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Update in Infectious Diseases
- From University of Virginia Health Sciences Center, Charlottesville, Virginia.
2001–2002 Series: Update Sessions from ACP–ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
In this Update, I cover developments in the management of hepatitis C, which is most often first encountered by general internists and treated by hepatologists rather than infectious disease consultants. I also describe several recent reports on the current state of antibiotic resistance and promising new approaches to this expanding problem. Following that discussion are sections on prevalent infections, including the common cold, sinusitis, and influenza, and on less common infectious disorders that nevertheless pose an increasing threat; for example, those that move from animals to humans (rabies, Creutzfeldt–Jakob disease) and those that are translocating from one part of the world to another (West Nile virus, cholera). The concluding section concerns novel treatment approaches, such as the use of immune globulin for streptococcal toxic shock and recent work on an AIDS vaccine.
Hepatitis C
Hepatitis C virus (HCV) infection may lead to liver failure or hepatic cancer and is the leading indication for liver transplantation. An inadvertent “experiment” provided a chance to examine the course of infection when batches of anti-IgD used in Ireland in 1977–1978 to prevent Rh isoimmunization were contaminated by HCV. The status of 376 women positive for HCV RNA was reviewed at an average patient age of 45 years, approximately 17 years after exposure. More than 81% of the patients described symptoms, most commonly fatigue, and more than half had elevated liver enzyme levels. Liver biopsies documented inflammation in 98% of women, although it usually was no more than moderately severe. Some fibrosis was evident in half the group, but only 7 women (2% of the total) had a diagnosis of probable or definite cirrhosis and 2 of them had used alcohol excessively (1). …
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