Epstein-Barr virus (EBV) causes various acute and chronic diseases. Chronic active EBV infection (CAEBV) is characterized by infectious mononucleosis-like symptoms that persist for more than 6 months with high viral loads in peripheral blood and/or an unusual pattern of anti-EBV antibodies. Severe CAEBV is associated with poor prognosis with severe symptoms, an extremely high EBV-related antibody titer, and hematologic complications that often include hemophagocytic lymphohistiocytosis. However, CAEBV which led to the development of aplastic anemia (AA) has not been reported yet. A 73-year-old woman was admitted to our hospital with intermittent fever, general weakness and elevated liver enzymes. In the serologic test, EBV-related antibody titer was elevated, and real-time quantitative-PCR in peripheral blood showed viral loads exceeding 10(4) copies/microg DNA. Liver biopsy showed characteristic histopathological changes of EBV hepatitis and in situ hybridization with EBV-encoded RNA-1 was positive for EBV. Pancytopenia was detected in peripheral blood, and the bone marrow aspiration biopsy showed hypocellularity with replacement by adipocytes. AA progressed and the patient was treated with prednisolone but deceased 8 months after the diagnosis due to multiple organ failure and opportunistic infection. Herein, we report a rare case of severe CAEBV in an adult patient accompanied by AA and persistent hepatitis.
Aged ; Anemia, Aplastic/*complications ; Carbapenems/therapeutic use ; Chronic Disease ; DNA, Viral/blood ; Epstein-Barr Virus Infections/complications/*diagnosis/pathology ; Female ; Hepatitis/*complications ; Herpesvirus 4, Human/*genetics/isolation & purification ; Humans ; Real-Time Polymerase Chain Reaction ; Severity of Illness Index ; Urinary Tract Infections/drug therapy

BACKGROUND/AIMS: There was a spiking incidence of acute hepatitis A (AHA) in 2009 summer, but it went down drastically after an outbreak of influenza A (H1N1). We assessed the relationship between 2009 H1N1 pandemic and AHA prevalence from August to December 2009. METHODS: We compared AHA cases nationwide and in our hospital for the period from the latter half of 2008 to the end of 2010. H1N1 cases in our hospital from August 2009 to December 2009 were included in the study and the correlation between 2009 H1N1 pandemic and AHA prevalence was assessed. RESULTS: The national surveillance system reported 2,233, 7,895, 15,231 and 7,660 AHA cases from 2007 to 2010, respectively. A similar trend was noted in our hospital in the same periods. Although the national total incidence was increased in 2009, it showed steep decreasing trend line in the final 21 weeks of 2009 (weeks 32-52), as compared with 2008 and 2010. The mean weekly incidence percentage (AHA cases in a week/total in a year) in weeks 32-52 of 2009 was 1.17+/-0.55%, significantly lower than that in 2008 and 2010 (1.61+/-0.43% and 1.56+/-0.51%; p<0.001). Furthermore, we found a significant negative correlation between 2009 H1N1 pandemic and AHA in our hospital for weeks 32-52 of 2009 (r=-0.597; p<0.001). CONCLUSIONS: The widespread occurrence of 2009 H1N1 pandemic highlighted the benefits of health care and good hygiene, such as effective hand washing and wearing of masks, which may have also interrupted hepatitis A virus transmission.
Acute Disease ; Hepatitis A/*epidemiology ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/*epidemiology/virology ; Pandemics ; Prevalence ; Republic of Korea/epidemiology ; Seasons

No abstract available.
Hepatitis A/*epidemiology ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/*epidemiology

INTRODUCTIONSingapore has experienced remarkable socioeconomic progress over the last few decades, with a corresponding rise in standards of sanitation and living conditions. We undertook a study to describe its epidemiological trends of hepatitis A over the last 2 decades.

MATERIALS AND METHODSWe analysed the epidemiological data on all laboratory-confirmed cases of hepatitis A from 1990 to 2009. We also described 3 outbreaks which occurred in 1991, 1992 and 2002. To determine the changing prevalence of hepatitis A virus (HAV) infection, we compared the findings from a seroepidemiological study conducted in 1993 with earlier surveys in 1975 and 1984/1985.

