Febrile Jaundice Research Articles

Analysis of the clinical characteristics of patients with Kawasaki disease complicated with cholestasis

BackgroundTo explore the clinical characteristics, related factors, and prognosis of Kawasaki disease (KD) combined with acute febrile cholestasis and improve the understanding of the liver complications of KD to avoid misdiagnosis and missed diagnosis.MethodsWe retrospectively analyzed the demographic, clinical, and laboratory data of 1803 patients with KD between January 2019 and July 2023 in our hospital. Based on the presence of cholestasis, patients were divided into the cholestatic and control groups. Logistic regression analysis was performed for the statistically significant indicators between the two groups to examine the risk factors for KD with coronary artery abnormalities (CAA) and intravenous immunoglobulin (IVIG) unresponsiveness. Additionally, patients with KD and cholestasis were compared with patients with acute febrile cholestasis due to other causes during the same period.ResultsCompared to the control group (n = 1720), patients in the cholestatic group (n = 83) were older, had higher levels of white blood cell count (WBC), C-reactive protein (CRP), D-dimer, N-terminal pro-brain natriuretic peptide (NT-proBNP), a shorter fever duration, and high incidences of IVIG unresponsiveness and CAA. KD was the leading cause of acute febrile cholestasis in children (72.6%). In the multivariate logistic regression analysis, younger age, cholestasis, hypoalbuminemia, and a high NT-proBNP level were risk factors for IVIG unresponsiveness, whereas male sex, longer fever duration before treatment, and high alanine aminotransferase (ALT), and CRP levels were risk factors for CAA.ConclusionKD with cholestasis was associated with a higher risk of IVIG unresponsiveness and coronary artery abnormalities. KD was the leading cause of acute febrile cholestasis in children. Attention to the possibility of KD is warranted in children with acute febrile cholestatic jaundice, especially if associated with elevated WBC, CRP, and D-dimer levels, or hypoalbuminemia.

Hepatitis E virus infections among patients with acute febrile jaundice in two regions of Cameroon: First molecular characterization of hepatitis E virus genotype 4.

Febrile jaundice is a common indicator of certain infectious diseases, including hepatitis E. In Cameroon, the yellow fever virus is the only pathogen that is monitored in patients who present with this symptom. However, more than 90% of the samples received as part of this surveillance are negative for yellow fever. This study aimed to describe the prevalence and hepatitis E virus (HEV) genotype among yellow fever-negative patients in the Far North and West regions of Cameroon. In a cross-sectional study, yellow fever surveillance-negative samples collected between January 2021 and January 2023 were retrospectively analyzed. Anti-HEV IgM and IgG antibodies were tested using commercially available ELISA kits. Anti-HEV IgM and/or IgG positive samples were tested for HEV RNA by real-time RT-PCR, followed by nested RT-PCR, sequencing and phylogenetic analysis. Overall, 121 of the 543 samples (22.3%, 95% CI: 19.0% - 26.0%) were positive for at least one anti-HEV marker. Amongst these, 8.1% (44/543) were positive for anti-HEV IgM, 5.9% (32/543) for anti-HEV IgG, and 8.3% (45/544) for both markers. A total of 15.2% (12/79) samples were positive for HEV RNA real-time RT-PCR and 8 samples were positive for HEV RNA by nested RT-PCR. Phylogenetic analysis showed that the retrieved sequences clustered within HEV genotypes/subtypes 1/1e, 3/3f and 4/4b. Our results showed that HEV is one of the causes of acute febrile jaundice in patients enrolled in the yellow fever surveillance program in two regions of Cameroon. We described the circulation of three HEV genotypes, including two zoonotic genotypes. Further studies will be important to elucidate the transmission routes of these zoonotic HEV genotypes to humans in Cameroon.

