Acute Fulminant Hepatitis Research Articles

S4401 Acute Fulminant Hepatitis Induced by Bacillus cereus: A Case Study and Clinical Insights

S4401 Acute Fulminant Hepatitis Induced by Bacillus cereus: A Case Study and Clinical Insights

Pathoimmunological analyses of fatal E11 infection in premature infants.

E11 causes acute fulminant hepatitis in newborns. We investigated the pathological changes of different tissues from premature male twins who died due to E11 infection. The E11 expression level was higher in the liver than in other tissues. IP10 was upregulated in liver tissue in the patient group, and might be regulated by IFNAR and IRF7, whereas IFNα was regulated by IFNAR or IRF5.

Study of acute kidney injury in children with nephrotic syndrome in a rural tertiary care hospital

Background: Acute kidney injury (AKI) is a common comorbidity in critically ill children and is associated with an increased risk of morbidity and mortality in children with nephrotic syndrome. The etiology of AKI in nephrotic syndrome is complex and multifactorial. Aims and Objectives: To determine the proportion, risk factors, and outcomes of patients with AKI in children hospitalized with nephrotic syndrome. Materials and Methods: This cross-sectional study was done on children between 1 month and 14 years of age attending the pediatric department for 1 year from October 2020 to June 15, 2022. Detailed history, physical examination, and investigations were done in children with nephrotic syndrome as per pro forma. Information was collected on demographic variables, vital signs, anthropometry, diagnosis, comorbidities, therapies, presence of hypovolemia, sepsis or shock, use of diuretics or nephrotoxic medications, need for oxygen, mechanical ventilation, vasopressors or renal replacement therapy, length of hospital stay, and outcome at discharge. For those children having AKI, clinical outcomes were measured in terms of duration of hospital stay, recovery of S.creatinine, and urine output. Results: A total of 64 patients with nephrotic syndrome were enrolled in this study. Fifteen patients had AKI (23.4%) among children with nephrotic syndrome. The most common etiology being sepsis accounting for 4 out of 15 (26.7%) of total cases followed by acute respiratory distress syndrome (13.3%), nephrotoxic medications (13.3%), renal parenchymal disease (13.3%), Post-streptococcal glomerulonephritis (13.3% each) and Sickle cell disease with nephritis and acute fulminant hepatitis (6.7%). There was significantly more mortality among subjects with stage 2 (14.3%) and 3 (14.3%) kidney disease. Conclusion: AKI is common in our children with nephrotic syndrome and the main risk factors of AKI include sepsis, gross hematuria, urinary tract infections, peritonitis, and exposure to potentially nephrotoxic medications. There is a need to identify the patients with nephrotic syndrome at risk of AKI and apply strategies to prevent AKI in focused at-risk groups.

Detection of hepatitis B virus genotypes in a group of hepatitis B virus-infected patients in central and northern Sri Lanka.

Introduction. Hepatitis B infection causes a spectrum of clinical diseases varying from asymptomatic infection to severe or fulminant acute hepatitis, chronic liver disease, cirrhosis and hepatocellular carcinoma. Hepatitis B virus (HBV) genotypes appear to influence transmission dynamics, clinical outcomes and responses to antiviral therapy. However, hepatitis B genotyping has been poorly investigated in Sri Lanka. This study intended to determine hepatitis B genotypes in a group of HBV-infected people in central and northern Sri Lanka. Methodology. The study was a laboratory-based descriptive cross-sectional study. Initial detection of HBV DNA in 100 EDTA blood samples was done by using a commercially validated quantitative real-time PCR kit. Hepatitis B genotyping was performed by in-house conventional semi-nested multiplex PCR using genotype-specific primers (for genotypes A-F). The serological profile was determined using a commercially validated ELISA/chemiluminescence immunoassay. The results were evaluated for genotype prevalence, viral load association and hepatitis B e antigen (HBeAg) expression in the study population. Results and conclusion. The study detected that genotype C (n=38) is most prevalent and infections with multiple genotypes (n=52, 52%) were commoner than mono-genotype (n=23, 23%) infections. In total, 25% of patients had no detectable genotype among genotypes A-F. The mean viral load in asymptomatic patients with a single genotype was 3.28 log10 copies ml-1 and in multiple genotypes was 4.18 log10 copies ml-1 before treatment. Statistical significance was not detected in mean viral loads and HBeAg expression in these two groups. In the future, chronic HBV infection may be effectively treated and managed according to the infected genotype.