RESULTSThe incidence of indigenous hepatitis A cases per 100,000 population declined significantly from 1.8 in 1989 to 0.7 in 2009, and more than half were imported. While majority of the imported cases were Singapore residents, the proportion of imported cases among Singapore residents had decreased significantly. Most of the Singapore residents contracted the disease from Southeast Asia and the Indian subcontinent. The overall prevalence of HAV infection in the population declined from 31.8% in 1984/85 to 25.9% in 1993.

CONCLUSIONThe incidence and seroprevalence of hepatitis A in Singapore are comparable to other developed countries. As Singapore is situated in a region highly endemic for HAV, it is very vulnerable to the introduction of the disease because of the high volume of regional travel and import of food, especially shellfish. While we note that there have been no further shellfish-associated outbreaks since 2002, sustained vigilance, strict control of food import by the authorities and public health education on the risk of consuming shellfish, especially cockles, raw and half-cooked, should be maintained.

Adolescent ; Adult ; Child ; Child, Preschool ; Disease Outbreaks ; Female ; Hepatitis A ; epidemiology ; etiology ; Hepatitis A Virus, Human ; isolation & purification ; Humans ; Immunoglobulin G ; immunology ; Infant ; Male ; Middle Aged ; Seroepidemiologic Studies ; Shellfish ; virology ; Singapore ; epidemiology ; Young Adult

OBJECTIVETo study the instructional significance of HBV-DNA load in maternal milk on breastfeeding of postpartum women infected with HBV.

METHODSHBV-DNA levels in serum and breast milk were detected by FQ-PCR in 152 postpartum women infected with HBV, and HBV-DNA ≥ 1.0 × 10(3) U/ml was defined as HBV positive. Correlation analysis was also conducted to estimate if there were relations in HBV levels in serum and breast milk.

RESULTSHBV-DNA positive rate were 50.66% (77/152) and 36.18% (55/152) in serum and breast milk, respectively. When HBeAg was positive, HBV-DNA positive rate were 95.38% (62/65) and 76.92% (50/65) in serum and breast milk; however when HBeAg was negative, HBV-DNA positive rate were 17.24% (15/87) and 5.75% (5/87) in serum and breast milk. When the concentration of HBV-DNA was 3-4 lg U/ml in serum, HBV-DNA positive rate was 20.00% (5/25) in breast milk; However, when the concentration of HBV-DNA was higher than 5 lg U/ml in serum, HBV-DNA positive rate was 96.15% (50/52) in breast milk.

CONCLUSIONThe HBV-DNA level in breast milk in postpartum women infected with HBV increased with the HBV-DNA levels in serum. Breastfeeding should be avoided when the concentration of HBV-DNA is higher than 1.0 × 10(3) U/ml in milk.

Adult ; Breast Feeding ; DNA, Viral ; isolation & purification ; Female ; Hepatitis B ; prevention & control ; transmission ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; Humans ; Infectious Disease Transmission, Vertical ; prevention & control ; Milk, Human ; virology ; Viral Load ; Young Adult

