Gilberta Bensabath

Hepatitis D and B virus genotypes in chronically infected patients from the Eastern Amazon Basin

Hepatitis D virus (HDV) is a defective hepatotropic virus whose infectivity is dependent on hepatitis B virus (HBV). HDV super- or co-infection leads to an increased risk of fulminant hepatitis or progression to severe chronic liver disease in HBV infected patients. The Brazilian Amazon Basin has been reported to be endemic for HBV and HDV, especially in the Western Amazon Basin. In this region, HDV infection is frequently associated with acute fulminant hepatitis with characteristic histologic features. HDV is classified into seven major clades (HDV-1 to HDV-7) and HBV is subdivided into eight genotypes (A-H). HDV and HBV genotypes have been shown to have a distinct geographic distribution. The aim of this study was to determine the HBV and HDV genotypes harbored by chronically infected patients from the Eastern Amazon Basin, Brazil. We studied 17 serum samples from HBV and HDV chronically infected patients admitted to a large public hospital (Santa Casa de Misericórdia) at Belém, state of Pará, Brazil, between 1994 and 2002. HDV-3 and HBV genotype A (subtype adw2) have been identified in all cases, in contrast to previous studies from other regions of the Amazon, where HBV genotype F has been found co-infecting patients that harbored HDV-3. The HDV-3/HBV-A co-infection suggests that there is not a specific interaction between HBV and HDV genotypes, and co-infection might merely reflect the most frequent genotypes found in a particular geographic area. The analysis of the carboxy-terminal region of the large hepatitis D antigen (L-HDAg), which interacts with the hepatitis B surface antigen (HBsAg) and is essential for HDV assembly, showed some diversity between the different isolates from the Eastern Amazon. This diversity is not observed among HDV-3 sequences from other South American regions.

Amapari, a New Virus of the Tacaribe Group from Rodents and Mites of Amapa Territory, Brazil.

Summary Amaparí virus is a new member of the Tacaribe virus group which has been isolated on 5 occasions at Serra do Navio, Amapá Territory, Brazil, during 1964 and 1965. One strain was recovered from organs of Neacomys, 3 from organs of Oryzomys and 1 from mites combed from Oryzomys. The new virus is closely related in complement-fixation (CF) testing to the other 3 members of the group—Tacaribe, Junín and Machupo—but differs from them in neutralization testing. Limited studies revealed no neutralizing antibody in sera of human residents of Serra do Navio. Oryzomys captured in the area had CF but not neutralizing antibody.

Infecções pelos vírus das hepatites B e C e o carcinoma hepatocelular na Amazônia oriental

Com o objetivo de contribuir para um melhor conhecimento do envolvimento das infeccoes pelos virus das hepatites B e C, na etioepidemiologia do CHC na Amazonia Oriental, estudou-se 36 pacientes em Belem-PA. Foram avaliados marcadores sorologicos e a pesquisa do HBV-DNA e HCV-RNA pela reacao em cadeia da polimerase. Observou-se etilismo em 33,3% e cirrose em 83,3%. Marcadores sorologicos das infeccoes pelo HBV e HCV foram encontrados respectivamente em 88,9% e 8,3%. O HBsAg foi encontrado em 58,3%; anti-HBc em 86%; anti-HBe em 85,7; HBeAg em 9,5%; anti-HBc IgM em 57,1%. O HBV-DNA foi detectado em 37,7% e em 65% dos HBsAg positivos; o HCV-RNA em 8,5% e em 100% dos anti-HCV positivos. AFP esteve alterada em 88,9% e acima de 400ng/ml em 75% dos casos. Conclui-se que a infeccao pelo HBV parece ter importância na etiologia do CHC e ressalta-se a importância de implementar programas de vacinacao e deteccao precoce do tumor.