Gastrointestinal Manifestations of Dengue Fever among Children: A Multicenter Cross-Sectional Study in Bangladesh

Background: Dengue fever is an arboviral illness spread by mosquitoes and is now a major public health issue on a global scale. Unfortunately, only few studies have documented unusual clinical characteristics of dengue among children. Objective: The objective of this study was to describe the gastro intestinal manifestations of dengue infected children during 2019 dengue outbreak in Dhaka city. Methodology: This cross-sectional study was conducted at Department of Virology at National Institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh among confirmed cases of dengue fever (Children aged less than 12 years) admitted in the pediatric ward of Dhaka Medical College Hospital, Kurmitola General Hospital, Sir Sallimullah Medical College Hospital, Dr M R Khan Sishu Hospital and BSMMU in Dhaka from June 2019 to November 2019 for period of six months. Data was collected using a structured questionnaire via face-to-face interview from guardian of the children. The investigation profile was collected from their hospital records. Results: Out of confirmed 200 pediatric dengue patients, children with dengue had an average age of 9.8±2.7 years with a slight female predominance. The majority (36.5%) of the children belonged to the age group of 5 to 9 years. Among 200 patients, 42 patients diagnosed as severe Dengue according to WHO classification. Gastrointestinal symptoms were the most common associated feature, including mostly Nausea/vomiting (81.0%), abdominal pain (61.0%), ascites (29.0%), hepatomegaly (19.0%), diarrhoea (13.0%) and others. Elevation of transaminases was found in 40.0% of the children. About 30% of the patients had platelet count more than or equal to 50000 and hematocrit more than 40 was observed in 12% patients. Atypical manifestations such as acalculous cholecystitis, acute fulminant hepatitis, acute pancreatitis, parotitis, AKI and paralytic ileus were noted in small number of patients. Conclusion: In conclusion, fever with vomiting and abdominal pain are common presentations of dengue fever. Bangladesh Journal of Medical Microbiology, July 2023;17(2):66-70

Hepatitis E Virus: Epidemiology, Clinical Aspects, and Its Significance as a Major Pregnancy Risk

HEV is a single-stranded, positive RNA virus. The hepatitis E virus (HEV) is the causing agent of hepatitis, with a high prevalence rate in low-income countries due to poor sanitary conditions. It can exhibit acute, continuous, or extrahepatic consequences in immunocompromised individuals such as those undergoing organ transplantation and having HIV infection. HEV infection is either self limiting (silent), meaning the patient will possibly recover on his own, or symptomatic, causing acute liver injury or fulminant hepatitis and may eventually cause death. It can also cause chronic hepatitis that can progress to cirrhosis or recovery. Pregnancy-related HEV infection has an incidence rate of 30%. HEV escape from innate immunity, hormonal imbalances, defective monocyte–macrophage function, downregulation of the T-cell-mediated immune system, high cytokine production, nutritional factors, and socioeconomic conditions may play fundamental roles in the prevalence of HEV infection. It is necessary to take particular measures to reduce the incidence burden of HEV infection in high endemic locations as the incidence data, not the prevalence data, is more accurate at estimating disease dynamics. The purpose of this study is to throw light on several aspects of the hepatitis E virus and to discuss the incidence of HEV infection concerning other diseases. HEV molecular features, clinical features, epidemiology, extrahepatic manifestations, and multiple available diagnostics and treatment strategies for HEV are debated in the current review.

