Annals of Tropical Medicine & Parasitology
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Antibody to hepatitis C virus in patients with chronic schistosomiasis K. Uemura, T. Kawaguchi, T. Sodeyama & K. Kiyosawa To cite this article: K. Uemura, T. Kawaguchi, T. Sodeyama & K. Kiyosawa (1992) Antibody to hepatitis C virus in patients with chronic schistosomiasis, Annals of Tropical Medicine & Parasitology, 86:3, 257-262, DOI: 10.1080/00034983.1992.11812662 To link to this article: http://dx.doi.org/10.1080/00034983.1992.11812662
Published online: 15 Nov 2016.
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Citing articles: 8 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypgh19 Download by: [Australian Catholic University]
Date: 12 August 2017, At: 15:35
Annals of Tropical Medicine and Parasitology, Vol. 86, No.3, 257-262 (1992)
Antibody to hepatitis C virus in patients with chronic schistosomiasis BYK. UEMURA*, T. KAWAGUCHI, T. SODEYAMAAND K.KIYOSAWA
Downloaded by [Australian Catholic University] at 15:35 12 August 2017
Kofu City Hospital, Kofu, Yamanashi-Ken, Japan, and Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano-Ken, Japan Received 18 September 1991, Revised 6 March 1992, Accepted 20 March 1992
To clarify the effect of hepatitis C virus (HCV) infection in patients with chronic schistosomiasis, 96 patients with schistosomiasis and 137 patients with chronic liver disease without schistosoma! infection were analysed by domination of antibody to HCV (anti-HCV). In 45 of 96 schistosomiasis patients, the serum alanine aminotransferase (AL T) level was continuously elevated, and the positive rate of anti-HCV was 52·9%, which is almost the same prevalence rate as in patients with chronic liver disease (48·9%). In contrast, in the remaining 51 schistosomiasis patients, serum AL T level was continuously within the normal range and the positive rate of anti-HCV was 0%. Histological investigation showed that the positive rate of anti-HCV in HBsAg-negative schistosomiasis patients was 14% for hepatic fibrosis, 71% for chronic hepatitis, 80% for liver cirrhosis and 56% for hepatocellular carcinoma. In all anti-HCV-positive patients, serumAL T level was continously elevated. The serum transaminase levels in anti-HCV-positive patients were higher than those in anti-HCV -negative patients. These data suggest that in patients with chronic schistosomiasis, HCV infection accelerates the derangement of liver function, and may be a major aetiological factor in the development of chronic hepatitis and liver cirrhosis, supporting a causative association between HCV infection and hepatocellular carcinoma.
Schistosomiasis is a parasitic disease that is endemic in many areas of the world (Warren, 1973). In Japan, the previously estimated number of patients in infected areas, including Yamanashi Prefecture, was more than 200 000 (Kitani and luchi, 1990). Recently, acute schistosoma! infection has disappeared, but several old people with chronic Schistosoma japonicum infection are still alive in the previously endemic region. In some cases, serum asparate aminotransferase (AST) and alanine aminotransferase (AL T) levels are continuously elevated, and histologically, lymphocytic infiltration of portal areas and parenchyma or cirrhotic liver changes were seen. Some patients with chronic schistosomiasis develop hepatocellular carci*Address correspondence to: Dr. Kazuyuki Uemura, Kofu City Hospital, 14-6, Saiwaicho, Kofu, YamanashiKen 400, Japan. 0003-4983/92/030257 + 06 $03.00/0
noma (HCC). In these patients, although the prevalence of hepatitis B surface antigen (HBsAg) was reported to be high (Nakashima et al., 197 5), the possible additional role of non-A, non-B hepatitis virus infection has also been postulated (Kitani et al., 1990). Recently, a serological marker highly specific for non-A, non-B hepatitis, designated antibody to hepatitis C virus (anti-HCV), has been checked (Choo et al., 1989; Kuo et al., 1989). After the antibody enzyme immunoassay for anti-HCV became available, serological analysis of the relationship between anti-HCV antibody and chronic liver disease was carried out, and it has been reported that HCV may be a common causative agent in chronic hepatitis (CH), liver cirrhosis (LC) and HCC (Hasan et al., 1990; Kiyosawa et al., 1990). © 1992 Liverpool School of Tropical Medicine
258
UEMURA ET AL.
In this study, we used the anti-HCV assay to clarify the prevalence of HCV infection in patients with chronic S. japonicum infection, and to investigate the association of HCV with liver dysfunction and HCC in these patients.