A evolução do conhecimento sobre as hepatites virais na região amazônica: da epidemiologia e etiologia à prevenção

Since the 1950 years a disease similar to yellow fever but thought to be a new disease with unknown etiology has been described to health and researcher authorities. This disease occurs in Jurua, Purus and Madeira Rivers valleys. It is feared by local people by its high lethality. It is clinically a hepato-encephalopathy (Average survival time of 5-6 days) About 90% of sick people with typical symptoms go to death. The disease is popularly known as black fever of Lábrea and by pathologist as Lábrea hepatites after the city where the first cases were observed. The specific histopatologic picture of vesicular degeneration of hepatocytes like spider cells motivate the local pathologist to think as a new disease: Lábrea hepatitis. The finding of HBsAg and marker of hepatites D virus (HDV) in the serum motivate the researchers to think the disease as a superinfection of HDV in chronic carriers of HBV. In absence of a specific vaccine against HDV, the vaccine against HBV, must be given soon after the birth is the recommended prevention.

TRANFUSION-TRANSMITED VIRUS (TTV) IN BRAZIL. PRELIMINARY REPORT

TTV is a recently discovered DNA virus, isolated from a patient with post-transfusion hepatitis of unknown etiology by Japanese researchers. In the present study, we evaluated the presence of TTV among chronic liver diseases patients in São Paulo and Pará states, representing two geographically distinct Brazilian regions. TTV DNA was found in 21/105 (20%) and 9/20 (45%) cases from São Paulo and Pará States, respectively. DNA sequence data confirmed the presence of TTV genotypes 1a and 2a, as well as other genotypes not yet described. In conclusion, TTV is present in chronic liver diseases cases from Southeast and North Brazil. However, further studies involving healthy populations are necessary before establishing any causal relationship among TTV and human hepatitis.

Arbovirus antibodies in children of rural Guanabara, Brazil.

School children living in Guanabara State, Brazil, have been tested for evidence of infection with 16 arboviruses. 3 percent were positive, and in every instance the positive reaction was attributable to St. Louis encephalitis (SLE) virus. Evidence of familial aggregation was observed.

Hepatitis C virus (HCV) in children and adolescent hemophiliacs

OBJECTIVE: To evaluate the prevalence of infection by HCV among hemophiliacs in the State of Pará (Brazil), and its possible relation to hepatic enzymes serum level, type of hemophilia involved, age, level of severity, kinds and combinations of treatment, as well as date in which treatment with hemoderivates was started.METHODS: Cross-sectional epidemiological investigation, analyzing 62 hemophilic patients of the Centro de Hemoterapia do Pará (HEMOPA), all born after 01/01/80, by means of the review of the medical records, physical examination and laboratory tests: Anti-HCV (ELISA 3.0), polymerase chain reaction - PCR - (HCV-RNA), and dosage of transaminases serum levels. Statistical analysis was carried out using Chi-square and Fishers Exact Test, the results being considered significant if p</=0.05.RESULTS: Out of the 62 patients analyzed, 48.4% (n=30) were HCV positive. Among these patients, 43.3% (n=13) presented viraemia with detection of viral RNA using the PCR technique. HCV infection was related to the condition beginning of treatment before 1993 (p=0.0005); the type of hemophilia, being type A more frequent (p=0.028); the level of severity, with higher frequency in the moderate condition (p=0.026); and age, with higher frequency among those who were older than 5 years of age (p=0.025).CONCLUSION: Infection by HCV among hemophiliacs in the State of Pará is high (48.4%) and was related to the beginning of the treatment before 1993, when obligatory serological trial for HCV was introduced in Brazilian blood banks. It is also significantly more frequent in children over five, with type A hemophilia of moderate gravity.

Hepatitis B virus surface antigen (HBsAg) and antibody (anti-HBs) forming immune complexes in fulminant hepatitis

This paper reports an unusual pattern of serological HBV markers and the presence of HBsAg/anti-HBs immune complexes in serum samples from two patients with fulminant hepatitis from the Brazilian Western Amazon Basin. The diagnosis was made by both serologic tests and demonstration of antigen/antibody complexes by transmission electron microscopy. Concurrent Delta virus superinfection is also discussed.

Presença de anticorpos para o vírus da hepatite a em didelphis marsupials (Vertebrata. Marsupialia) da Amazônia

Anti-HAV was detected by enzyme - immunoassay in sera collected from 6 (18,75%) of 32 Didelphis marsupialis trapped in the Amazon region. No anti-HAV were found in the sera from 136 other wild animals, including small rodents, reptiles and other marsupials.