Acute reversible fulminant hepatitis associated with rifampicin

Tuberculosis in India contributes to significant endemicity, morbidity and mortality. Rifampicin is the most potent bactericidal drug used as a first line agent in the Anti-Tubercular Treatment (ATT) in rifampicin sensitive cases. Adverse effects of the ATT add to morbidity

Autoimmune Hepatitis Presenting as Acute Fulminant Hepatitis in a Nigerian Woman

Autoimmune hepatitis is rare in sub-Saharan Africa except for south Africa. Only 3 cases have been previously reported in Nigeria with a population of 200 million. All the 3 cases had features of liver cirrhosis at presentation.
 We report a case of a 49-year-old woman who presented with acute fulminant hepatitis and turned out to be autoimmune hepatitis based on elevated serum gammaglobinaemia, amino transferases, positive anti-nuclear antibody, and absence of other aetiology. Patient had a good response to steroid treatment.
 Autoimmune hepatitis occurs in Nigerian patients and can present in a rarer form of acute fulminant hepatitis which seen in about 10% of cases globally.

Prevalence of Precipitating Factors of Hepatic Encephalopathy at Nangarhar Regional Hospital

‌Backgroud: Hepatic encephalopathy (HE) or portosystemic encephalopathy (PSE) is a satiuation of disordered in central nervous system’s functions characterrized by the failure of the liver to detoxify noxious substances of gastrointestinal origin due to hepatocellular dysfunction and portosystemic shunting. HE is a complication of chronic liver disease brought on by a number of precipitating circumstances and factors. The aim of this study is to analyze the precipitating factors of HE in cases seen in the Infectious Diseases Ward of Nangarhar Regional Hospital. Materials and Mehtods: A non-interventional hospital based descriptive study was conducted on 50 HE patients in the Infective Ward of Nangarhar Regional Hospital during May 2021 – December 2021. This study also included patients with liver cirrhosis developing HE, known as acute fulminant hepatitis. A comprehensive questionnaire was developed for a better data collection. Detailed clinical history of the patients were taken regarding the present and past diseases. All patients were carefully examined with special attention to anemia, jaundice, asterixes, fever and ascites. Laboratory examinations that recommended for these diseases were also investigated. Results: The results revealed that most of the patients were aged between 40 – 70 years old (82%). The highest frequency of HE disease was recorded in the age of 60-69 (42%). There were four classes of patients according to the classification. Majority of the patients were in fourth class (52%), followed by second class (20%), third class (16%) and first class (12%) of hepatic encephalopathy. It is found that the most crucial exacerbating factors were including infections, constipation and gastrointestinal bleeding. Among them, infections were more frequent which were recorded in 22 patients (44%), followed by constipation in 10 patients (20%) and gastrointestinal bleeding in 6 patient (12%). Among the type of infections the urinary tract infections were accounted for 19% followed by gastrointestinal tract infections (16%) and respiratory tract infections (12%). Conclusion: To determine which precipitating factor is responsible for HE in the eastern region of Afghanistan, frequency of several precipitating factors was examined. Knowing the primary triggering factor makes it simple to develop a plan of action to significantly reduce the incidence of HE. In our investigation, gastrointestinal bleeding, constipations, and infections were the most typical precipitating factors. Due to the fact that hepatitis C is the main and leading cause of liver cirrhosis in Afghanistan.

Clinical manifestations of wasp stings: a case report and a review of literature

BackgroundWasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.Case presentationA 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive.ConclusionIn conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.

