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Background: HCV infection represents the major cause of chronic liver disease in hemodialysis and renal transplant patients. The clinical course of liver disease in hemodialysis patients is generally asymptomatic. Only few studies describe the natural history of HCV infection in haemodialysis patients, showing an association between HCV infections and poor survival., Methods: A prospective cohort study of our haemodialysis population was conducted to define the natural history of HCV infection and its relation to mortality. 77 patients on haemodialysis were enrolled, 24 (31%) of whom were anti-HCV and 53 (69%) anti-HCV-negative., Results: The HCV-RNA was positive in 18 of the 24 anti-HCV-positive subjects (75%). None of the anti-HCV-negative subjects was HCV-RNA-positive. Eight of the 18 HCV-RNA-positive patients (40%) developed cirrhosis with portal hypertension and ascites within 7 years after the first increase of GPT. Seven of these died, nobody developed hepatocarcinoma (HCC). During 58+/-37-follow-up months mortality rate was higher among anti-HCV-positive patients than among anti-HCV-negative. Besides, the 6 deaths occurred only among anti-HCV-positive and HCV-RNA-positive patients., Conclusion: in our haemodialysis patient population the presence of antibodies anti-HCV and HCV-RNA is associated with an increased risk of developing liver cirrhosis and of death, in comparison to anti-HCV-negative patients. Our data show that anti-HCV-positive patients have an accelerated course towards chronic hepatopathy and cirrhosis.

Recurrent aphthous stomatitis is a frequently occurring disorder which may be a clinical feature of systemic disease. For many other patients, it is a tedious problem often having no known cause. The aim of this study was to verify if immune responses to common foods and/or viruses are involved in the etiopathogenesis of recurrent aphthous stomatitis. Sixteen patients with this disorder were studied by measurement of immunoglobulin classes (IgG, IgA, IgM), blood lymphocyte subpopulations, blood circulating immune complexes, and complement fractions (C3 and C4). Intradermal skin tests for common food and inhalant allergens were performed in all cases. In 5 patients with positive skin tests, serum specific IgE were tested for the same allergens by radioallergosorbent test. Skin patch tests for dental material were performed in all cases. Oral mucosal biopsies and/or cytology samples were taken in 10 cases for histopathological evaluation and in situ hybridization for Papillomavirus, Cytomegalovirus, Herpes simplex virus I and II, Epstein Barr virus. In 13 patients, lymphocyte subpopulations were altered, with a reduced CD4/CD8 ratio. No other alterations of serum immunological parameters were observed. Skin patch tests for dental material were negative in all cases, while skin tests for food allergens were positive in 5 cases (not confirmed by radioallergosorbent test or food challenge tests). Virus antigen and DNA were not found in mucosal specimens, although one patient was positive for Epstein Barr virus DNA by in situ hybridization. An alteration of the CD4/CD8 ratio was demonstrated in most of the patients with recurrent aphthous stomatitis, although immune responses to food and/or dental material and/or common viruses did not seem to be involved in the etiopathogenesis of this disorder.

Human papilloma virus (HPV) may have an important role in oral carcinoma etiology. Our work compares the presence of HPV in the epithelium of oral mucosa of patients with oral carcinoma with other factors of risk (smoking, alcohol, chronic mucosal trauma). We studied 33 patients operated for oral cancer at St. Salvatore Hospital in l'Aquila, in January-December 1990. The presence of HPV was proved by a direct valuation of morphological signs (coilocytosis, nuclear inclusions, etc.) and by immunohistochemical technique with primary antibodies against structural virus antigens. Among the 33 patients 19 (57.6%) were positive for HPV and 14 (42.4%) were negative. Among the HPV positive subjects 13 were smokers, 11 usually assumed alcohol and 6 had chronic mucosal trauma. Among the HPV negative subjects 9 were smokers, 7 assumed alcohol and 3 had chronic mucosal trauma. The statistical evaluation of data showed the lack of significance of viral infection compared to other factors of risk. In spite of a few cases examined, we suppose that HPV doesn't play a primary role in oral cancerogenesis, but is a concomitant cause with other factors of risk.

The paper reports a case of HSVE observed in a 46-year-old patient with a negative anamnesis for previous HSV infection and with no objective signs of herpetic muco-cutaneous infection at time of hospitalisation. Due to the impossibility of carrying out bioptic and cultural tests, the diagnosis was based on the increased levels of specific anti-HSV1 antibodies in the liquor; these findings were compared to those found in serum, taking into account the increased antibody titres and in particular the ratio between the level of liquor and serum albumin and that of specific antibodies in both liquor and serum. The diagnostic importance of cerebral CT was confirmed by the early revelation of morphostructural alterations during the acute phase. RMN also allowed a more detailed imaging diagnosis to be made. From a therapeutic point of view, the paper confirms the value of acyclovir treatment.

