Acute Hepatitis Patients Research Articles

A Nationwide Survey of the Seroprevalence of Hepatitis E Virus Infections Among Blood Donors in Thailand.

Hepatitis E virus (HEV) is a common cause of acute hepatitis infections. Our previous 3-year study at two large Thai hospitals established an occurrence of 4-5% of HEV infections from swine HEV genotype 3 in suspected acute hepatitis patients, with the high incidence in older adults. This study was a serosurvey to determine the prevalence of HEV infections among Thai adults. We obtained sera from 630 healthy blood donors with a median age of 38 (18-64) years who attended Thai Red Cross transfusion units throughout Thailand. The donors were domiciled in 16 provinces in the northern (n = 159), central (n = 193), northeastern (n = 158), and southern (n = 120) regions. The seroprevalence of IgG antibody to HEV (anti-HEV) was determined by the EUROIMMUN test kit, using indirect enzyme-linked immunosorbent assay (ELISA) based on recombinant antigens derived from ORF2 of HEV genotypes 1 and 3. Demographic data, including information related to HEV infection risk (the number of pigs and the proportion of Muslims in each province), were also obtained. The overall anti-HEV prevalence among Thai adults was 29.7%. The frequencies of anti-HEV found in the northern (28.9%, 95% confidence interval [CI] = 22.4-36.4), northeastern (34.8%, 95% CI = 27.8-42.5), and central (35.8%, 95% CI = 29.3-42.7) regions were similar, whereas the frequency in the southern (14.2%, 95% CI = 9.0-21.5) region, known to have a large Muslim population, was low. An increasing frequency of the specific antibody was observed among the elderly. A low HEV infection rate was associated with an Islamic population where there are low number of pigs and low swine consumption. Furthermore, the higher anti-HEV incidences in the northeastern provinces might relate to the local cultural practice of consuming undercooked pork. Besides the need for an HEV vaccination in the future, there is a requirement for rapid early diagnosis; the undertaking of prevention-management campaigns might also reduce the number of infected patients.

Viral hepatitis among acute hepatitis patients attending tertiary care hospital in central India.

Viral hepatitis is a considerable public health burden affecting millions of people throughout the world. The incidence of viral hepatitis varies greatly depending upon geographic locations, age and gender. Exploring the etiological spectrum and clinic-epidemiological profile of acute viral hepatitis (AVH) becomes essential for strategizing the preventive measures to control the diseases. An epidemiological data depicting AVH situation and its etiologies is missing from central India. With the aim of fulfilling this lacuna, the present analysis was done on samples tested over a period of 2years from July 2015 to June 2017. Of the 1901 hepatitis cases, 597 individuals (31.4%) were positive for AVH infection and HEV was the predominant cause followed by HBV, HAV and HCV. Co-infections of hepatitis viruses were detected in 42 cases. Co-infection of HEV with HBV was the commonest pattern. Male preponderance was observed among AVH positive cases and the age group of 26-45years was the most susceptible to the viral hepatitis infections, except hepatitis A, which was the most frequent among children. Two hundred patients (33.45%) required hospitalization and 51 deaths were attributed to AVH infections. The analysis for the first time reports intricacies and viral etiologies of AVH in central India. Regular diagnosis of AVH etiology and monitoring of cases will help in patient management and assist disease control programs to take policy decisions.

Clinico-epidemiological profile of hepatitis A virus and hepatitis E virus co-infection in pediatric age group: a hospital based retrospective study

Background: Hepatitis-A virus (HAV) and Hepatitis E virus (HEV) are two major hepatotropic viruses of great public health importance in the developing countries like India. Both HAV and HEV are enterically transmitted and there are speculations that their co-infection might be associated with a more severe clinical course and increased rate of mortality. The objective of this study is to determine the prevalence, clinical features and biochemical parameters of Hepatitis A and Hepatitis E co-infection in hospitalized patients at a tertiary care centre in Uttarakhand.Methods: It is a retrospective study, covering a period of 4years and conducted in Himalayan Institute of Medical Sciences, SRHU Jolly Grant, Dehradun. Records of the patients with Hepatitis A and Hepatitis E co-infection were retrieved and analyzed.Results: Out of total 125 patients of acute viral hepatitis, 13 patients had HAV and HEV co-infection. 100% of the patients with co-infection presented with complaints of fever and jaundice, followed by 76.92% with vomiting, 69.23% with pruritis, 61.53% with pain in abdomen and 23.07% with altered sensorium. Mean Bilirubin, ALT, AST were 8.69±7.27 mg/dl, 2030.69±1726.93IU/L and 1880.07±1881.11IU/L respectively. Average duration of stay was 8.2 days. Encephalopathy was seen in 2 patients. However, no mortality was reported.Conclusions: Co-infection of HAV and HEV is not rare in pediatric age group. Knowledge about this will be of immense help for planning of future vaccination strategies and for better sanitation program in developing countries like India.

