Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuraminidase inhibitors have been widely used in Japan since 2001, and several side-effects of their use have been reported. However, erythema toxicum has rarely been described as a side-effect of these drugs in patients with liver function disorder. Here, we report a case of generalized rash after treatment with the neuraminidase inhibitors zanamivir and oseltamivir administered prophylactically to prevent influenza infection in two patients with hepatoma associated with liver cirrhosis.
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PMID:A side effect of neuraminidase inhibitor in a patient with liver cirrhosis. 1572 87

Congenital and neonatal viral infections usually display their acute manifestations in highly recognisable ways, for example, congenital rubella, cytomegalovirus (CMV), varicella, human immunodeficiency (HIV) and herpes simplex virus (HSV) infection. By contrast, congenital hepatitis B virus (HBV) infection may go undetected for years. Some of these are preventable, but what is not immediately apparent is that the long-term consequences are being prevented as well. The long-term consequences of congenital and neonatal infections include endocrine, immunological and cardiovascular disease, deafness, visual problems, intellectual handicap and cerebral palsy. With the survival of HIV-infected infants into adulthood the long-term consequences will soon be described. Maternally and neonatally transmitted HBV infection predisposes to carriage, liver cirrhosis and hepatocellular carcinoma in young adults. Neonatal HBV vaccination prevents adult cancer. Acquired viral infections may predispose to subsequent lung disease, malabsorption, fertility problems or neurological disability. In the prevention of acquired rubella, varicella, HBV, influenza, poliovirus, measles and hepatitis A, one should mention the added bonus of preventing secondary cases by preventing transmission from infants and children to other children and adults. Preventing paediatric HSV, HBV and HIV infection in females may even be preventing subsequent transmission to future generations. Turning to paediatric bacterial infections, vaccinating infants and young children against pertussis could not only prevent transmission to older children and adults but also break the cycle, which then transmits from adults back to infants and young children. There is evidence that disease in older age groups, including adults, has been prevented by virtue of herd immunity from paediatric vaccination, e.g. Neisseria meningitidis Group C and Streptococcus pneumoniae. The add-on benefits for other generations, including for adults, arising from the prevention of paediatric infections are considerable.
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PMID:Paediatric infections: prevention of transmission and disease--implications for adults. 1575 76

Infections in patients affected with liver cirrhosis are frequent, recurrent and associated to unfavorable outcome. They are facilitated by acquired and progressive defects on the innate immune and reticuloendothelial system that are aggravated by alcohol consumption. Infections in patients with cirrhosis are typically bacterial or viral in origin and have in most cases a stereotyped clinical presentation, although diagnosis may be difficult in some cases. Pneumonia, urinary tract infection, bacteremia and spontaneous bacterial peritonitis explain more than 90% of the cases. The latter requires a high clinical suspicion and a standardized diagnostic work up. Preventive strategies are important in the management of these patients and include chemoprophylaxis against spontaneous bacterial peritonitis in selected cases, vaccines against pneumococcal and influenza infections, and hepatitis A and B vaccine in susceptible patients. Due to limited seroconversion, active immunization should be applied as earlier as possible, before clinical deterioration ensues.
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PMID:[Diagnosis, management and prevention of infections in cirrhotic patients]. 1579 72

Hepatitis C virus (HCV) infects approximately 3 % of the global population and represents a major public health problem worldwide. Treatment of chronic hepatitis C is based on the combination of pegylated interferon alpha (PEG IFN) with ribavirin. With this treatment, sustained virological response is obtained in around 80% of patients infected with HCV genotype 2 or 3 and 50% of patients infected with HCV genotype 1. The most frequent adverse events are the flu-like syndrome and psychiatric disorders for PEG IFN, and anaemia for ribavirin; they need a careful follow-up. Determination of viral load and genotype is essential for the indication of therapy and the follow-up during treatment. Patients infected with HCV genotype 2 or 3 should be treated for 24 weeks. In patients infected with HCV genotype 1, a decrease in viral load by 2 log after 12 weeks of treatment (early virological response) is needed to take the decision to continue treatment, for a total duration of 48 weeks. A poor response to treatment is associated with host factors (age, alcohol consumption, cirrhosis) and viral factors (genotype 1, high viral load, co-infection with HBV or HIV). New therapeutic approaches should be based on the combination of PEG IFN and specific inhibitors of HCV replication to increase the rate of sustained response.
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PMID:[Treatment of hepatitis C]. 1591 15