Downloaded by [Australian Catholic University] at 15:35 12 August 2017
PATIENTS AND METHODS Patients Ninety-six patients with chronic schistosomiasis and 137 patients with CH, LC or HCC without chronic schistosomiasis, admitted to the Kofu City Hospital between July 1989 and June 1990, were examined. In addition, 649 voluntary blood donors were also examined. The diagnosis of schistosomiasis was made if either of the following diagnostic criteria were met: (a) chronic schistosomiasis confirmed by liver biopsy, (b) positive intradermal tests using antigen made from adult worms of S.japonicum by Melcher's method (Melcher, 1943) and characteristic hepatic changes confirmed by ultrasonography or computed tomography. In all patients meeting criterion (b), infection with S. japonicum was confirmed by rectal biopsy. CH and LC were confirmed histologically. In some patients, HCC was diagnosed by imaging examinations such as ultrasonography, computed tomography and selective angiography. Patients with liver disease caused by autoimmune mechanisms, alcohol, drugs, metabolic disorders and congestive heart failure were excluded. Of96 patients with chronic schistosomiasis, liver biopsy showed that eight had hepatic fibrosis, 10 had CH, and six had LC. Seventeen of 96 patients had HCC. The 137 patients without chronic schistosomiasis consisted of 88 patients with CH, 33 patients with LC and 16 patients with HCC. The history of blood transfusion was established by taking a detailed medical history from the patients and their families. Patients with chronic schistosomiasis were divided in two subgroups according to the serum ALT level; 'ALT-normal' group with serum AL T level consistently less than 30 IU for at least six months, and 'AL Televated' group with serumAL T level elevated to greater than 30 IU on at least one occasion during the preceding six months. Serum
samples taken between July 1989 and March 1990 were stored frozen at - 20°C until testing. Serological Testing Serum HBsAg was assayed by radioimmunoassay (Ausria II, Abbott Laboratories, North Chicago, IL, U.S.A.). Anti-HCV was tested by using the first generation enzyme-linked immunosorbent assay (ELISA: HCV Antibody ELISA Test System, Ortho Diagnostics Co., Raritan, NJ, U.S.A.). These tests were performed according to the manufacturer's instructions, and for the reactive samples, testing was repeated in duplicate. The positive serum samples were tested by using the first generation recombinant immunoblot assay (RIBA: Ortho Diagnostic Co., Raritan, NJ). Reactive sera for both ELISA and RIBA were judged as positive for anti-HCV. Serum AST and AL T were measured by autoanalyser (JCA-RX30, Japan Electron Optics Laboratory Ltd, Kanagawa, Japan). Statistical Analysis Statistical analyses were performed by Odds Ratios, Chi-square test and analysis of variance. Confidence intervals (C. I., 95%) were calculated using the Mantel-Haenszel method. P values less than 0·05 were considered statistically significant. All values were expressed as mean±s.o.
RESULTS The prevalences of HBsAg and anti-HCV in the AL T -elevated group, AL T -normal group, CLD and healthy controls are shown in Table 1. In patients with chronic schistosomiasis, the prevalences of HBsAg and anti-HCV antibody in the AL T -elevated group were significantly higher than those in the AL T -normal group (P
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Antibody to hepatitis C virus in patients with chronic schistosomiasis K. Uemura, T. Kawaguchi, T. Sodeyama & K. Kiyosawa To cite this article: K. Uemura, T. Kawaguchi, T. Sodeyama & K. Kiyosawa (1992) Antibody to hepatitis C virus in patients with chronic schistosomiasis, Annals of Tropical Medicine & Parasitology, 86:3, 257-262, DOI: 10.1080/00034983.1992.11812662 To link to this article: http://dx.doi.org/10.1080/00034983.1992.11812662
Published online: 15 Nov 2016.
Submit your article to this journal
View related articles
Citing articles: 8 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypgh19 Download by: [Australian Catholic University]
Date: 12 August 2017, At: 15:35
Annals of Tropical Medicine and Parasitology, Vol. 86, No.3, 257-262 (1992)
Antibody to hepatitis C virus in patients with chronic schistosomiasis BYK. UEMURA*, T. KAWAGUCHI, T. SODEYAMAAND K.KIYOSAWA
Downloaded by [Australian Catholic University] at 15:35 12 August 2017
Kofu City Hospital, Kofu, Yamanashi-Ken, Japan, and Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano-Ken, Japan Received 18 September 1991, Revised 6 March 1992, Accepted 20 March 1992
To clarify the effect of hepatitis C virus (HCV) infection in patients with chronic schistosomiasis, 96 patients with schistosomiasis and 137 patients with chronic liver disease without schistosoma! infection were analysed by domination of antibody to HCV (anti-HCV). In 45 of 96 schistosomiasis patients, the serum alanine aminotransferase (AL T) level was continuously elevated, and the positive rate of anti-HCV was 52·9%, which is almost the same prevalence rate as in patients with chronic liver disease (48·9%). In contrast, in the remaining 51 schistosomiasis patients, serum AL T level was continuously within the normal range and the positive rate of anti-HCV was 0%. Histological investigation showed that the positive rate of anti-HCV in HBsAg-negative schistosomiasis patients was 14% for hepatic fibrosis, 71% for chronic hepatitis, 80% for liver cirrhosis and 56% for hepatocellular carcinoma. In all anti-HCV-positive patients, serumAL T level was continously elevated. The serum transaminase levels in anti-HCV-positive patients were higher than those in anti-HCV -negative patients. These data suggest that in patients with chronic schistosomiasis, HCV infection accelerates the derangement of liver function, and may be a major aetiological factor in the development of chronic hepatitis and liver cirrhosis, supporting a causative association between HCV infection and hepatocellular carcinoma.