In this work the Authors describe the case of a 16-month-old child, who presented neuraxitis infection of cerebellum, during exanthem subitum. From the present etiological considerations about exanthem subitum, referable to human herpes virus type 6, the Authors stress the usefulness of executing the dosage of anti-HHV6 antibodies in all the cases of exanthem subitum and in all febrile convulsions, because it is possible to have atypical clinic forms of VI disease, without exanthem.

This paper reports data concerning the immune status of 252 pregnant women with regard to rubella infection. The inverse haemagglutination was used to titrate rubella virus-antibodies and it was carried out for each pregnant woman on two blood samples, collected at three weeks' interval. Thirty-nine of the 252 pregnant women (15.50%) contracted the infection in the first trimester of pregnancy. Fifty-seven women (22.60%) showed a low degree of protection against the infection while only forty-five women had a protective rubella virus-antibody titre. Finally, 111 of the 252 (44.60%) pregnant women were rubella virus seronegative and therefore susceptible to the infection.

Congenital CMV infection occurs frequently as a consequence of primary maternal CMV infection during pregnancy: clinical abnormalities are present at birth or may become apparent later in about 25% of infected infants. Transmission of CMV to the fetus occurs less frequently as a consequence of CMV reactivation in immune mothers, and is rarely associated with clinical manifestations at birth or long-term sequelae. The incidence of congenital CMV infection can be reduced by avoiding primary infection during pregnancy and knowledge of the epidemiology of CMV infection allows physicians to inform pregnant women on major risk factors. Since vaccination of nonimmune women could prevent congenital disease, the development of a suitable and safe CMV vaccine would be desirable. New anti-viral agents with anti-CMV activity are expected to be lifesaving in infants with disseminated visceral disease; moreover, if safe, they could be used to treat CMV disease prenatally. If effective anti-CMV drugs were available the development of simple, rapid and inexpensive methods for the early diagnosis of congenital CMV infection would become more urgent. Instruction of parents, family doctors and all those involved in child care can improve prevention of congenital CMV infection.

Enteric infections in childhood are estimated to be a primary cause of illness and death in the third world and Rotaviruses play a very important role in acute nonbacterial diarrheal enterocolitis. The Authors analyse the latest results of the direct investigation of the virus in the feces by ELISA method. The improvements in diagnostic techniques and the new knowledges about Rotaviruses and their pathogenic power acquired during the last decade have made it easier to know the consequences of Rotavirus infections particularly in the poorest countries, with very bad sanitary conditions. Much attention has therefore been paid to the study of dietetics and immunoprophylaxis in order to find the most suitable cure. At present only some vaccines of animal origin are available that many Authors consider to be harmless, and that, might hopefully be employed in the third world countries.

Thirty patients with congestive cardiomyopathy (C.C.) have been studied for the prevalence of neutralizing antibodies to coxsackie B viruses in comparison with age and sex matched controls. Seropositivity toward each antigen was similar in cases and controls: an exception was coxsackie B5 virus, where a significantly seropositivity was found in the control group. As a whole, high antibody titers to any antigen were observed more frequently on sera of cardiopathic patients; however the difference between cases and controls of g.m.t. to each antigen tested was not statistically significant, with the exception of coxsackie B1 virus. The absence of a clear relationship between C.C. and viral infections might be explained through biological as well as epidemiological considerations; of particular relevance, the long duration of cardiac disease (average length 71 months, median 54). Final considerations are offered regarding the methodologic approach for a better understanding of the etiology of this elusive disease.

Acute-and convalescent-phase sera from 22 children were examined by ELISA in comparison with a routine complement fixation (CF) test for detection of anti-CMV antibodies. All these subjects were excreting CMV from urine and/or saliva. The results showed that ELISA is more sensitive than CF test. Particularly ten children showed, by ELISA, anti-CMV antibody titers more agreeing with clinical-virological features. Generally, in other subjects the results of the two serological tests were similar. Three cases showed discordances both between the two methods and between serological data and clinical virological findings.

