei QIU ; Yushan CUI ; Jun SUN ; Guosheng GAO

Chinese Journal of Clinical Infectious Diseases.2015;12(3):248-252. doi:10.3760/cma.j.issn.1674-2397.2015.03.015

Objective To identify antimicrobial susceptibilities of community-acquired Staphylococcus aureus infections and the risk factors of severe infections.Methods Clinical data of 184 cases of community-acquired Staphylococcus aureus infections collected from 4 hospitals in Ningbo during May 2008 and May 2013 were reviewed.Microbial sensitivity test and virulence genes ( pvl and tst) detection were performed in clinical isolates, and SCCmec genotyping was performed in methicillin-resistant Staphylococcus aureus ( MRSA) strains.Binary logistic regression analysis was used to identify the risk factors for severe infections.Results Among 184 cases of community-acquired Staphylococcus aureus infections, 39 ( 21.20%) were severe cases. Staphylococcus aureus strains were highly resistant to penicillin, erythromycin and clindamycin, but more than 75% strains were sensitive to oxacillin, aminoglycosides, quinolones, rifampicin and vancomycin.Logistic regression analysis showed that advanced age (OR=1.024, 95%CI:1.005-1.043, P<0.05), malignant tumor (OR=15.288, 95%CI:1.609-145.229, P<0.05) , autoimmune diseases or long-term hormone therapy ( OR=12.102, 95%CI:2.082-70.338, P <0.01 ) were risk factors for severe community-acquired Staphylococcus aureus infections. Conclusions Strains isolated from the patients with community-acquired Staphylococcus aureus infections in Ningbo are usually sensitive to oxacillin, aminoglycosides, quinolones, rifampicin and vancomycin, which may be recommended for clinical use.Elder patients and those with malignant tumor, autoimmune diseases or long-term hormone therapy are more likely to develop severe Staphylococcus aureus infections.

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Efficacy of antiviral treatment in chronic HBV infected patients with mild hepatic dysfunction and marked pathological injury

Jiaojian LYU ; Huiling SUN ; Yi LU

Chinese Journal of Clinical Infectious Diseases.2015;12(3):243-247. doi:10.3760/cma.j.issn.1674-2397.2015.03.014

Objective To evaluate the efficacy of entecavir treatment in chronic hepatitis B virus ( HBV ) infected patients with mild hepatic dysfunction and marked pathological injury.Methods One hundred and fifty five chronic hepatitis B ( CHB) patients with HBV DNA>1.0 ×104 U/mL admitted in Lishui People’ s Hospital during January 2008 to October 2011 were enrolled in the study.Patients were divided into three groups: those with serum ALT <2 ×ULN and liver inflammation injury ≥G2 and/or fibrosis stage≥S2 were in observation group ( n=75 ); patients with ALT ( 2-5 ) ×ULN were in control group 1 (n=38);patients with ALT>5 ×ULN were in control group 2 (n=42).All patients were given entecavir (0.5 mg, 1/d, p.o) treatment.ALT normalization rates, HBV DNA negative rates, HBeAg negative conversion rates and seroconversion rates at 12-, 24-,48-, 96-and 144-week were observed and compared among groups.Variance analysis andχ2 test were performed for measurement data and numeration data, respectively.Results ALT normalization rates in observation group were 86.7%, 90.7%, 90.7%, 92.0%and 96.0%at 12-, 24-, 48-, 96-and 144-week, which were higher than those in control group 1 (χ2 =2.04, 2.15, 2.78, 2.69 and 2.47, P <0.01), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.53,2.42,2.09,2.24 and 2.32,P>0.05) . HBV DNA negative rates in observation group were 70.7%, 78.7%and 82.7%at 12-, 24-and 48-week, which were higher than those in control group 1 (χ2 =4.56, 4.23 and 4.28, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.75, 2.62 and 2.98, P>0.05).HBeAg negative conversion rates in observation group were 6.6%, 21.3%and 25.3%at 48-, 96-, and 144-week, which were higher than those in control group 1 (χ2 =4.68, 4.78 and 5.01, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.24, 2.57 and 2.13, P>0.05).HBeAg seroconversion rate in observation group was 4.0%at 24-week, which were higher than that in control group 1 (χ2 =2.87, P <0.05), but the seroconversion rates at 96-and 144-week were lower than those in control group 2 (χ2 =2.92 and 3.14, P<0.05).Conclusion The efficacy of entecavir treatment for HBV infected patients with mild hepatic dysfunction and marked pathological injury is satisfactory.