Four to 6 months of conventional interferon alpha (IFN-alpha) (5MU daily or 10MU three times weekly) resulted in HBeAg loss in approximately 33% of HBeAg positive patients (controls: 12%). Longer treatment duration improved HBeAg seroconversion. Children with chronic HBV infection and high ALT respond to IFN-a at similar rates. Good end-of-treatment (ET) biochemical and virological response were also achieved with IFN-alpha in HBeAg negative, HBV-DNA positive hepatitis patients. Sustained response (SR) however, was disappointing, but improved with longer duration of treatment: (10-15% SR with 4/6 months treatment: 30% SR with 24 months treatment). Weekly pegylated IFN-alpha2a (PegIFN-alpha2a) for 24 weeks gave a significantly higher HBeAg conversion rate (33%) than conventional IFN-alpha2a (25%). Fifty-two weeks of PegIFN-alpha2b gave a sustained HBeAg loss in 35% patients and HBeAg seroconversion in 29% patients. Similar results were obtained with 48 weeks of weekly PegIFN-alpha2a. PegIFN-alpha2a monotherapy was found to be superior to lamivudine monotherapy in affecting a 6-month SR (normal ALTs and HBV DNA < 20,000 copies/mL) in HBeAg negative/anti-HBe positive chronic hepatitis B patients. There is a tendency for IFN-a and lamivudine combination to result in better sustained response than lamivudine monotherapy. This tendency is also observed with PegIFN-a and lamivudine combination although the combination did not appear to be better than PegIFN-alpha monotherapy. IFN induced HBeAg seroconversion is durable, could increase over time and resulted in better overall survival and survival free of hepatic decompensation or hepatocellular cancer. The main advantage of IFN-a therapy is that a course of finite duration may achieve sustained off-therapy response in a proportion of both HBeAg positive and HBeAg negative chronic hepatitis B patients. However, IFN treatment is usually associated with side-effects, especially flu-like symptoms, fatigue, neutropenia, thrombocytopenia and depression. These are usually tolerable but may require dose modification and premature cessation of treatment (5%). Interferon therapy induced hepatitis flares may lead to decompensation in patients with cirrhosis and can be dangerous in patients with decompensated liver function despite dose reduction.
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PMID:Treatment of chronic hepatitis B infection using interferon. 1610 70

Chronic liver disease patients may benefit from certain vaccines, but their immunization coverage levels have not been widely studied. We examined the serologic and vaccination status of 693 chronic liver disease patients from 37 primary care and specialist centers. Patients in primary care had more often received influenza (47 versus 32%; P < .001) and pneumococcal (39 versus 19%; P < .001) vaccines. Among patients without documented prior exposure, those seeing specialists had more often completed hepatitis A (28 versus 5%; P < .001) and hepatitis B (29 versus 14%; P < .001) vaccination. Coverage was higher in centers with a policy of vaccinating on-site, among non-Hispanic whites, and among patients with hepatitis C and cirrhosis. In summary, most patients were unprotected against one or more vaccine preventable diseases. The higher coverage rates evident in centers vaccinating on-site suggests a breakdown may occur when patients are referred to alternative vaccination venues.
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PMID:Immunization needs of chronic liver disease patients seen in primary care versus specialist settings. 1611 Aug 47

Polysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 serotypes of Streptococcus pneumoniae, representing near 90% of strains involved in invasive pneumococcal disease in immune competent adults. Vaccine confers protection against invasive pneumococcal disease. Immunization is recommended in adults over 65 years old, in patients affected by chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage in brain-blood barrier, functional or anatomical asplenia, alcoholism), in immunocompromised hosts, including HIV infection, chemotherapy treatment and hematological malignancies. Influenza vaccine is prepared with particulated antigens, including two influenza A strains and one influenza B strain, selected according to influenza epidemiological worldwide surveillance the year before. On account of continuous antigenic changes (drifts), it is necessary to modify the vaccine antigen's composition yearly. Cost/effectiveness evaluation has confirmed the efficacy of influenza vaccine in reducing morbidity and mortality associated to influenza epidemic and health economical resources involved in patient care. Besides, clinical trials have confirmed that immunization reduces the risk of acquiring pneumonia, of hospitalization and death in elderly people during the influenza epidemic, when vaccine antigenic composition is similar to the circulating strains. Vaccination is recommended annually in healthy adults over 65 years old, in patients with chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage of blood-brain barrier, functional or anatomical asplenia, alcoholism). It is also recommended in women who will be in the second or third trimester of pregnancy during the influenza season, in immunocompromised hosts, in institutionalized patients (geriatrics), health care workers, and travelers to geographical areas that are affected by the influenza epidemic.
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PMID:[Prevention of community-acquired pneumonia in adults]. 1616 21

