Search

Objective: The purpose of this randomized multicentric study was to evaluate the diagnostic contribution of screening for HCV infection on saliva samples in day-to-day practice in the intravenous drug-user (IVDU) population., Methods: Between January and May 2004, 274 presumably HCV-negative IVDU were screened for HCV infection in 15 centers in France (median age 29 years). After centralized randomization, screening tests were performed on blood samples (arm A) or saliva samples (arm B). Screening tests were performed in 78 subjects (28%) had never been screened before and in 196 subjects (72%) who had had a negative HCV screening test on average 12 months prior to the beginning of the study. In the event of a positive saliva test for anti-HCV Ab, a serum test for anti-HCV Ab was performed. In the event of a positive serum test for anti-HCV Ab, PCR was performed on serum to measure HCV-RNA., Results: Fourteen individuals were positive for HCV RNA (7 in each arm). Six of these cases had not been detected before. In eight cases, the median time between the last negative screening test and study inclusion was 11 months (range 6-94 months)., Conclusions: Viremia tests were positive in 5% percent of the target population, although one-third of the individuals in arm A (blood samples) were not tested. The saliva test may be a useful alternative in the event of refusal of a blood test or when poor venous conditions compromise venous puncture. A confirmatory blood test still remains difficult to obtain in nearly half of patients.

A pregnant woman presented at 32 weeks of amenorrhea with jaundice secondary to acute hepatitis C. Spontaneous delivery took place 3 days later. The infant's serum tested negative for C viral RNA 6 months after delivery. Treatment with high doses of interferon-alpha for a period of 4 weeks was begun 4 days after delivery. Although a virological response was noted at the end of the treatment, the hepatitis relapsed and progressed toward chronicity. Case reports of acute hepatitis C during pregnancy are very rare, as the methods used for the follow-up of pregnant women render the diagnosis of asymptomatic forms difficult. In one case, the acute hepatitis C was severe. The occurrence of acute hepatitis C during pregnancy seems to increase the risk of premature delivery, but not that of vertical transmission. Given the frequency of side effects, it seems preferable not to begin interferon treatment until after delivery.

Digestive side effects associated with interferon and ribavirin in the treatment of chronic hepatitis C seem to be non specific. So far, inflammatory bowel diseases have only been rarely described in this context. We report two cases of Crohn's disease which occurred a few months after interferon and ribavirin treatment for chronic hepatitis C. The first case was a 43 year old man treated for 7 months with a interferon and ribavirin combination for chronic hepatitis C who experienced colitis related to Crohn's disease, with the occurrence of articular and cutaneous manifestations. The second case was a 43 year old women treated for 8 months with a pegylated interferon and ribavirin combination for chronic hepatitis C who developed Crohn's disease with right ileo-colic topography and severe evolution requiring an ileo-coecal resection because of the failure of medical treatment. The alpha interferon used for its antiviral action against hepatitis C virus, has complex immuno-modulation effects which could reveal latent Crohn's disease.

Aim: The purpose of this study was to evaluate the efficacy of anti-hepatitis C virus (HCV) antibody detection in the saliva samples of 108 drug users in an inter-laboratory study., Methods: Between January and June 2001, 108 subjects in Lille, Metz and Lens received a test to detect anti-HCV antibodies in their saliva. Two consecutive saliva samples were taken in each subject (Salivette system, Sarstedt). An HCV serology (Axsym HCV 3.0, Abbott) was also performed and serum HCV RNA detection by Amplicor HCV 2.0 (Roche) was performed when HCV serology was positive. Sixty three patients had a negative HCV serology, 45 had a positive HCV serology, and 31 of these had positive HCV RNA as well. Tests for the detection of the anti HCV antibody in saliva samples were performed as a blind study in both the Lille and the Thionville laboratories., Results: The sensitivity of saliva anti-HCV antibody tests was respectively 71% (32/45) and 78% (35/45) in Lille and Thionville. In the event of positive HCV viremia, the sensitivity was respectively 90% (28/31) and 93% (29/31). The specificity was respectively 97% (61/63) and 98.5% (62/63). Results from the two laboratories agreed for 101 saliva tests while discrepancies were found in 7 (Kappa Concordance Coefficient: 0.85)., Conclusions: This study confirms, in a large, unselected population sample, that anti-HCV antibody detection tests in saliva allow the detection of 90% of viremic HCV-antibody-positive patients with excellent specificity. The simplicity and reproductibility of this technique makes it a precious tool for epidemiological studies.

Colonic lymphoma is a rare complication of ulcerative colitis. We report two cases of B cell colonic lymphoma occurring in two patients who had a left-sided ulcerative colitis for 7 and 24 years respectively. The diagnosis was made during surgery in one case and at colonoscopy in the other. Complete remission was achieved after surgery and chemotherapy with a 8-year and 15-month follow-up respectively.

Objectives: The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users., Methods and Results: Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8)., Conclusions: This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

Jejunal secretion of albumin, immunoglobulins and secretory component was studied using the segmental perfusion technique with an occluding balloon, in two patients with common variable hypogammaglobulinemia and one patient with selective immunoglobulin A deficiency. Results were compared with those of twenty-two controls previously studied under the same conditions. In all three cases, jejunal secretion rate of immunoglobulin A was nil and secretion rates of albumin and immunoglobulin G were increased as compared to controls. Jejunal secretion rate of immunoglobulin M was increased in the patient with selective immunoglobulin A deficiency, normal in one case of common variable hypogammaglobulinemia and almost nil in the other case. Secretory component was secreted in the jejunal lumen mostly or exclusively under a free form depending on partial or total absence of immunoglobulin A and M. This study allowed to confirm in vivo that secretion of secretory component is independent of the presence of immunoglobulins. Intestinal perfusion might be a useful tool in the investigation of immunological diseases of the intestinal tract.

A case of Peutz-Jeghers syndrome associated with ovarian mucinous cystadenoma and ovarian sex cord tumor with annular tubules is presented. The sec cord tumor with annular tubules was described in 1970 by Scully, who recognized its striking association with the Peutz-Jeghers syndrome. This tumor is an almost constant finding in patients' ovaries with this disorder. Three cases of ovarian mucinous cystadenoma and sex cord tumor with annular tubules associated with Peutz-Jeghers syndrome were found in the literature. Our observation confirms that gynecologic abnormalities are an important manifestation of the syndrome and require careful surveillance.