Hematological changes associated with hepatitis by hepatitis E virus

The purpose of the study was to find out the changes in the common hematological parameters in patients (n=998) of acute viral hepatitis caused by hepatitis E virus from April to May, 2018. The mean hemoglobin level was 13.5 g/dL. However, seven patients were found to have hemoglobin level <11.0 g/dL. The mean red cell count was 4.5 x 1012/L. The mean packed cell volume was 40.6%. The mean white blood cell count was 7.1 x 109/L. However, leucopenia was found in 8 cases. The mean platelet count was 186.2 x 109/L. Among the hematological changes associated with hepatitis E virus infection, thrombocytopenia is a notable finding.

Urinary acrolein metabolite levels in severe acute alcoholic hepatitis patients.

Alcohol-associated liver disease (ALD) remains a major health concern worldwide. Alcohol consumption gives rise to reactive/toxic acrolein, a pathogenic mediator of liver injury in experimental ALD. Elevated acrolein adducts and metabolites are detectable in blood and urine. This study evaluates the major urinary acrolein metabolite, 3-hydroxypropylmercapturic acid (HPMA), in patients with acute alcoholic hepatitis (AAH) and examines its association with disease severity and markers of hepatic inflammation and injury. Urine HPMA was significantly higher in patients with severe [model for end-stage liver disease (MELD) ≥ 20] AAH compared with nonsevere AAH (MELD ≤ 19) or non-alcohol-consuming controls, suggesting that urine HPMA is a novel noninvasive biomarker in severe AAH. The association between HPMA and MELD in patients with AAH was nonlinear. In patients with nonsevere AAH, there was a positive trend, although not significant, whereas in severe AAH the association was negative, indicative of extensive injury and glutathione depletion. Consistent with the multifactorial etiology of ALD, our data identified strong combined effects of HPMA and proinflammatory cytokines on hepatocyte cell death, thereby supporting the pathogenic role of acrolein in liver injury. HPMA, together with IL-1β, showed robust associations with cytokeratin 18 caspase-cleaved fragment (CK18-M30; adjusted R2 = 0.812, P = 0.016) and cytokeratin 18 full-length protein (CK18-M65; adjusted R2 = 0.670, P = 0.048); similarly, HPMA, with IL-8, correlated with CK18-M30 (adjusted R2 = 0.875, P = 0.007) and CK18-M65 (adjusted R2 = 0.831, P = 0.013). The apoptosis index (CK18-M30:CK18-M65 ratio) strongly correlated with HPMA, together with IL-1β (adjusted R2 = 0.777, P = 0.022) or tumor necrosis factor-α (TNFα; adjusted R2 = 0.677, P = 0.046). In patients with severe AAH, IL-1β, IL-8, and TNFα are the predominant proinflammatory cytokines that interact with HPMA and play important mediating roles in influencing the extent/pattern of liver cell death. NEW & NOTEWORTHY This is the first study to examine the urinary acrolein metabolite 3-hydroxypropylmercapturic acid (HPMA) in alcoholic liver disease. HPMA was higher in patients with severe acute alcoholic hepatitis (AAH) compared with controls or nonsevere AAH and may be a novel selective, noninvasive biomarker for severe AAH. Consistent with the multifactorial etiology of alcohol-associated liver disease, we identified strong combined effects of HPMA and proinflammatory cytokines (IL-1β, IL-8, and TNFα) on the extent/pattern of liver cell death, thereby supporting the pathogenic role of acrolein.