DOENÇA DE KAWASAKI COM SINTOMAS INICIAIS ATÍPICOS: UM RELATO DE CASO

Introduction: Kawasaki disease (KD) is an acute, self-limited, systemic vasculitis of unknown etiology. The diagnosis is essentially clinical and the treatment is based on the use of intravenous human immunoglobulin (IVIG) and acetylsalicylic acid (ASA) in anti-inflammatory dose, being ideally initiated by the tenth day of the onset of symptoms in order to avoid the complications associated with this pathology. Metodology: This is a case report of a 9-year-old child with Kawasaki syndrome with atypical initial presentation. Discussion: Previously healthy child, presenting febrile jaundice hemorrhagic syndrome and influenza syndrome, associated with radiological changes that could be correlated with SARS-COV-2 infection, without initially ruling out the hypothesis of Pediatric Multisystemic Inflammatory Syndrome (SIM-P). After negative serologies and cultures, there was a progressive remission of symptoms, except for the fever. Criteria for KD were met on the 16th day of evolution, when monotherapy with ASA without IVIG was initiated, with resolution of the fever. Conclusion: It is essential to be aware of the possible variations in the clinical presentation of KD and correlate it with the epidemiological and social context of the patient, due to the morbidity related to this vasculitis.

Cholestatic Jaundice during Epstein-Barr Virus Primary Infection: A Rare Manifestation

Infectious mononucleosis, induced by the Epstein-Barr virus (EBV), is a very frequent infection, affecting mostly young adults. Although liver damage is often mild and self-limiting, only a few cases of severe EBV-induced cholestatic hepatitis and jaundice have been reported in the literature. EBV infection should be considered as part of the differential diagnosis in patients with an obstructive pattern on liver function tests without evidence of biliary obstruction demonstrated on advanced imaging. The diagnosis is usually confirmed only by serology and the evolution is generally favorable. We report the observation of an 16 year old female with no particular medical history, who developed a febrile cholestatic jaundice without signs of hemolysis and without biliary obsruction on imagery.

Aetiology and Clinical Profile of Infectious Section Causes of Febrile Jaundice at a Tertiary Care Hospital in Eastern OdishaAn Observational Prospective Study

Introduction: Fever with jaundice is one of the most common presentations seen in both outdoor and indoor patients. This manifestation is seen in many individuals infected with hepatotropic viruses (A to E), bacteria, protozoa, fungi, and non hepatotropic viruses. In viral hepatitis due to hepatotropic viruses the patient presents with a short febrile prodrome followed by jaundice, and is often self-limiting without any treatment whereas in patients other than viral hepatitis the patients present with ongoing fever and jaundice and need specific treatment. Aim: To evaluate clinical profile of patients presenting with febrile jaundice and finding the infections agent responsible for fever with jaundice baring viral hepatitis (A to E). Materials and Methods: This observational prospective study included 107 patients admitted in the Kalinga Institute of Medical Sciences, from September 2019 to August 2021, who were found to have febrile jaundice after initial evaluation, based on liver function tests and hepatotropic viral markers (hepatitis B surface antigen, Immunoglobulin M antibody against hepatitis C virus Immunoglobulin M antibody against hepatitis A virus, Immunoglobulin M antibody against hepatitis E virus). Routine laboratory parameters, chest radiograph, and electrocardiogram were performed in all cases. Appropriate investigations like specific serological, radiological investigations and cultures were performed to identify the causal pathogen. Statistical analysis of categorical variables was conducted by Statistical Package for Social Sciences (SPSS) 26.0 version. Results: Out of 107 patients, (23.3%) patients were found to have scrub typhus. Dengue was found in 23 (21.4%) patients (three had dengue associated with scrub typhus). Coronavirus Disease 2019 (COVID-19) was found in 11 patients (10.2%) of study population. Malaria, tuberculosis, S. typhi, K. pneumonia, E. coli, B. cepacia, E. feacalis were isolated in other individuals. Among these, 41.12% patients had associated transaminitis, whereas, 16 had elevated aspartate transaminase/ alanine transaminase (>3 times of ULN). Overall, 18.4% patients had hepatomegaly, and 6.5% were found to have splenomegaly. Eight patients had septic shock, and associated Multiple Organ Dysfunction Syndrome (MODS) was seen in six patients. No definitive aetiology was found in 25 patients. Conclusion: The study identified a variety of organisms in sera from the patients presenting with febrile jaundice. The most common clinical feature was anorexia followed by headache. The common aetiology for febrile jaundice was viral infections {barring viral hepatitis (A to E)} followed by bacterial Infections.