In 38.6% of 88 patients without anamnesis of alcoholism and/or chronic exposure to hepatotoxic drugs, selected among 120 cirrhotic subjects subsequently observed, the illness was HBV related. Markers indicating active viral replication (anti-HBc, HBsAg, HBeAg or anti-HBe) were detected in 48% of patients with active cirrhosis, and in 26% with inactive cirrhosis. It is suggested that high titers of CF antibodies anti-HSV and anti-CMV observed in several patients, indicate either reactivation of latent infections or over-infections. The absence of alcoholism and/or chronic exposure to hepatotoxic drugs, and the absence of viral markers, suggest in 61% of the 88 cirrhotic subjects either a nonA-nonB viruses etiology of the illness, or other etiological factors that escape available diagnostic and prophylactic procedures.

The authors have looked for the markers of HBV by R.I.A. method (HBsAg, anti HBsAg, HBeAg, anti HBeAg, anti HBcAg), of HAV (by measurement on two samples of HAVab or by measurement of HAVab IgM), the immune-complexes (I.C.C.) by C1q solid-phase binding assay method with E.L.I.S.A. with determination after division I.C.C. of HBsAg by R.I.A. method in 33 cases of HBsAg negative acute viral hepatitis. The 9% (3 cases) were HAV acute hepatitis, the 42,4% (14 cases) no A no B acute hepatitis, the 36,3% (12 case) were HBV acute hepatitis, in 9 anti HBcAg positive cases the I.C.C. with HBsAg positive after division resulted positive, the 12,3% (4 cases) had a positivity for HAVab by stereoconversion (2 cases) or HAVab IgM (2 cases) with HBsAg positivity after division I.C.C. This result puts a nosologic problem about the 4 cases of acute viral hepatitis, which, from epidemiological and clinical point of the view are HAV acute hepatitis.

The authors review the epidemiologic and etiopathogenetic aspects of AIDS, in agreement with data published in december by the Center for Disease Control and by the WHO for the States, Europe and Italy. In their experience twenty-one patients, with clinical clues of AIDS, undergoing lymph node biopsy, have been analysed (18 LAS-ARC and 3 AIDS) and the role of prophylaxis for the surgical approach to the patient with aids or related syndrome has been underlined.

The behaviour of anti-HAV antibodies was studied in the following conditions: a) a sample group of 2645 subjects from a healthy population; b) a group of 32 subjects with previous HB-Ag negative viral hepatitis; c) 12 cases of acute virus A hepatitis; d) a group of 18 anti-HAV positive women at the end of their pregnancies the antibodies were thus also studied in the funicular blood and in the newborn babies. The results showed: a) high reactivity (78%) of the healthy population to anti-HAV's; b) the possibility of an a posteriori diagnosis of virus A hepatitis in the presence of serology, negative for B type hepatitis, and positive for the anti-HAV's but with a titre higher than 1:200; c) the possibility of a serological diagnosis of acute virus A hepatitis in the presence of serology, negative for B type hepatitis and positive for the anti-HAV's with high and progressively increasing titre; d) the possibility of anti-HAV antibodies passing from mother to foetus, and the rapid elimination of the antibodies by the newborn baby within a month of his birth.

The prevalence of serum HBsAg and Anti-HBs was studied in 201 staff members from two Renal Dialysis Units, one Medical and one Dermatological Division from two Hospitals in the Milano area. The overall prevalence of HBsAg was significantly greater among staff members (8.9%) as compared to controls (4.9%). On the contrary, the prevalence of Anti-HBs was only slightly higher in hospital personnel than in controls. Non-medical staff members (nurses, technicians) showed a prevalence of HBV markers (HBsAg and/or Anti-HBs) twice as high as medical staff members (46.1% vs 23.2%). When the prevalence of HBV markers was correlated to the duration of work in the hospital, a steady increase in the prevalence of Anti-HBs was observed. On the contrary, the prevalence of HBsAg rose in the first 3 years and remained constant thereafter. The prevalence of HBV markers was significantly higher among staff members from Renal Dialysis Units (HBsAg+ and/or Anti-HBs+:50%) than in the personnel from the Medical and Dermatological Divisions (32.4%). However, the difference was solely related to a higher prevalence of Anti-HBs in the former (42% vs 23%). This may reflect a higher risk of infection in Dialysis Units as compared to other Hospital Divisions. However, the difference might be magnified by the frequent use of HBIG in the Dialysis Units personnel.

Three new rapid immunological tests (ELISA, hemolisis-in-gel, single-radial-complement-fixation) have been applied for detecting antibodies in 200 sera against widespread virus infections. Results were compared with those of complement fixation and hemagglutination inhibition tests and good correlation was found. The new tests are simple to perform, rapid, sensitive and could be well suited for screening of large number of serum samples.