Role of Interleukin-28B in clearance of HCV in acute and chronic hepatitis patients in Kirkuk city

Role of Interleukin-28B in clearance of HCV in acute and chronic hepatitis patients in Kirkuk city

Role of Interleukin-28B in clearance of HCV in acute and chronic hepatitis patients in Kirkuk city

A cross sectional study was conducted in Kirkuk city from June 2017 to March 2018. The number of hepatitis patient understudy were 62 hepatitis C (27 acute and 35 chronic) whose ages were between 20-75 years old. The purpose of this study was to evaluate the effect of IL28B in the clearance of HCV. These patients admitted to Hepatology and Gastroenterology centers of Kirkuk. The control group who were matched to the patients studied, included 30 individuals who admitted to blood bank for blood donation, for molecular test of HCV Real-time quantitative test and serum IL-28B ELISA. The study exhibited that 81.48 % of acute HCV patient who positive by ELISA were positive by PCR and 82.86 % of chronic HCV patients were positive by PCR with highly significant relation between them. Regarding the relation of IL-28B with HCV infection, the study presented that the highest mean of IL-28B was recorded among PCR –ve acute HCV patients (17.78 pg/ml) followed by PCR +ve acute HCV and the lowest means was found in the control group with highly significant differences among the groups. The study indicated that the highest mean of IL-28B was recorded among PCR –ve chronic HCV patients (17.78 pg/ml) followed by PCR +ve chronic HCV and the lowest means was found in the control group with highly significant relation. The study showed that the highest mean of ALT and AST were found in acute HCV patients (72.06 and 36.73 IU/ml) respectively followed by chronic HCV and the control group with highly significant relation among the groups.

The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia

IntroductionLiver involvement is common in hematological malignancies, but the incidence and pattern of liver injury vary among the different types. The aims of our study were to determine the incidence and clinical course of acute hepatitis and the important factors for its development in patients with leukemia after chemotherapy.Materials and methodsAll patients with the diagnosis of leukemia who were treated at the Department of Hematology between January 2008 and January 2013 were included in the study. A detailed medical history, clinical and laboratory findings, treatment modalities, complications, and clinical course were recorded retrospectively.ResultsA total of 124 patients (64 females) with the diagnosis of leukemia were included in the study. The mean age was 45.2 years (16-89 years) and mean follow-up time was 29.7 months (0.25-192 months). A total of 43 (34.6%) patients had acute hepatitis after chemotherapy. Pattern of liver injury was hepatocellular in 31 patients, cholestasis in 2, and mix in 10 patients. Age (p = 0.001), hepatitis B surface antigen (HBsAg, p = 0.007), acute leukemia (p < 0.001), positive blood culture (p = 0.004), the amount of transfused red blood cell (p = 0.001), and amount of transfused platelets (p = 0.002) were significantly different under univariate analysis between the acute hepatitis group and the nonacute hepatitis group. Under multivariate analysis, only acute lymphoblastic leukemia (ALL) was identified as independent predictive factor for development of acute hepatitis after starting chemotherapy.ConclusionAcute and self-limited hepatitis develops in the substantial proportion of patients with leukemia. The most important factor for development of acute hepatitis is the type of leukemia.How to cite this article: Kaya M, Akdogan R, Uçmak F, Ayyildiz MO, Karakus A, Kaplan MA. The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia. Euroasian J Hepato-Gastroenterol 2018;8(1):31-37.

Small Animal Models of Hepatitis E Virus Infection.

Novel hepeviruses have been recovered from many different animal species in recent years, increasing the diversity known to exist among the Hepeviridae, which now include two genera, Piscihepevirus and Orthohepevirus Multiple viral genotypes in the Orthohepevirus A species are able to replicate and cause acute hepatitis E in humans, and thus represent an important public health problem in industrialized as well as developing countries. Although hepatitis E virus (HEV) infections typically result in acute and self-limited hepatitis, immunocompromised and transplant patients are vulnerable to prolonged infections and to chronic hepatitis. Cell culture systems have been established for several HEV strains and offer new opportunities for the study of HEV biology. Similarly, a variety of new small animal models have been developed, using either nonhuman hepeviruses in their cognate hosts as surrogates for human HEV, or human HEV infection of immunodeficient mice with chimeric livers engrafted with human hepatocytes. These new models provide several advantages over previous nonhuman primate models of hepatitis E infection and will facilitate studies of pathogenicity, cross-species infection, mechanisms of virus replication, and vaccine and antiviral agent development. This article reviews the current understanding of small animal models for HEV.

