Clinical burden of hepatitis E virus infection in a tertiary care center in Flanders, Belgium

Background: Hepatitis E virus (HEV) infection is increasingly recognized as a cause of hepatitis in developed countries. A high HEV IgG seroprevalence in humans and pigs is reported as well as sporadic clinical cases of autochtonous HEV but there are currently no data available on the clinical burden of HEV in Belgium. Objectives: The objective of the current study was to evaluate the actual clinical burden of HEV infections in our tertiary care center in Flanders, Belgium. Study design: In the setting of Ghent University Hospital, patients were assessed for the presence of HEV IgG and IgM as well as HEV RNA if no other cause was found for one of the following clinical presentations: a) elevation of liver enzymes in post-liver transplant; b) suspicion of acute or toxic hepatitis; c) unexplainable elevation of liver enzymes; d) cirrhosis with acute-on-chronic exacerbation. Results: In a period of 39 months (January 2011-April 2014) 71 patients were enrolled. HEV IgG was found positive in 13 (18,3%) patients; HEV IgM in 6 patients (8,5%) and HEV RNA in 4 (5,6%) patients. All HEV IgM/ RNA positive patients were male, aged 41-63, and classified in the clinical groups a), b) or d). HEV IgG seroprevalence was slightly higher but not significantly different from the seroprevalence in the general population in this region in Belgium previously reported to be 14% (p-value 0.41) by our group. Conclusions: HEV should be considered as a cause of liver pathology especially in middle-aged men with elevation of liver enzymes

The South African guidelines on enuresis-2017

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (beta 3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document. Conclusion: An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field

Evaluation of two new automated chemiluminescent assays (HemosIL® AcuStar HIT-IgG and HemosIL® AcuStar HIT-Ab) for the detection of heparin-induced antibodies in the diagnosis of heparin-induced thrombocytopenia

Introduction: Recently, two new, fully automated quantitative chemiluminescent immunoassays, the HemosIL (R) AcuStar HIT-IgG (PF4-H), specific for IgG anti-PF4/H antibodies, and the HemosIL (R) AcuStar HIT-Ab(PF4-H), detecting IgG, IgM and IgA anti-PF4/H antibodies, were introduced into the market. In this study, their performance was compared mutually and with the Zymutest HIA IgG and HIA IgGAM ELISA. Methods: Citrated plasmas from 87 patients with clinical suspicion of heparin-induced thrombocytopenia (HIT) were analyzed with all four assays and with a functional confirmation assay. Apart from the manufacturers cutoffs, optimalized cutoffs were evaluated as well. Results: Sensitivities of all assays were 100%. The Acustar HIT-IgG assay showed a higher specificity compared with the HIT-Ab assay (85%vs. 73%), using the manufacturers cutoffs. Specificities of all assays, except for the AcuStar HIT-IgG, could be significantly improved when altering the cutoff. Titers were significantly higher for the HIT-Ab assay compared with the HIT-IgG assay (P = 0.0001). This was also the case for the patients with confirmed HIT (P = 0.0495), indicating that the one cutoff (1.0 OD) for both Acustar assays, as proposed by the manufacturer, can be adapted for the AcuStar Hit-Ab assay resulting in an increased specificity. Conclusion: Performance characteristics of the Acustar HIT-IgG and HIT-Ab assay are comparable to the Zymutest HIA IgG and HIA IgGAM

Performance evaluation of a modified chromogenic medium, ChromID MRSA New, for the detection of methicillin-resistant Staphylococcus aureus from clinical specimens

A novel chromogenic medium for the detection of methicillin-resistant Staphylococcus aureus (MRSA), ChromID MRSA New, was evaluated and compared with the original ChromID MRSA agar, using 355 consecutive screening specimens from nose (120), throat (121) and perineum (114). The specimens were collected with an E-swab and inoculated within 24 hours onto both ChromID MRSA New and on ChromID MRSA. ChromID MRSA New was more sensitive than ChromID MRSA in detecting MRSA after 24 hours of incubation (94.3% versus 81.4%; p < 0.05). With the ChromID MRSA New, processing time is reduced from 48 h to 24 h and confirmation of the resistance to methicillin is redundant

Serological assessment of HEV in unexplained acute hepatitis

Background: Hepatitis E virus (HEV) infection is considered a rare cause of acute hepatitis in industrialized countries. However, this view is challenged by several reports of autochtonous hepatitis E in Western countries such as France, the Netherlands and the UK. No systematic analysis of HEV infection has been performed yet in Belgium. We therefore decided to retrospectively assess serological markers of HEV infection in cases of liver injury not due to infection with more common hepatotropic viruses. Methods: Frozen serum samples, collected in Ghent University Hospital between 2008 and 2010, were considered eligible for this study if an elevation in serum transaminases was present, if the patient had clinical evidence of acute hepatitis, if anti-HAV IgM, HBV surface antigen, anti-CMV IgM and anti-EBV IgM levels had been determined for routine diagnostic purposes (reflective of possible infectious origin of the hepatitis), and if these markers had been found to be negative. Cases with a clear explanation for the hepatitis were ruled out. Selected sera (n=25) were analyzed for the presence of anti-HEV IgM and anti-HEV IgG using a commercial ELISA method that has been reported to be more sensitive than other assays (Biorex Diagnostics). Results: Mean serum transaminase levels were 445 IU/L for ALT (range, 76-3202 IU/L) and 287 IU/L for AST (range, 30-1169 IU/L). Three out of the 25 samples had an increased anti-HEV IgG level, whereas none of the samples was positive for anti-HEV IgM. Conclusion: HEV infection is not a common cause of acute hepatitis in our study