Health state utilities of patients with hepatitis B and C and hepatitis-related conditions in Japan

Health state utilities are global measurements of quality of life and have been used to evaluate health outcomes for the cost-utility analysis. This study aimed to estimate the health state utilities of patients with hepatitis B (HB), hepatitis C (HC), and hepatitis-related diseases in Japan. We distributed a self-administered questionnaire, including the EuroQol 5-Dimension 5-Level (EQ-5D-5L), to 9,952 outpatients with several clinical conditions caused by HB or HC virus infection (such as asymptomatic chronic hepatitis, chronic hepatitis, compensated cirrhosis, and decompensated cirrhosis) and estimated the condition-specific utilities of patients with HB or HC. In patients with more severe conditions (patients with acute hepatitis, fulminant hepatitis, and hepatocellular carcinoma and patients undergoing post-liver transplantation), the utilities of these severe conditions were estimated by three hepatitis experts using the EQ-5D-5L. The means of the utilities for acute hepatitis, fulminant hepatitis, asymptomatic chronic hepatitis, chronic hepatitis, compensated cirrhosis, compensated cirrhosis, hepatocellular carcinoma stage I/II, hepatocellular carcinoma stage III/IV, and post-liver transplantation were 0.529, − 0.111, 0.904, 0.868, 0.845, 0.722, 0,675, 0,428, and 0.651 and 0.876, 0.821, 0.737, 0.671, 0.675, 0.428, and 0.651 in HB and HC, respectively. To the best of our knowledge, this is the first study that comprehensively assessed the health state utilities of patients with HB, HC and hepatitis-related conditions from a nationwide survey in Japan using the EQ-5D-5L.

An Unusual Cause of Acute Isolated Hepatitis in a Cancer Patient Post-COVID Pneumonia: HSV-2

Herpes simplex virus is a rare cause of hepatitis in immunosuppressed and immunocompetent individuals. It can cause clinical pictures in patients ranging from an asymptomatic course to fatal acute fulminant hepatitis. Early diagnosis and treatment may be delayed if it is not suspected because of the patients’ nonspecific clinic. This study presents a case of isolated HSV-2 hepatitis in a patient with a history of cancer chemotherapy and a recent diagnosis of COVID-19 who received steroid therapy.

Increasing Burden of Acute Hepatitis A among Ethiopian Children, Adolescents, and Young adults: A Change in Epidemiological Pattern and Need for Hepatitis A Vaccine.

Hepatitis A is a vaccine-preventable, feco-oral infection due to poor sanitary conditions. It is predominantly acquired during early childhood and results in lasting acquired protective immunity. However, it results in severe disease which can end up in acute fulminant hepatitis and hepatic failure when acquired during adolescence and adulthood. The prevalence of acute hepatitis A is increasing among children, adolescents, and young adults from higher-income households. They acquire this infection at a later age when they are exposed for the first time to contaminated food and drinks after being brought up in a relatively clean environment. This calls for the introduction of the Hepatitis A vaccine in Ethiopia; possibly as part of the Expanded Program on Immunization (EPI). Socio-demographic and clinical data were collected from patients who were diagnosed to have hepatitis A infection at Adera Medical Center in 2020. This study showed that clinical acute hepatitis A is becoming common among children, adolescents, and young adults from relatively high-income families. Among patients with acute hepatitis, 89% were from middle and high-income families. There is a need for the incorporation of hepatitis A vaccine in the Ethiopian EPI program.

Клінічне спостереження вдалого лікування фульмінантної форми гострого гепатиту В

У статті наведено власне клінічне спостереження успішного лікування фульмінантної форми гострого гепатиту В із застосуванням глюкокортикостероїдів та аналогів нуклеозидів. Особливістю клінічного випадку виявився розвиток аспергільозу легень, що потребувало хірургічного лікування. З урахуванням зникнення антигенних маркерів гепатиту В, появи серoконверсії anti-HBs у високому титрі (через 6 та 12 місяців) пацієнтка, як реконвалесцент гострого гепатиту В, була знята з диспансерного обліку.