Expression of glutathione s-transferase-fusion hepatitis E virus ORF2, 3 antigens in escherichia coli and its application for diagnosis

Context Hepatitis E infection, caused by the hepatitis E virus (HEV), is a common cause of acute hepatitis in developing countries with poor sanitation and hygiene. Aims In this paper, we expressed HEV ORF2 C-terminal 802 bp and ORF3 C-terminal 107 bp fragments and its glutathione S-transferase (GST) fusion genes in Escherichia coli and tested the immunoreactivity of HEV antibody from sample serum with recombinant GST-HEV ORF2, 3 antigens by enzyme-linked immunosorbent assay (ELISA). Settings and design Eight primers designed for gene synthesis. Materials and methods HEV ORF2, 3 and its GST-fusion gene fragments were amplified by PCR. Expression of target genes in E. coli was induced by Isopropyl-β-D-Thio-alactopyranoside (IPTG) (0.1 mmol/l) and temperature (42°C). The detection of anti-HEV antibody with purified GST-HEV ORF2, 3 antigens was performed using the indirect ELISA method. Results When our ELISA was compared with the HEV-ELISA kit, the sensitivity of our assay is 97.9%, specificity is 100%, and consistency is 99.6%. The positive rate of anti-HEV antibody from the serum in acute hepatitis patients with recombinant GST-HEV ORF2, 3 antigens by our ELISA was 29.5 and 26.1%, respectively, and this result corresponded with the HEV-ELISA kit. Conclusion The new HEV ELIA developed in the present study is a highly specific diagnostic assay for the detection of anti-HEV antibody in serum specimens obtained from acute hepatitis patients.

Southern Tunisia: A still high endemicity area for hepatitis A.

BackgroundHepatitis A (HAV) and E (HEV) viruses are responsible for enterically transmitted hepatitis. Tunisia is reported to be of intermediate endemicity for HAV and of low seroprevalence for HEV; however, data from rural areas of South Tunisia are lacking.MethodsSera from 216 asymptomatic pregnant women and from 92 patients with acute hepatitis were collected between October 2014 and November 2015. Total and IgM anti-HAV immunoglobulins and anti-HEV IgG and IgM were investigated. Anti-HAV IgM-positive samples were subjected to RT-PCR targeting the VP1/2A region and sequenced. HEV IgM positive samples and all samples from acute hepatitis patients were assessed for HEV RNA.ResultsAmong pregnant women (mean age 32+/-8), HAV seroprevalence was 98.6%, none presented anti-HAV IgM; HEV seroprevalence was 5.1% and three presented weakly reactive anti-HEV IgM without detectable RNA. Among acute hepatitis patients (mean age 18.5 +/- 14), HEV seroprevalence was 19,5%, none presented anti-HEV IgM, nor HEV RNA. HAV seroprevalence exceeded 90% by age 5 and acute HAV infection was detected in 20 patients (21,7%), younger than patients with other hepatitis causes (9,8 years vs. 20,4 years, p = 0,004); 65% were male. Most acute HAV infections were observed in a coastal area where HAV infections represented 52% of hepatitis etiology. Phylogenetic analysis identified genotype IA strains, clustering close to previously published Tunisian sequences.ConclusionThe present study confirmed a low HEV endemicity and evidenced a still high level of HAV circulation in Southern Tunisia, suggesting distinct dissemination patterns for these viruses.