Performance of two new, automated chemiluminescence assay panels for anticardiolipin and anti-beta2-glycoprotein I antibodies in the laboratory diagnosis of the antiphospholipid syndrome

Introduction : Anticardiolipin (aCL) and anti-beta 2-glycoprotein I (a beta(2)GPI) antibodies are two of the three laboratory criteria for antiphospholipid syndrome (APS). All assays for antiphospholipid antibodies (aPL), coagulation assays as well as ELISAs, show methodological shortcomings, which makes the search for better assays everlasting. The purpose of this study was to investigate the diagnostic performance of two new, fully automated systems (Zenit RA and HemosIL Acustar) applying chemiluminescent technology for aPL detection. Methods : The study cohort consisted of a patient population presenting with thrombosis. In such patient population, the demonstration of aPL determines whether a patient has APS or not with implications for treatment. One hundred and twenty-four patients with thrombotic complications, of whom 26 were patients with definite APS, were integrated in this study. Besides, aPL titres were compared to the Sapporo standards. Results : Results of both systems agreed well with ELISA and mutually. Analysis of the discrepant results between Zenit and Acustar finally led to one misclassification as APS. Conclusion : Diagnostic performances of both Zenit RA and HemosIL Acustar were comparable with odds ratios lower limits of CI of 5 for a beta(2)GPI IgG for Zenit and Acustar and 6 and 5 for aCl IgG on Zenit and Acustar, respectively. However, even with these new automated systems, titres differed largely between systems, especially for a beta(2)GPI IgG

Hepatitis E seroprevalence in East and West Flanders, Belgium

Background and study aim : Hepatitis E virus (HEV) infection is increasingly recognized as a cause of hepatitis in developed countries. The goal of this study is to provide an estimate of the seroprevalence of HEV in Belgium, more precisely in East and West Flanders, since data for this country are currently lacking. Patients and methods : One hundred patients presenting at the gynecological (mainly fertility center) or orthopedic clinics of our hospital were randomly selected to be tested for anti-HEV IgG antibodies using a sensitive indirect ELISA and, in the case of a borderline result, a strip immunoassay. Results : The anti-HEV IgG seroprevalence was found to be 14%. Conclusions : The observed seroprevalence rate suggests that HEV infection is not an uncommon occurrence in Belgium. Comparisons with published seroprevalence data of other Western European countries should be made with caution due to differences in the analytical performance of anti-HEY IgG assays

Hepatitis E seroprevalence in Belgium

Introduction: Hepatitis E virus (HEV) typically causes waterborne outbreaks of acute hepatitis in parts of the world with poor sanitation. However, HEV infection is now increasingly recognized as a cause of hepatitis in developed countries as well. This autochthonous hepatitis E is usually caused by genotype 3, which has been shown to have a high prevalence in pig populations worldwide and which may be transmitted zoonotically. Previous seroprevalence studies in Western Europe have yielded widely differing estimates, probably because of the variability in analytical performance of the assay used for detection of anti-HEV antibodies. The goal of this study is to provide an estimate of the seroprevalence of HEV in Belgium, since data for our country are currently lacking. Patients and methods: One hundred patients presenting to our hospital without gastroenterological problems were randomly selected to be tested for anti-HEV IgG antibodies. This was done using a sensitive indirect ELISA (Biorex, Antrim, United Kingdom) and, in the case of a borderline result, a strip immunoassay (Mikrogen, Neuried, Germany) for confirmation. Results: The anti-HEV IgG seroprevalence was found to be 14%. Discussion: Published seroprevalence rates of HEV in other Western European countries are as follows: 3.2% to 16.6% in France, 2.0% to 15.5% in Germany, 1.1% to 6.0% in the Netherlands, 5.3% to 16.2% in the UK and 0.8% to 7.3% in Spain. As pigs may serve as a reservoir for HEV infection in humans, we calculated pig/inhabitant ratios by dividing the number of pigs by the number of inhabitants for these countries (data from 2009). The pig/inhabitant ratio was 0.59 in Belgium, 0.23 in France, 0.33 in Germany, 0.73 in the Netherlands, 0.08 in the UK and 0.57 in Spain. It is clear from these data that a simple linear correlation between the seroprevalence of HEV and the pig/inhabitant ratio does not exist. However, it should be kept in mind that HEV seroprevalence rates from different studies are difficult to compare due to large differences in the analytical sensitivity of the available anti-HEV IgG assays. Conclusions: The observed seroprevalence rate suggests that HEV infection is not an uncommon event in Belgium. Comparisons with published seroprevalence data of other Western European countries should be made with caution due to differences in the analytical performance of anti-HEV IgG assays