Hepatic impairment as a risk factor of adverse drug reactions

There are a lot of clinical variants of hepatic impairment ranging from asymptomatic increase in transaminases to acute liver failure and fulminant hepatitis. Hepatic impairment is a polietiologic syndrome. According to the epidemiological study conducted in the United States (19982008), the main causes of hepatic impairment were paracetamol overdose (46%), idiopathic liver dysfunction (14%), other drugs (excluding paracetamol, 11%), viral hepatitis B (7%), other infectious and non-infectious diseases with liver damage (except for viral hepatitis) 7%, autoimmune hepatitis (5%), ischemic hepatitis (syn. hypoxic hepatitis, liver infarction) 4%, viral hepatitis A (3%) and Wilson's disease (2%). Hepatic impairment have a direct impact on the pharmacokinetics and pharmacodynamics of drugs decreasing clearance, elimination and excretion of drugs. Also Transjugular intrahepatic porto-systemic shunts, which are often used to treat portal hypertension in patients with liver cirrhosis, can significantly reduce the presystemic elimination of drugs, thereby increasing their absorption. Moreover, in patients with liver cirrhosis, concomitant renal dysfunction also requires an adjustment of the dose of drugs. Correction of pharmacotherapy in accordance to pharmacokinetic and pharmacodynamic changes of drugs ingested by patients with impaired liver function will improve the quality of medical care and reduce the risks of adverse drug reactions.

Aplastic Anemia Frequency and Management in Pediatric Liver Transplantations Due to Non-A-E Hepatitis.

Hepatitis-associated aplastic anemia (HAAA) is a rare complication that presented with bone marrow failure after acute hepatitis. HAAA usually occurs in adolescent men within 1-6 months following hepatitis. Most of HAAA's etiology has non-A-E viral hepatitis. Our retrospective study included patients with acute fulminant hepatitis who had been treated in Ege University Pediatric Gastroenterology, Hepatology and Nutrition Department and İzmir Kent Hospital Clinical, laboratory, and epidemiological data of the patients were collected from the files. In this study, 499 children underwent liver transplantation (LT) in two pediatric transplantation centers. Sixty-eight (13.6%) out of 499 patients, underwent liver transplantation due to fulminant hepatic failure (FHF). Therefore, a total of 64 patients (34 girls, 30 boys) with a diagnosis of FHF have included in the study. Thirty-two (50.0%) of 64 FHF were due to non-A-E hepatitis and 4 out of the 64 patients (6.2%) with FHF developed HAAA. All of the patients received prednisolone as immunosuppression treatment after LT. Three patients were also given Tacrolimus and 1 received an additional mycophenolate mofetil. One of the patients was given prednisolone and cyclosporine treatment without tacrolimus. Bone marrow transplantation was performed in 1 patient (25.0%). Two of the patients received immunosuppressive treatment including rabbit-derived anti-thymocyte globulin, cyclosporine, and initially prednisolone. In children who underwent liver transplantation for non-A-E FHF are at high risk to develop aplastic anemia. The clinicians should be alert after orthotropic liver transplantation patient could develop aplastic anemia and early treatment with immunosuppressive therapies result in a more successful outcome.

Seroprevalence of Hepatitis- A virus in North Karnataka and its changes over a 5 year period

Introduction: Worldwide, the most common type of acute viral hepatitis is hepatitis A, transmitted via the fecal-oral route occasionally leading to death due to acute fulminant hepatitis. The present study was undertaken to study the seroprevalence of HAV infection in a tertiary care hospital over a five year period. Materials and Methods: A cross-sectional study was conducted from January 2012 to December 2016 on samples of blood obtained from cases of clinically suspected hepatitis infection by IgM 'capture' assay ELISA. Results: A total of 173 cases were included in the study. The number of positive cases were 35(20.2%). The percentage positivity rate of anti HAV IgM was higher among the children tested 32(30.8%) when compared to adults tested 3(4.3%). Seasonal distribution showed maximum number of seropositive cases in the monsoon months. Conclusion: Increase in the number of samples received during 2014 and 2015 and a zero positive rate in 2015 indicates a rise in the awareness about preventive measures against hepatitis A virus infection. Uniform and well structured protocols which monitor HAV cases and assess disease load are necessary to capture and probe into the sudden rise in the seropositivity, as seen in the last four months of 2016 in this study. Keywords: Fulminant hepatitis, Feco-oral route, Hepatitis A, Sero prevalence.