Schistosomiasis is a parasitic disease that is endemic in many areas of the world (Warren, 1973). In Japan, the previously estimated number of patients in infected areas, including Yamanashi Prefecture, was more than 200 000 (Kitani and luchi, 1990). Recently, acute schistosoma! infection has disappeared, but several old people with chronic Schistosoma japonicum infection are still alive in the previously endemic region. In some cases, serum asparate aminotransferase (AST) and alanine aminotransferase (AL T) levels are continuously elevated, and histologically, lymphocytic infiltration of portal areas and parenchyma or cirrhotic liver changes were seen. Some patients with chronic schistosomiasis develop hepatocellular carci*Address correspondence to: Dr. Kazuyuki Uemura, Kofu City Hospital, 14-6, Saiwaicho, Kofu, YamanashiKen 400, Japan. 0003-4983/92/030257 + 06 $03.00/0
noma (HCC). In these patients, although the prevalence of hepatitis B surface antigen (HBsAg) was reported to be high (Nakashima et al., 197 5), the possible additional role of non-A, non-B hepatitis virus infection has also been postulated (Kitani et al., 1990). Recently, a serological marker highly specific for non-A, non-B hepatitis, designated antibody to hepatitis C virus (anti-HCV), has been checked (Choo et al., 1989; Kuo et al., 1989). After the antibody enzyme immunoassay for anti-HCV became available, serological analysis of the relationship between anti-HCV antibody and chronic liver disease was carried out, and it has been reported that HCV may be a common causative agent in chronic hepatitis (CH), liver cirrhosis (LC) and HCC (Hasan et al., 1990; Kiyosawa et al., 1990). © 1992 Liverpool School of Tropical Medicine
258
UEMURA ET AL.
In this study, we used the anti-HCV assay to clarify the prevalence of HCV infection in patients with chronic S. japonicum infection, and to investigate the association of HCV with liver dysfunction and HCC in these patients.
Downloaded by [Australian Catholic University] at 15:35 12 August 2017
PATIENTS AND METHODS Patients Ninety-six patients with chronic schistosomiasis and 137 patients with CH, LC or HCC without chronic schistosomiasis, admitted to the Kofu City Hospital between July 1989 and June 1990, were examined. In addition, 649 voluntary blood donors were also examined. The diagnosis of schistosomiasis was made if either of the following diagnostic criteria were met: (a) chronic schistosomiasis confirmed by liver biopsy, (b) positive intradermal tests using antigen made from adult worms of S.japonicum by Melcher's method (Melcher, 1943) and characteristic hepatic changes confirmed by ultrasonography or computed tomography. In all patients meeting criterion (b), infection with S. japonicum was confirmed by rectal biopsy. CH and LC were confirmed histologically. In some patients, HCC was diagnosed by imaging examinations such as ultrasonography, computed tomography and selective angiography. Patients with liver disease caused by autoimmune mechanisms, alcohol, drugs, metabolic disorders and congestive heart failure were excluded. Of96 patients with chronic schistosomiasis, liver biopsy showed that eight had hepatic fibrosis, 10 had CH, and six had LC. Seventeen of 96 patients had HCC. The 137 patients without chronic schistosomiasis consisted of 88 patients with CH, 33 patients with LC and 16 patients with HCC. The history of blood transfusion was established by taking a detailed medical history from the patients and their families. Patients with chronic schistosomiasis were divided in two subgroups according to the serum ALT level; 'ALT-normal' group with serum AL T level consistently less than 30 IU for at least six months, and 'AL Televated' group with serumAL T level elevated to greater than 30 IU on at least one occasion during the preceding six months. Serum
samples taken between July 1989 and March 1990 were stored frozen at - 20°C until testing. Serological Testing Serum HBsAg was assayed by radioimmunoassay (Ausria II, Abbott Laboratories, North Chicago, IL, U.S.A.). Anti-HCV was tested by using the first generation enzyme-linked immunosorbent assay (ELISA: HCV Antibody ELISA Test System, Ortho Diagnostics Co., Raritan, NJ, U.S.A.). These tests were performed according to the manufacturer's instructions, and for the reactive samples, testing was repeated in duplicate. The positive serum samples were tested by using the first generation recombinant immunoblot assay (RIBA: Ortho Diagnostic Co., Raritan, NJ). Reactive sera for both ELISA and RIBA were judged as positive for anti-HCV. Serum AST and AL T were measured by autoanalyser (JCA-RX30, Japan Electron Optics Laboratory Ltd, Kanagawa, Japan). Statistical Analysis Statistical analyses were performed by Odds Ratios, Chi-square test and analysis of variance. Confidence intervals (C. I., 95%) were calculated using the Mantel-Haenszel method. P values less than 0·05 were considered statistically significant. All values were expressed as mean±s.o.
RESULTS The prevalences of HBsAg and anti-HCV in the AL T -elevated group, AL T -normal group, CLD and healthy controls are shown in Table 1. In patients with chronic schistosomiasis, the prevalences of HBsAg and anti-HCV antibody in the AL T -elevated group were significantly higher than those in the AL T -normal group (P