Consistency analysis on acute hepatitis B inpatients reported by hepatitis B surveillance pilot spots in six provinces of China

Objective: To understand the characteristics of acute hepatitis B inpatients reported by the hepatitis B surveillance pilot points and to estimate the consistency between the diagnosed and reported types of hepatitis B by the clinicians involved. Methods: Data related to acute hepatitis B was from the NNDRS and the characteristics of acute hepatitis B were classified by querying Hospital Information System. We recorded the results based on clinical diagnosis and analyzed the consistency between the reported and diagnosed types that the clinicians made, on hepatitis B. Results: A total of 179 patients were included in this study with all of them as acute hepatitis B reported through NNDRS in 2015-2016. In terms of the durations of disease, among the 179 cases who were HBsAg positive, 32.40% (58/179) of them exceeding 6 months, 2.79% (5/179) within 6 months and 64.80% (116/179) tested the first time or never. Among the 179 cases who claimed having the history of hepatitis, 33.52% (60/179) of them identified as having hepatitis B, 1.12% (2/179) were hepatitis A, C or E, 41.34% (74/179) did not have the signs on hepatitis, while the rest 24.02% (43/179) did not know the situation. Only 79.89% (143/179) of the patients showed the symptoms or signs of hepatitis, but the rest 20.11% (36/179) did not. Among the 179 reported acute hepatitis patients, 67 of them were diagnosed as acute hepatitis B while 112 cases were as non-acute hepatitis B. The consistent rate of acute hepatitis B was 37.43% (67/179). Among the 112 cases that were diagnosed as non-acute hepatitis B, proportions of chronic hepatitis B and cirrhosis were 49.11%(55/112) and 16.07%(18/112) respectively. Conclusion: Consistency between the reported type of acute hepatitis B inpatients and the types diagnosed by clinicians was poor. Our results suggested that clinicians should make the accurate diagnosis at first place and then report to the Network in accordance with the clinical diagnosis classification criterfia, set by the government.

Hepatitis A and E among asymptomatic pregnant women and acute hepatitis patients from South Tunisia

Hepatitis A and E among asymptomatic pregnant women and acute hepatitis patients from South Tunisia

Role of HEV antigen detection in HEV-related acute viral hepatitis and acute liver failure.

Detection of HEV antigen presents as an interesting low cost, novel, and rapid diagnostic technique to ascertain HEV viremia where facilities for reverse transcriptase polymerase chain reaction (RT PCR) are sparse. This study was undertaken to assess the relative efficacy of HEV antigen detection by ELISA with currently available diagnostic tests in patients of HEV-related acute viral hepatitis (AVH) and acute liver failure (ALF). This study included 36 ALF and 64 AVH cases. HEV RNA and HEV viral load were determined by RT PCR and real time PCR, respectively. Evidence of recent HEV infection was detected in 45/64 AVH cases and 22/36 ALF cases. IgM anti-HEV antibody, HEV RNA, and HEV antigen were positive in 34/45 (75.56%), 26/45 (57.77%), and 21/45 (46.66%), in the AVH group, and 16/22 (72.72%), 14/22 (63.63%), 12/22 (54.54%) in ALF group, respectively. The concordance between HEV RNA and HEV antigen was 75.56% (P < 0.01) with κ-coefficient of 0.516 and 75.27% (P = 0.07) with κ-coefficient of 0.441 (P = 0.07) in the AVH and ALF patients, respectively, indicating moderate concordance. It was established that HEV antigen detection can be used as a valuable marker of active viremia and a cheaper surrogate to HEV RT PCR, particularly in window period, pregnant and immunocompromised patients, however, it did not correlate with severity of disease or influence the final outcome of illness in any of the study groups. J. Med. Virol 88:2179-2185, 2016. © 2016 Wiley Periodicals, Inc.

Is Low Dose Synacthen Test Reliable in Detecting Adrenal Insufficiency in Cirrhosis