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Efficancy and safty of antiviral treatment for chronic hepatitis B patients in second trimester of pregnancy

Xiaoxian JIANG ; Wenbao HUANG ; Min WU ; Yunfeng PAN ; Huiqin LI ; Jie JIN

Chinese Journal of Clinical Infectious Diseases.2015;12(3):238-242. doi:10.3760/cma.j.issn.1674-2397.2015.03.013

Objective To evaluate the efficacy and safty of antiviral treatment for chronic hepatitis B ( CHB ) patients in second trimester of pregnancy.Methods Seventy-nine CHB patients in second trimester of pregnancy were collected from Hangzhou First People’ s Hospital and Xixi Hospital of Hangzhou during January 2010 to December 2013.Patients were divided into antiviral treatment group ( n=47) and the control group (n=32) according to their own wishes.Patients in antiviral treatment group were given lamivudine or telbivudine treatment plus hepatoprotective medication, while those in control group were only given hepatoprotective medication.All pregnant women were observed for 12 weeks after childbirth and the neonates were followed-up for 6 months after birth.The liver function, HBV DNA loads, HBV serological markers were measured;adverse effects during pregnancy, blocking rates of mother-to-child transmission and the growth of neonates were documented.t test or Chi-square test was used for statistical analysis.Results Alanine aminotransferase ( ALT) normalization rate and HBV DNA negative rate in antiviral treatment group before childbirth were 88.6%(39/44) and 84.1%(37/44) , while those in the control group were 60.0%(18/30) and 0 (χ2 =8.27 and 50.46, P<0.05).After 12 weeks of childbirth, ALT normalization rate and HBV DNA negative rate in antiviral treatment group were both 100.0% (44/44), which were higher than those in control group (90.0%and 0) (χ2 =4.59 and 74.00, P<0.05).HBeAg seroconversion was observed in 1 (2.8%) and 4 (11.1%) patients in antiviral treatment group before and 12 weeks after childbirth, but it was not observed in the control group.The difference in HBeAg seroconversion rate bwteen two groups was not of statistical significance (P>0.05).No patient in antiviral treatment group terminated pregnancy due to abnormal liver function or adverse effect of drugs, while 2 out of 30 patients (6.7%) in the control group terminated the pregnancy, but the difference between two groups was not of statistical significance (χ2 =1.01, P >0.05).Mother-to-child transmission of HBV was successfully blocked in antiviral treatment group, while 3 cases (11.5%) in control group were failed (χ2 =5.19, P<0.05).No significant differences in gestational age, body mass, body length, Apgar score between two groups were observed (t=0.65, 0.84, 0.25 and 0.77, P>0.05).Conclusion Antiviral treatment can improve liver function, inhibit HBV replication and reduce the risk of mother-to-child transmission, and is safe for CHB patients in second trimester of pregnancy.

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Jia SHANG ; Xiaoyuan XU ; Xinyue CHEN ; Zhiliang GAO ; Guozhong GONG ; Yinong FENG ; Xiaoguang DOU ; Qing XIE ; Guofeng CHEN ; Ruifeng YANG ; Huiying RAO ; Lai WEI

Chinese Journal of Clinical Infectious Diseases.2015;12(3):232-237. doi:10.3760/cma.j.issn.1674-2397.2015.03.012

Objective To evaluate the efficacy of pegylated interferon ( PegIFN ) α-2a plus ribavirin ( RBV) therapy for chronic hepatitis C ( CHC) in non-responders, and to investigate the related influencing factors.Methods A prospective, open, multicenter and randomized study was conducted.A total of 81 CHC non-responders were recruited from 10 clinical centers during February 2009 to November 2011.Patients were randomly assigned into two groups:group A (n=37) was given PegIFNα-2a plus RBV treatment for 72 weeks and group B (n=44) was given PegIFNα-2a plus RBV treatment for 96 weeks.Both groups were followed up for 24 weeks after treatment.Virological responses in two groups were observed, and treatment efficacies among patients with different genotypes, and among those with different previous treatment were compared.SAS software was used for statistical analysis.Results Fifty-two patients ( 28 from group A and 24 from group B) completed the study in total.The rates of rapid virological response ( RVR) , complete early virological response ( cEVR ) , end of treatment viral response ( ETVR ) and sustained virological response (SVR) in group A were 25.0% (7/28), 60.7% (17/28), 67.9%(19/28) and 60.7%(17/28), respectively; while those in the group B were 41.7% (10/24), 70.8%(17/24), 70.8%(17/24) and 70.8% (17/24), respectively; and there were no significant differences between two groups (P>0.05).SVR was observed in 82.9%(29/35) of patients with CC genotype of IL-28B, which was higher than that in patients with other genotypes ( 3/13 ) , and the difference was of statistical significance (P<0.01).There was no significant difference in viral responses between patients previously treated with IFN plus RBV and those treated by IFN only (P>0.05).The rates of RVR, cEVR, ETVR and SVR in patients who were previously treated with IFN were 36.4%(12/33), 81.8%(27/33), 81.8%(27/33) and 75.8%(25/33), and the rates of cEVR, ETVR and SVR were higher than those in patients who were previously treated with PegIFN (P<0.05), but no significant difference was observed in RVR (P>0.05).Adverse events occurred in 38 patients (46.9%), but no severe ones were observed. Conclusion The efficacy of PegIFNα-2a plus RBV therapy for CHC in non-responders is satisfactory, which may influenced by IL-28B genotypes and previous treatment.