The Authors describe the two years follow up of complement fixing antibodies vs 4 viral antigens (Herpes simplex, Herpes zoster, Cytomegalovirus, respiratory syncytial virus, Mycoplasma pneumoniae). They evaluate the seasonal trend and the eventual clinical correlations on 3267 sera and 254 spinal fluids from hospitalized patients.

Here is referred the case history of a boy - age 6 yrs - who was hospitalised for a persistent high temperature with generalised limphonodes hypertrophy. The limphonode biopsy together with decreased NK activity and increased antiEAD and antiVCA antibodies allowed the diagnosis of chronic mononucleosis.

53%, and 29.8% respectively, of a sample of 500 adults living in Turin have been shown lacking of any antibody against A/Victoria/3/75 and B/Hong Kong/8/73 influenza strains; less than 20%, and 45.4% respectively, possessed antibodies at a protective level (greater than or equal to 1:40). Furthermore, the study of age distribution of immunity against A/New Jersey/76 has confirmed specific h.a.i. antibodies to be present, at a significant level, only from the sixth decade onwards.

Following a rubella epidemic in 1977; 1,133 samples of umbilical cord blood and 532 samples of maternal blood were assayed for specific anti-rubella haemoagglutino-inhibiting antibodies and IgM. Clinical follow-up failed to show either any increase in number of malformations and of IgM values in the malformed, or variations of mean weight and of the number of small-for-date infants. In none out of 1.031 newborns the virus was isolated from the pharynx, urine and faeces. The Authors conclude that the epidemic may have been caused by a poorly virulent virus and/or the mothers were possibly already immunized by previous infections.

The research of specific IgM anti virus A (anti HAV-IgM), by absorbtion of IgG with Staphylococcus aureus A protein, has been conducted in the sera of 49 patients with acute hepatitis non B (HBsAg negative). Twenty-nine of these patients (59.2%) were anti HAV-IgM positive and therefore were diagnosed as viral hepatitis A, while twenty (40.8%) were anti HAV-IgM negative and were considered as non A-non B hepatitis. In the present work the practical utility of the detection specific IgM by absorbtion with A protein is discussed also in respect of the more expensive and less sensitive technique of gel fractionation of the sera. In addition our preliminary results document a decreasing incidence of viral hepatitis A in all the cases seen in the period 1978-1979. This event, which needs further investigations, could also be due to a more significant incidence of non A-non B hepatitis, probably as consequence of increasing drug-addiction.

A comparative study of CF, IF and ELISA was carried out in order to comparatively evaluate the characteristics of sensitivity and specificity of the tests. The results seem to confirm the validity of both IF and ELISA in the laboratory diagnosis of CMV infections.

Cytomegalovirus and Toxoplasma gondii antibodies were titered in 133 serum specimens from students, physicians and technical staff of Monrovia hospital. The findings obtained show that both infections are widely spread: Cytomegalovirus antibody was detected in 81%, and Toxoplasma antibody in 70% of tested sera. No significative differences were observed among sera from different tribes and birth places.

Human infection by BK virus (BKV), a human papovavirus isolated from the urine of a transplanted patient, occurs early in life and is very widespread. The clinical features of the primary infection are unknown. After the primary infection, BKV remains latent in the host tissues. Immunosuppression of the host induces the activation of the latent virus; BKV has been isolated only from immunosuppressed patients so far. In our study the incidence of BKV infection in immunosuppressed children and in children with normal immunological defenses was investigated both by antibody and virus research, the cultural research of the virus being performed in the urine and other specimens, such as nasal-pharyngeal swabs and cerebrospinal fluids. Our results show that the incidence of the primary infection in immunosuppressed children is comparable to the incidence in children with normal immunological defenses. Two antigenically identical viruses, which showed only partial correlation with BKV, were isolated from the urine of two immunosuppressed children. These two viruses were considered as a same antigenic variant of the BKV prototype. Of all the subjects examined, only 9 immunosuppressed children had antibodies to the newly isolated viruses.

Severe cytomegalic pulmonary infections are very common in immunosuppressed patients. The incidence and the real significance of lung involvement by Cytomegalovirus in chronic hemodialysis patients is not known. A positive serologic response with antibody titers rise was observed in seven cases with chest x-ray findings of alveolar infiltrates; in four patients the lesion presented a cavity. The authors express the opinion that the diagnosis of Cytomegalovirus pneumonia in hemodialysis patients needs further confirmations.