Among 256 patients with acute hepatitis A, 17 (6.6%) had a relapse of the disease between 30 and 90 days after the primary episode. We studied 7 of these patients. Serologic testing showed mean alanine aminotransferase levels of 1668 IU/L during the acute stage, 107 IU/L during the early convalescence, and 1027 IU/L during the relapse. Tests for IgM antibody against hepatitis A virus were positive in the 7 patients at the onset of disease, with decreasing levels in 3 of the 4 patients tested during the evolution of the illness. Stools collected during the relapse phase showed hepatitis A virus by immune electron microscopy, radioimmunoassay, and molecular hybridization using a 32P-labeled cDNA-hepatitis A virus probe. Stools collected from 4 of these patients 6 to 12 months after the onset of disease were negative for the virus. The finding of hepatitis A virus in the stool of these patients during the relapse phase strongly implicates hepatitis A virus as the causative agent of the clinical relapse.
Epstein-Barr virus superinfection of the human lymphoblastoid cell line Raji, a Burkitt lymphoma-derived line that contains Epstein-Barr virus genomes in an episomal form, results in the sequential synthesis of 29 detectable proteins, which range in molecular weight from approximately 155,000 to 21,000, and in the shutoff of the bulk of host protein synthesis within 6 to 9 h after infection. There are three classes of virus-induced proteins; these are an early class, consisting of eight proteins synthesized by 6 h postinfection, an intermediate class, containing two proteins synthesized 9 h postinfection, and a late class, consisting of five proteins synthesized 12 h postinfection. In addition, there is a fourth class of polypeptides, called persistent, that are found both before and after superinfection. The rates of synthesis of the proteins fall into three patterns; these are pattern A, in which the rate of synthesis decreases, pattemn B, in which the rate of synthesis remains steady, and pattern C, in which the rate of synthesis increases after the initial appearance of the polypeptide. Both 9-(2-hydroxyethoxymethyl)guanine (acyclovir) and phosphonoacetic acid inhibit the appearance of one intermediate protein and at least three late proteins. Seven polypeptides are phosphorylated at different times after infection.
After Epstein-Barr virus superinfection of the human lymphoblastoid cell line Raji, a Burkitt lymphoma-derived line that contains Epstein-Barr virus genomes in an episomal form, at least 40 polypeptides could be resolved by polyacrylamide gel electrophoresis. Eleven of the 40 polypeptides were immunoprecipitable by early antigen+/viral capsid antigen+ antiserum. The polypeptides could be divided into six classes, immediate-early, early, intermediate, late, very late, and persistent, depending upon the time of synthesis. Ten of the 40 polypeptides appeared to preexist before superinfection and persisted despite general cessation of host protein synthesis; none of the persistent proteins was immunoprecipitated by the Epstein-Barr virus antibody-containing serum. When viral DNA replication was blocked by a variety of inhibitors of DNA synthesis, a number of different patterns of polypeptide synthesis could be detected. The synthesis of six polypeptides was blocked by the most virus-specific inhibitors, acyclovir and phosphonoacetic acid. Additionally, in the presence of 1-beta-D-arabinofuranosylcytosine, 1-beta-D-arabinofuranosyladenine, and methotrexate, seven polypeptides showed oversynthesis.
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