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Risk factors for fatality of Acinetobacter baumannii bloodstream infection

Kun LU ; Jing LI ; Jin LI ; Bin TIAN ; Yanchun LI ; Zhidong HU

Chinese Journal of Clinical Infectious Diseases.2014;7(5):401-404. doi:10.3760/cma.j.issn.1674-2397.2014.05.004

Objective To investigate the antibiotic resistance of Acinetobacter baumannii,and to identify the risk factors for fatality of Acinetobacter baumannii bloodstream infection.Methods A retrospective review was conducted on 80 patients with Acinetobacter baumannii bloodstream infections admitted in Tianjin General Hospital during January 2011 to May 2014.Clinical data including demographic information,the ward of stay,underlying diseases,treatment,invasive procedures,antibiotic resistance,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission were collected.Multivariate Logistic regression analysis was performed to identify the risk factors for fatality.Results There were ≥90％ strains resistant to ceftazidime,ceftriaxone and cefoxitin,and 66.3％ strains were resistant to imipenem.While most strains were sensitive to cefoperazone/shubatan and tigecycline,and the resistance rates were 7.5％ and 2.5％,respectively.ICU admission (OR =6.67,95％ CI:2.01-22.07,P ＜0.01),multi-drug resistance (OR =3.55,95％ CI:1.30-9.69,P ＜ 0.05),APACHE Ⅱ score ≥ 19 (OR =39.00,95％ CI:9.87-154.09,P ＜ 0.01),artery catheterization (OR =3.24,95％ CI:1.16-9.04,P ＜ 0.05),central venous catheterization (OR =3.33,95％ CI:1.22-9.12,P ＜ 0.05),tracheal catheterization (OR=3.60,95％CI:1.31-9.88,P＜0.05),tracheostomy (OR=3.21,95％CI:1.19-8.66,P＜0.05),and other invasive procedures (OR =3.00,95％ CI:1.11-8.08,P ＜ 0.05) were the risk factors for fatality.Conclusion Invasive procedures and multi-drug resistance are associated with increased fatality of patients with Acinetobacter baumannii bloodstream infection.

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Cross-sectional survey on nosocomial infections in Zhejiang Cancer Hospital in 2011 and 2012

Xiaoxian XU ; Xiaofang ZHOU ; Yuanming YU ; Yefang WU

Chinese Journal of Clinical Infectious Diseases.2014;7(5):405-408. doi:10.3760/cma.j.issn.1674-2397.2014.05.005

Objective To investigate the prevalence rate of nosocomial infections and the use of antibacterial agents in Zhejiang Cancer Hospital.Methods The cross-sectional survey on nosocomial infections was conducted among inpatients in Zhejiang Cancer Hospital on August 11,2011 and June 19,2012.The differences in prevalence rates of nosocomial infections,purposes of antibacterial agents use (for treatment,for prevention,or for both treatment and prevention),methods of medication (single or combined medication),and pathogen detections between 2011 and 2012 were analyzed with x2 test.Results There were 854 and 886 patients enrolled in the study in 2011 and 2012,and the prevalence rates of nosocomial infections were 5.27％ (45/854) and 5.08％ (45/886),respectively (x2 =0.186,P ＞ 0.05).Lower respiratory tract infection was the most common nosocomial infections both in 2011 and 2012,which accounted for 28.89％ and 36.96％ of all infections,respectively; and there was no significant difference in infection sites between 2011 and 2012 (x2 =1.415,P＞0.05).Totally 154 out of 854 patients (18.03％)in 2011 and 186 out of 886 patients (20.99％) in 2012 received antibacterial agents,and single medication was the most common.There were no significant differences in the purposes and methods of medication between 2011 and 2012 (x2 =1.994 and 3.042,P ＞ 0.05).Pathogen detections were performed in 56 out of 59 patients (94.92％) and 57 out of 65 patients (87.69％) who received antibacterial agents for treatment in 2011 and 2012,respectively.The most common pathogens were Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumanni.Conclusion The prevalence rate of nosocomial infection in Zhejiang Cancer Hospital is of the satisfactory level,which is due to the good management of antibacterial agents use.

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