Yellow Fever and Hepatitis B Co-Infection in A Nigerian Girl with Acute Febrile Jaundice: A Case Report

Yellow fever is a lethal re-emerging viral disease transmitted by infected Aedes mosquitoes. It is largely endemic in sub-Saharan Africa, with high risk of widespread outbreak in an unimmunized population. Recent outbreaks have been reported in several states in Nigeria. Yellow fever causes an acute febrile jaundice which can be confused with several endemic diseases, particularly viral hepatotropic infections such as hepatitis B, emphasizing the need for surveillance of co-viral pathogens during outbreaks. We report a rare case of yellow fever with hepatitis B co-infection in a 15-year-old girl who was successfully managed in a tertiary hospital in South-East Nigeria.

Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a\xa0case report

BackgroundMethotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy.Case presentationA 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure.ConclusionsOur case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit.

Prevalence and Diversity of Hepatitis Virus Markers among Patients with Acute Febrile Jaundice in Chad

Only a minority of the patients with acute febrile jaundice evaluated through the Yellow Fever surveillance program were found positive for antibodies against Yellow Fever Virus (YFV). In order to characterize patients with acute febrile jaundice negative for YFV, we collected 255 sera between January to December 2019. We screened for HBV antigens, and antibodies against HCV and HEV. The seroprevalences observed were 10.6% (27/255) for HBV, 2% (5/255) for HCV, 17.3% (44/255) for HEV IgG, 4.3% (11/255) for HEV IgM, and 12.5% (32/255) for both IgG and IgM HEV. Prevalence of HEV was significantly higher in females than males (p < 0.01). HEV IgG prevalence was highest in those 20–29 years old, but the highest incidence rate (IgM positive) was in children 0–9 years old. Exposure to HEV was higher in the Sahelian zone (55.8%, 95% CI: 40.97–70.66) than in the Sudanese zone (30.2%, 95% CI: 24.01–36.37, p = 0.003). The high prevalence rates and hepatitis virus diversity underline the challenge of routine clinical diagnosis in Chad’s Yellow Fever surveillance program.

Herpes Infections in Suspected Cases of Yellow Fever in the Democratic Republic of the Congo.

In the battle to quickly identify potential yellow fever arbovirus outbreaks in the Democratic Republic of the Congo, active syndromic surveillance of acute febrile jaundice patients across the country is a powerful tool. However, patients who test negative for yellow fever virus infection are too often left without a diagnosis. By retroactively screening samples for other potential viral infections, we can both try to find sources of patient disease and gain information on how commonly they may occur and co-occur. Several human arboviruses have previously been identified, but there remain many other viral families that could be responsible for acute febrile jaundice. Here, we assessed the prevalence of human herpes viruses (HHVs) in these acute febrile jaundice disease samples. Total viral DNA was extracted from serum of 451 patients with acute febrile jaundice. We used real-time quantitative PCR to test all specimens for cytomegalovirus (CMV), herpes simplex virus (HSV), human herpes virus type 6 (HHV-6) and varicella-zoster virus (VZV). We found 21.3% had active HHV replication (13.1%, 2.4%, 6.2% and 2.4% were positive for CMV, HSV, HHV-6 and VZV, respectively), and that nearly half (45.8%) of these infections were characterized by co-infection either among HHVs or between HHVs and other viral infection, sometimes associated with acute febrile jaundice previously identified. Our results show that the role of HHV primary infection or reactivation in contributing to acute febrile jaundice disease identified through the yellow fever surveillance program should be routinely considered in diagnosing these patients.

