A47-year-old manwas admitted to our hospital for community-acquired pneumoniacomplicated with acute renal failure. Legionella pneumophila serogroup type 1 was grown in BCYE(buffered charcoal yeast extract) agar for sputum culture. Although his respiratory illness responded to intravenous erythromycin therapy, renal failure worsened and necessitated hemodialysis. Renal biopsy showed profound tubulointerstitial nephritis. After initiation of steroid therapy his renal function improved and he was discharged thereafter. These findings suggest that in Legionnaires' disease with acute renal failure, tubulointerstitial nephritis should also be considered and steroid therapy may be an effective modality for the renal complication. (Internal Medicine 39: 150-153, 2000)

A seroepidemiological study was performed to clarify the prevalence of hepatitis delta virus (HDV) infection among the general population in the Irabu islands, Okinawa, Japan. Of 2028 healthy people examined who had received their annual health check-up in 1994-95, 195 (9.6%) were positive for hepatitis B surface antigen (HBsAg). Of these 195 HBsAg-positive individuals, 46 (23.6%) showed a positive reaction for antibody to HDV (anti-HDV). The positivity rate of anti-HDV among HBsAg-positive subjects tended to increase with age up to 50-59 years of age. The prevalence of anti-HDV also varied among the seven districts in the islands (0-63.3%). None of the anti-HDV-positive subjects was included in the high risk group for parenterally transmitted diseases. The unusually high prevalence of anti-HDV among HBsAg-positive individuals, particularly in the older age groups, seemed to reflect the natural prevalence or previous HDV infection, rather than a current or imported infection of HDV. Although the great majority of HBsAg-positive subjects with anti-HDV were asymptomatic, abnormally high values of serum transaminases were more frequently seen in these subjects compared with HBsAg-positive subjects without anti-HDV.

The clinical characteristics of chronic hepatitis C virus (HCV) carriers with HCV genotype 1a/I infection were investigated and compared with those of chronic HCV carriers infected with 1b/II, 2a/III, 2b/IV and the mixed type of infection. We found that 16 of 408 (3.9%) carriers had HCV genotype 1a infection, comprising four of 67 (6.0%) blood donors, 11 of 263 (4.2%) patients with chronic hepatitis and one of 39 (2.6%) patients with liver cirrhosis. Three of 408 subjects had a mixed infection of genotypes 1a/I and 1b/II. All carriers with genotype 1a (including those with the mixed infection) were of Japanese origin and all, except one who was born in Brazil, were born in Okinawa Prefecture. Nine of 14 patients infected with genotype 1a for whom medical records were obtained had a history suggestive of infection through blood exposure; six had had blood transfusions, one had tattoos, one is a nurse and one had a history of drug addiction. There were no haemophiliacs or other multitransfused patients in the genotype 1a group. Of 10 patients infected with genotype 1a who received interferon (IFN) therapy, four (40%) showed a complete response. Although the small number of patients infected with genotype 1a in the present study precluded statistical analysis of the response to IFN, the response in patients with genotype 1a was better than the response in those infected with genotype 1b and poorer than the response in those patients infected with genotype 2a/III or 2b/IV.

The aims of this study were twofold: (1) to determine the prevalence and clinical features of hepatitis delta virus (HDV) infection among subjects positive for hepatitis B surface antigen (HBsAg) living in the Miyako Islands, Okinawa Prefecture, Japan, and (2) to clarify the relationship between HDV-RNA level and severity of HDV-related liver disease. One hundred and ninety-nine HBsAg-positive subjects (123 asymptomatic carriers [ASCs], 3 patients with acute hepatitis [AH], 50 patients with chronic hepatitis [CH], 15 patients with liver cirrhosis [LC], and 8 patients with hepatocellular carcinoma [HCC], were tested for antibody to HDV (anti-HDV) by radioimmunoassay. Anti-HDV-positive individuals were examined to determine semi-quantified HDV-RNA level by polymerase chain reaction (PCR). The overall prevalence of anti-HDV among the 199 subjects was 21.1%. The positivity rate tended to increase with age or the severity of the underlying liver disease: anti-HDV-positive rates were 10.6% (13/123) in ASCs, 32.0% (16/50) in patients with CH, 40.0% (6/15) in patients with LC, and 87.5% (7/8) in patients with HCC. None of the patients with AH were positive for anti-HDV. There was no correlation between semi-quantified serum HDV-RNA levels and the severity of chronic liver disease in patients positive for anti-HDV. The present study showed the local spread of HDV infection in the Miyako Islands, Okinawa, Japan. Although the anti-HDV positivity rate tended to increase with the severity of the underlying liver disease, the severity of HDV-related liver disease did not correlate with the semi-quantified serum HDV-RNA level.

No abstract