Twenty Danish patients with the acquired immunodeficiency syndrome (AIDS) had been diagnosed by January 1984, 14 of them after 1982. Eighteen patients were male homosexuals, 8 of whom had visited the USA after 1979, 2 were heterosexual males with a history of sexual contacts in Central Africa, suggesting a transmission of AIDS from woman to man. AIDS has not been observed in drug abusers, hemophiliacs or transfused non-risk persons in Denmark. The clinical picture varied according to the presence of Kaposi sarcoma or the type of opportunistic infections, but was in general similar to that reported from the USA. Investigation of T-lymphocyte subsets revealed that the AIDS patients differed from controls and healthy homosexual men by having either a very low number of helper cells or a low helper/suppressor cell ratio. Functional immunological studies revealed a decreased natural killer cell activity and decreased blast transformation by mitogens. The survival two years after diagnosis was 16%.
Among 73 consecutive patients with biopsy documented acute non-toxic hepatitis, half of the patients (49%) had acute type B hepatitis, while 27 patients (37%) had acute type A infection. One patient had a significant rise in antibodies against cytomegalovirus. The remaining 10 patients (14%) fulfilled the criteria of hepatitis type non-A, non-B. The main type of exposure for hepatitis A was visit to endemic hepatitis areas (41%), and for type B it was drug addiction (46%). Half of the patients with hepatitis non-A, non-B had no known hepatitis exposure while some had visited endemic hepatitis areas or were drug addicts. The patients with non-A, non-B hepatitis had significantly less biochemical changes as compared to the patients with hepatitis B. In contrast, the histological findings showed the greatest activity in the biopsies from patients with hepatitis B and non-A, non-B. Follow-up liver biopsies in half of the patients with non-A, non-B hepatitis showed no signs of chronic active liver disease. It is concluded that hepatitis type non-A, non-B is a significant problem in Denmark.
In order to elucidate the time when HIV was introduced into a population of patients with acute hepatitis B, serum samples collected in the period 1975-1984 from 331 patients with hepatitis B were analysed for the presence of antibody to HIV (anti-HIV). Anti-HIV was not detected in any of the serum samples from 97 females. 5/234 serum samples from males (2%) were repeatedly positive. Anti-HIV was first demonstrated in 1978, 3 years before the first patients with AIDS were recognized in Denmark. None of the 4 Danish patients with anti-HIV developed AIDS during a follow-up period of 1-7 years. However, at the time of follow-up in 1985 3 had decreased cell mediated immunity. The hepatitis B infection had an uncomplicated course in 4/5 patients with anti-HIV. One patient had a protracted delta hepatitis and was a HBsAg carrier before as well as after the acute hepatitis. Thus, the HIV infection did not cause any complicated course in this study.
Infectious diseases in children are common in general practice. It is crucial not to overlook a case of purulent meningitis, and the aim of the present study was to evaluate and suggest ways of improving the diagnostic ability of the general practitioners in this respect. During a seven-year period 157 children under the age of 16 years, out of a population of 10,500 children, were referred from general practice to a district hospital for observation with symptoms and signs that suggested a possible diagnosis of meningitis. Seventy-eight underwent lumbar puncture, but only 14 of them received a final diagnosis of purulent meningitis. During the same period three other children proved to be cases of purulent meningitis, though they had been referred with other diagnosis. Twenty children had aseptic meningitis or encephalitis. The clinical findings in the groups of children with and without purulent meningitis were very similar, but an impaired level of consciousness and presence of petechiae were commoner in the former. Children with purulent meningitis had a significantly shorter duration of symptoms than children without meningitis. The present study could not suggest any ways of improving the referral procedures.
Owing to the low incidence of hepatitis B in Denmark, screening of blood donors for HBsAg has mostly been done by immunoelectroosmophoresis (IEOP). The purpose of the present study was to carry out a cost-effectiveness analysis prior to the introduction of a third-generation test for HBsAg in Danish blood donors. The analysis was performed on data from a subsequent screening of 48 750 blood units by radioimmunoassay (RIA) 3 weeks after donation. The RIA-pos., IEOP-neg. blood donors identified in the study were evaluated by a follow-up examination, and the recipients of RIA-pos., IEOP-neg. blood units were monitored for up to 9 months as to the development of acute hepatitis B. The study shows that the estimated cost for each prevented case of transfusion-associated hepatitis B in Denmark is US$ 1100 when screening donors not previously tested by a third-generation technique, and US$ 240 000 when screening donors tested before by this technique.