Influenza vaccine has been shown to successfully reduce influenza- and pneumonia-associated hospitalizations and deaths. Yet in liver cirrhosis, influenza vaccines have received little attention in determining the potential benefits. Thus, we undertook this study to evaluate the humoral and cellular immune responses to vaccination against influenza in patients with advanced cirrhosis. We measured interferon (IFN)-gamma secretion response and hemagglutinin inhibition (HI) of antibody titer from pre- and post-vaccination blood samples in 80 cirrhotic patients (Child-Pugh class B or C) and 80 healthy, age-matched subjects. Although the patients with advanced cirrhosis showed similar humoral immune response against influenza vaccination compared to the healthy controls, cell-mediated immunity showed different results according to the remnant liver function.
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PMID:Humoral and cellular immune responses to influenza vaccine in patients with advanced cirrhosis. 1640 76

The etiology of granulomatous hepatitis is extremely extensive for which the granulomatous reaction induced hepatic inflammation is characteristic. In the majority of cases it is part of a systemic disease but sometimes there is primer hepatic lesion in the background. The 21 year-old Caucasian female patient was taken to hospital having flu-like symptoms and icterus. While searching for the cause of her cholestatic hepatocellular lesion infections, tumors, storage diseases were excluded. However the root cause could not be identified. The histology showed granulomatous reaction, inflammation, intrahepatic bile duct proliferation and micronodular cirrhosis in the liver tissue. Taken it into consideration together with the the clinical picture and the laboratory findings primer sclerosing cholangitis was rendered probable. Her state deteriorated and even the necessity of liver transplantation emerged. The patient was treated with ursodeoxycholic acid which resulted in remission lasting for years now. Two years after the onset of the hepatic disease pancolitis ulcerosa with affection of the ileum terminalis was found in the patient which supports the diagnosis of primary sclerosing cholangitis.
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PMID:[Granulomatous hepatitis successfully treated with ursodeoxycholic acid]. 1698 20

Carboxylesterases constitute a class of enzymes that play important roles in the hydrolytic metabolism of drugs and other xenobiotics. Patients with liver conditions such as cirrhosis show increased secretion of proinflammatory cytokines [e.g., interleukin-6 (IL-6)] and decreased capacity of hydrolysis. In this study, we provide a molecular explanation linking cytokine secretion directly to the decreased capacity of hydrolytic biotransformation. In both primary hepatocytes and HepG2 cells, treatment with IL-6 decreased the expression of human carboxyl-esterases HCE1 and HCE2 by as much as 60%. The decreased expression occurred at both mRNA and protein levels, and it was confirmed by enzymatic assay. In cotransfection experiments, both HCE1 and HCE2 promoters were significantly repressed, and the repression was comparable with the decrease in HCE1 and HCE2 mRNA, suggesting that transrepression is responsible for the suppressed expression. In addition, pretreatment with IL-6 altered the cellular responsiveness in an opposite manner of overexpression of HCE1 and HCE2 toward various ester therapeutic agents (e.g., clopidogrel). Transfection of HCE1, for example, decreased the cytotoxicity induced by antithrombogenic agent clopidogrel, whereas pretreatment with IL-6 increased the cytotoxicity. Such a reversal was observed with other ester drugs, including anticancer agent irinotecan and anti-influenza agent oseltamivir. The altered cellular responsiveness was observed when drugs were assayed at sub- and low-micromolar concentrations, suggesting that suppressed expression of carboxylesterases by IL-6 has profound pharmacological consequences, particularly with those that are hydrolyzed in an isoform-specific manner.
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PMID:Interleukin-6 alters the cellular responsiveness to clopidogrel, irinotecan, and oseltamivir by suppressing the expression of carboxylesterases HCE1 and HCE2. 1753 33


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