HBV-HDV co-infection: Alarming prevalence at a tertiary care Hospital, Karachi, Pakistan

Background: Pakistan is currently facing an epidemic of viral hepatitis due to B, C and D viruses which share parallel routes of transmission. Hepatitis D virus (HDV) can only replicate in individuals who are already infected with hepatitis B virus. Patients having HBV-HDV co-infection may have more severe disease and higher risk of fulminant hepatitis in acute cases and cirrhosis and hepatocellular carcinoma in chronic infections within 5-10 years compared to individuals suffering from HBV monoinfection. The worldwide trend of HDV infection is decreasing due to HBV vaccination. Pakistan has still high endemicity of HDV. This study was conducted to determine the prevalence of hepatitis D virus infection among the HBV positive patients population and associated risk factors. Methods and materials: Blood samples were collected aseptically in red top vaccutainer from 12679 patients who reported at hepatitis Clinic of Civil Hospital, Karachi, Pakistan, during a period of two years. Demographic data including age, sex and risk behaviour were recorded. All serum samples were screened for the presence of HBsAg by one step ELISA technique and confirmed by PCR for HBV DNA. Samples from HBV positive patients were processed to determine HDV specific antibodies by Sandwich ELISA technique. Results: A total of 2472 (19.5%) patients with symptoms of hepatitis tested positive for presence HBsAg, and HBV DNA out of these HBV positive patients, 1954 were tested for anti HDV, 693 (35.5%) were found to be positive for HDV specific antibodies. HDV infection was most prevalent in patients on both extremes of age, i.e., under 10 years and 71–80 years, slightly higher in females than males and majority had a history of injections (therapeutic) and previous surgery. Conclusion: Our results indicated a very high prevalence of HDV infection among the hepatitis B infected patients population which would suggest that all patients with hepatitis B virus infection should be tested for hepatitis Delta Virus infection to avoid serious complications of the disease like acute fulminant hepatitis, cirrhosis, hepatocellular carcinoma and even death. Mass screening, HBV vaccination campaigns and awareness about the route of spread of the disease must be carried out.

Dengue Hemorrhagic Fever with Acute Fulminant Hepatitis: A Case Report

Dengue virus is estimated to cause over 100 million infections throughout the world annually. Although dengue infections can have a wide range of clinical pictures, atypical manifestations have been described recent years. The liver is a susceptible organ affected in dengue infection. Mild liver dysfunction is common in cases of dengue infection but severe liver function impairment and even encephalopathy are rare. The following is a case report of dengue hemorrhagic fever (DHF) with acute fulminant hepatitis. A 43-year-old woman has fulminant hepatitis on day 3 of treatment. Her AST level increased dramatically from 363 U/L to 3,246 U/L. The causes of other hepatitis infection has been excluded. Her dengue IgM-antibody level was reactive. Level of dengue IgM antibody reactive. Clinical improvement experienced by patient after supportive therapy and administration glisirizin or Stronger Neo-Minophagen-C (SNMC).

Cholestatic hepatitis with ciprofloxacin therapy: A Case Report

Ciprofloxacin has generally been well-tolerated and is the commonly prescribed fluoroquinolone antibiotic for treatment of urinary tract and gastrointestinal infection. The adverse effects on the liver usually range from asymptomatic elevation of liver enzymes to fulminant hepatitis. However, acute fulminant hepatitis and cholestatic hepatitis are reported rarely in literature. Here, we report a case of ciprofloxacin induced cholestatic hepatitis in a 52 year old woman following intravenous ciprofloxacin for acute gastroenteritis.