Background and Aim: To detect adrenal insufficiency in cirrhosis using low dose (1 μg) synacthen test and to compare it with, S. cortisol and salivary cortisol. Background adrenal insufficiency is very common in CLD. Even in stable CLD patients various studies showed prevalence of cirrhosis varying from 20 to 70%. Free cortisol is the most reliable method used for estimation of adrenal insufficiency. But it is expensive and time consuming. Salivary cortisol in various studies correlated well with free cortisol. Serum total cortisol may not be a reliable in detecting adrenal insufficiency. Low dose (1 μg) synacthen test may be reliable and cost effective method in detecting adrenal insufficiency. Methods: Prospective observational study. 31 stable CLD patients admitted in medical gastro trivandrum were taken and S. total cortisol, salivary cortisol at 8 am was sent. Low dose (1 μg) synacthen was administered i.v. to the patients at 8 am and S. total cortisol at 8.30 am was also measured. Similar tests were also done for 15 acute viral hepatitis patients. Those with basal S. cortisol <4 μg/dl, post-synacthen <18 μg/dl were considered to have adrenal insufficiency. Results: Prevalence of adrenal insufficiency in stable CLD using low dose synacthen was 40%. Prevalence of adrenal insufficiency in stable CLD using salivary cortisol is 44%. Prevalence of adrenal insufficiency in stable CLD using total was S. cortisol 12% which rose to 60% when higher cut off 10 μg/dl was used. Similarly prevalence of adrenal insufficiency in a/c viral hepatitis was 6%, 25% and 33% using S. cortisol, low dose synacthen test and salivary cortisol. The prevalence of adrenal insufficiency was more in those with alcohol as etiology of cirrhosis, MELD > 16 and Child C cirrhosis. Conclusion: Low dose synacthen test is a reliable test to detect adrenal insufficiency in cirrhosis. Prevalence of adrenal insufficiency in cirrhosis was 44%. Total serum cortisol at lower cutoff has high false negativity and higher cutoff has high false positivity. Low dose synacthen was found to have equally efficient compared to salivary cortisol in detecting AI in cirrhosis and is very cost effective. The authors have none to declare.

Vaccination against hepatitis A and B in patients with chronic liver disease and type 2 diabetes: has anything changed?

Given the severity of acute hepatitis in patients with chronic liver diseases (CLD) and patients with type 2 diabetes (DM), most of these patients are recommended to be vaccinated. The aim is to assess the recent changes in HAV and HBV vaccination rates in patients with CLD and DM in the U.S. using the most recent population data. We used the National Health and Nutrition Examination Surveys (NHANES) cycles 2009-2012 and 2013-2014, and compared those to previous cycles (1999-2004 and 2005-2008). In general U.S. population, the rates of quality measure (QM, serologic immunity or history of vaccination) for HBV increased from 31.9% in 1999-2004 to 49.5% in 2013-2014 (P < 0.0001), synchronously with an increase in self-reported HBV vaccination: from 24.4% to 41.3% (P < 0.0001). A similar increase was noted for HAV: 12.0% in 1999-2004 to 33.4% in 2013-2014 in vaccination, 44.0% to 52.4% in HAV QM (all P < 0.0001). Greater recent increases in HBV QM were noted in non-HBV CLD patients: 34.7% to 56.8% in HBV QM and 22.7% to 51.1% in HBV vaccination (all P < 0.0001), while the changes in patients with diabetes were similar to those in general U.S. population despite the recent CDC recommendation (for the age 19-59): 31.0% to 45.1% (P = 0.007) in HBV QM, and 22.3% to 39.0% (P = 0.0004) in HBV vaccination. Despite recommendations, HAV and HBV vaccination rates in patients with CLD and DM remain relatively low. Better vaccination strategies for these high risk patients should be undertaken.

Hepatitis E Virus Genotype 3 in Sewage and Genotype 1 in Acute Hepatitis Cases, Israel.

Hepatitis E virus (HEV) is an emerging infectious agent in developed countries. HEV genotypes 1 (G1) and 3 (G3) have been identified in environmental and clinical samples in Europe. In Israel, the overall prevalence of anti-HEV IgG antibodies was found to be 10.6%; however, reports of HEV infection are scarce. In this study, the presence of HEV in Israel was investigated using 169 sewage samples from 32 treatment facilities and 49 samples from acute hepatitis patients, all collected between 2013 and 2015. Fourteen sewage samples, from Haifa (11/18 samples), Tel Aviv (2/29 samples), and Beer Sheva (1/17 samples), regions with good sanitary conditions and middle-high socioeconomic populations, were HEV positive. Among the patient samples, 6.1% (3/49) were HEV positive, all returning travelers from India. Genotype analysis revealed G1 HEV in patients and G3 HEV sequences in sewage. Evidence that HEV could be establishing itself in our region may justify more active surveillance to monitor its spread.

Clinical characteristics and molecular analysis of hepatitis B virus reactivation in hepatitis B surface antigen-negative patients during or after immunosuppressive or cytotoxic chemotherapy.