BACKGROUND: The safety of plasma derivatives has been reinforced since 1980s by variable pathogen inactivation or elimination techniques. Nucleic acid amplification test (NAT) for the source plasma has also been implemented worldwide. Recently nanofiltration has been used in some country for ensuring safety of plasma derivatives to eliminate non-enveloped viruses such as parvovirus B19 (B19V) and hepatitis A virus (HAV). We evaluated the efficacy of nanofiltration for the elimination of B19V and HAV. METHODS: To verify the efficacy of nanofiltration, we adopted a 20 nm Viresolve NFP (Millipore, USA) in the scaling down (1:1,370) model of the antithrombin III production. As virus stock solutions, we used B19V reactive plasma and porcine parvovirus (PPV) and HAV obtained from cell culture. And 50% tissue culture infectious dose was consumed as infectious dose. The methods used to evaluate the virus-elimination efficacy were reverse-transcriptase polymerase chain reaction for B19V and the cytopathic effect calculation after filtration for PPV and HAV. RESULTS: B19V was not detected by RT-PCR in the filtered antithrombin III solutions with initial viral load of 6.42x10(5) IU/mL and 1.42x10(5) IU/mL before filtration. The virus-elimination efficacy of nanofiltration for PPV and HAV were > or =10(3.32) and > or =10(3.31), respectively. CONCLUSIONS: Nanofiltration would be an effective method for the elimination of B19V and HAV. It may be used as a substitute for NAT screening of these viruses in source plasma to ensure safety of plasma derivatives in Korea.
Antithrombin III/isolation & purification ; DNA, Viral/analysis ; Filtration/*methods ; Hepatitis A virus/genetics/*isolation & purification ; Humans ; Nanotechnology/*methods ; Parvovirus B19, Human/genetics/*isolation & purification ; RNA, Viral/analysis ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUND: In previous studies, most hepatitis A virus (HAV) isolates had been genotype IA in Korea. Recently, a small number of different genotypes were reported with an upsurge of acute hepatitis by HAV. We investigated the distribution of HAV genotypes. METHODS: RNA was extracted from anti-HAV IgM positive sera which were collected from March 2007 to February 2008 at a tertiary care hospital in Northeastern Seoul, Korea. Nested reverse transcription (RT)-PCR and direct sequencing for VP1/P2A region of the HAV were performed. RESULTS: A total of 699 cases with suspected acute hepatitis were tested for anti-HAV IgM, and positive results were obtained in 56 sera (8.0%), which were collected 2 to 15 days (median, 7 days)after the onset of symptoms. Of the 56 seropositive samples, 52 (92.9%) were positive for HAV RNA, among which 28 isolates (53.8%) belonged to genotype IA and the remaining 24 (46.2%) belonged to genotype IIIA. Both IA and IIIA genotypes were isolated from 6-7 neighboring administrative districts throughout the year without geographic or seasonal restrictions. CONCLUSIONS: Co-circulation of two distinct HAV genotypes (IA and IIIA) was observed from the northeastern Seoul for the year studied.
Adolescent ; Adult ; Amino Acid Sequence ; Child ; Female ; Genotype ; Hepatitis A/*virology ; Hepatitis A Virus, Human/classification/*genetics/isolation & purification ; Humans ; Immunoglobulin M/blood ; Korea ; Male ; Middle Aged ; Molecular Sequence Data ; Phylogeny ; RNA, Viral/analysis ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Viral Structural Proteins/genetics ; Young Adult

Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the flaviviridae family, and this virus is transmitted by the bite of the mosquito Aedes aegypti. It occurs in the tropical climates of the South Pacific, Southeast Asia, India, Africa and the subtropical zone of America. Imported cases of Dengue fever and Dengue hemorrhagic fever are rapidly increasing as many Koreans are now traveling abroad. Liver injury is usually detected by laboratory investigation according to a surveillance protocol. Although liver injury by dengue virus has been described in Asia and the Pacific islands, the pathogenic mechanisms are not yet fully clarified. It is usually expressed in a self-limiting pattern and the patient has a complete recovery. We report here on a case of a young woman who presented with general weakness, nausea and significant elevation of the aminotransferase levels, and she was diagnosed with dengue fever.
Acute Disease ; Adult ; Dengue Hemorrhagic Fever/complications/*diagnosis/virology ; Dengue Virus/*isolation & purification ; Female ; Hepatitis, Viral, Human/*diagnosis/virology ; Humans

Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme disorder worldwide, it has rarely been reported among Korean. The patient was previously healthy 39 yr old male who showed severe hemolytic anemia and acute renal failure accompanied by hyperbilirubinemia after hepatitis A infection. The additional studies for differential diagnosis of hemolytic anemia showed a moderate deficiency of G6PD enzyme. Because hepatitis A infection in patient with G6PD deficiency present much more severe clinical symptoms, G6PD enzyme should be examined in patients with triggering factors of hemolysis such as hepatitis A infection.
Adult ; Diagnosis, Differential ; Glucosephosphate Dehydrogenase/genetics ; Glucosephosphate Dehydrogenase Deficiency/*complications/diagnosis ; *Hemolysis ; Hepatitis A/*complications/diagnosis ; Hepatitis A Virus, Human/isolation & purification ; Humans ; Hyperbilirubinemia/etiology ; Kidney Failure, Acute/*diagnosis/etiology ; Male

HSP70 Heat-Shock Proteins ; analysis ; Hemorrhagic Fever with Renal Syndrome ; metabolism ; pathology ; Hepatitis Antigens ; analysis ; Hepatitis, Viral, Human ; immunology ; pathology ; Humans ; SARS Virus ; isolation & purification ; Severe Acute Respiratory Syndrome ; pathology ; virology