Reactivation of hepatitis B virus (HBV) in hepatitis B surface antigen (HBsAg)-positive patients treated with immunosuppressive or cytotoxic chemotherapy is well known and has emerged as an important clinical issue. The risk is low, but reactivation of HBV in HBsAg-negative patients after resolution of HBV infection also occurs; however, the clinical and virological characteristics remain somewhat unclear. We investigated HBsAg-negative patients who developed HBV reactivation during or after immunosuppressive or cytotoxic chemotherapy to clarify the clinical and virological features. Reactivation of HBV in 30 previously infected that is HBsAg-negative patients during or after immunosuppressive or cytotoxic chemotherapy was examined. Direct sequencing at the time of reactivation was used to evaluate 11 patients. The majority of patients had diffuse large B cell lymphoma treated by rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone. Fulminant hepatic failure developed in three patients, who did not survive. HBV subgenotypes A2/Ae (n=1), B1/Bj (n=2), and C2/Ce (n=8) were detected. There were no significant differences in the prevalence of BCP/PC variants between HBV reactivation and acute self-limited hepatitis patient groups. BCP and PC variants were not associated with development of fulminant hepatic failure from HBV reactivation. The prevalence of HBV S region variants, including immune-escape mutants, among reactivation patients was significantly higher than that in acute self-limited hepatitis patients. Reactivation risk factors included male sex, advanced age, and hematological malignancy. HBV S gene immune-escape mutants were frequently found in the HBsAg-negative reactivation patients during or after immunosuppressive or cytotoxic chemotherapy.

Age wise seroprevalence of hepatitis viral markers in acute infectious hepatitis patients at a tertiary care centre in India

Introduction: Age wise seroprevalence of acute viral hepatitis still remains debatable. The burden of the disease could be reduced to a considerable extent, if seroprevalence of different viruses are known for various age groups. Objectives: To determine the age wise seroprevalence of hepatitis viral markers in clinically suspected infectious hepatitis at a tertiary care hospital in urban India Methodology: This prospective study was conducted over a period of 1 year from January -December 2008. The study arm had 600 patients with clinically suspected acute infectious hepatitis while control arm had 200 age and sex matched subjects. Both groups were divided into 0-10,11-20, 21-30, 31-40 and >40 years age groups .Serum samples were tested for IgM anti HAV, IgM anti HEV, IgM anti HCV and HBsAg using commercially available enzyme linked immunosorbent assay kits. Results: Highest seropositivity of anti-HAV IgM was in 0-10 years of age for the study arm. HAV seroprevalence decreased with increasing age. Highest seropositivity of HBsAg was in 20-30 years of age group for the study group (7.6%) followed by 11-20 years (4.5%), 0-10 years (2.8%) and >40 years (2.5%). Highest seropositivity to IgM anti HCV was seen in 11-20 years(9%) in the study arm followed by 21-30 years (6.1%), 0-10 years (5.1%) and >40 years (3.7%) of age. Highest seropositivity of anti-HEV IgM was in the 21-30 years (10.7%) in the study arm followed by 31-40 years (2.9%), 11-20 years (2.7%) and 0-10 years (0.9%). Conclusion: Both HAV and HEV are significant causes of enterically transmitted acute viral hepatitis. HAV is the major cause of acute viral hepatitis in childhood. Hepatitis B virus is the major cause of acute viral hepatitis in adults. HCV is a common cause of acute hepatitis in young adults. HCV infections remain under reported while the actual disease burden is much higher. Keywords: Seroprevalence, Age wise, HBsAg, HCV, HAV, HEV

A Preliminary Study to Assess the Clinical – Epidemiological Profile of Acute Viral Hepatitis in Indian Subcontinent

Acute viral hepatitis (AVH) is a major public health problem and is an important cause of morbidity and mortality in India. A study to examine the clinical – epidemiological profile of acute viral hepatitis was carried in Aligarh, Uttar Pradesh. It was found that in a total of 90 serologically positive acute viral hepatitis patients, Hepatitis E was the most prevalent and with most fatalities in pregnant women. Hepatitis B had the most fulminant course followed by hepatitis E. The disease was statistically insignificantly distributed among different age groups, sex and residency rural or urban. The individual courses of the different types of acute viral hepatitis were thereby studied and discussed.