Evaluation of yellow fever surveillance in Chad, 2015-2020

The present study was conducted to determine the seroprevalence of yellow fever virus in patients with clinical signs of febrile jaundice giving suspicion of yellow fever and to evaluate diagnostic techniques for surveillance of yellow fever in the Republic from Chad. From January 2015 to July 2020, an observational study of virological markers was conducted in jaundice patients in Chad. Of the 1730 patients included in this study, a seroprevalence of 0.28% of yellow fever virus was determined. The distribution of pathogens responsible for diseases associated with yellow fever was: 49.47% (Plasmodium falciparum), 2% (hepatitis E virus), 4.62% (hepatitis C virus), and 29.00% (hepatitis virus B), respectively. Discrepancies in the results between the regional reference laboratories and the national laboratory of the Republic of Chad were observed. All genders and age groups were affected. Of the 1730 samples taken, 55.49% were female and 44.51% male (p = 0.01, a significant difference in favor of the female sex). The male/female sex ratio was 1.25. This study, the first, made it possible to determine the rate of the yellow fever virus in the absence of an outbreak in forest areas and with heavy rainfall and to evaluate the MAC-ELISA-CDC techniques used between the national laboratory of the Republic of Chad and those regional references. It was recommended that real-time polymerization chain reaction techniques be made available to national laboratories and reagents from the same manufacturing company in order to carry out effective monitoring of yellow fever. Key words: Evaluation, surveillance, seroprevalence, techniques, yellow fever.

Hepatitis E virus\xa0outbreak associated with rainfall in the Central African Republic in 2008-2009

BackgroundInfection by hepatitis E virus (HEV) can cause a high burden of morbidity and mortality in countries with poor access to clean water and sanitation. Our study aimed to investigate the situation of HEV infections in the Central African Republic (CAR).MethodsA retrospective analysis of the blood samples and notification forms collected through the national yellow fever (YF) surveillance program, but for which a diagnosis of YF was discarded, was carried out using an anti-HEV IgM ELISA and a HEV-specific RT-PCR.ResultsOf 2883 YF-negative samples collected between January 2008 and December 2012, 745 (~ 26%) tested positive by at least either of the 2 tests used to confirm HEV cases. The results revealed that the CAR was hit by a large HEV outbreak in 2008 and 2009. The results also showed a clear seasonal pattern with correlation between HEV incidence and rainfall in Bangui. A phylogenetic analysis showed that the circulating strains belonged to genotypes 1e and 2b.ConclusionsOverall, this study provides further evidences that HEV can be a significant cause of acute febrile jaundice, particularly among adults during rainy season or flood, in a country from Sub-Saharan Africa.

Comparative Sero-prevalence of Herpes Simplex Virus Type-1 IgG Antibodies in Nigerian Children by Two Methods; IFA and ELISA

Herpes simplex virus type-1 (HSV-1) are common cause of fatal sporadic encephalitis in 70% of children and can cause chronic ulcerative infection in immuno- suppressed children leading to latency with subsequent reactivate in the conjunctiva resulting in scarring, thickening of the cornea and blindness. This comparative study determined the sero-prevalence of HSV-1 IgG antibodies in children attending some selected Hospitals in Kaduna state, Nigeria. A total of 377 blood samples were collected from children less than five years old attending some selected hospitals in Kaduna State and analyzed for HSV-1 IgG antibodies employing Enzyme immune assay technique by using commercially available ELISA Kits and Indirect Fluorescent Antibody (IFA) test. Sero-prevalence rate of 57.8 % (218 /377) was obtained by ELISA and 67.4% (255/377) by IFA test. The highest prevalence of HSV-1 infection was obtained in children in age group 49-60 months (85.2%) and lowest in children in age group 13-24 months (44.8%). Herpes simplex virus type -1 infection was significantly associated with age. Though a higher prevalence was obtained in female children than male children the difference observed in the prevalence was not statistically significant .The infection was significantly associated with children who were in school (χ2= 15.28, df = 1, P= 0.001) by only the ELISA test. Clinical symptoms significantly associated with HSV-1infection in children in this study were febrile illnesses, conjunctivitis, jaundice, skin infections and oro-facial lesions while the risk factors were age and educational status of children. Over half of the children sampled were protected from HSV-1 infection while about 40% of the children were susceptible to the infection and were at risk of developing severe HSV-1 manifestation which includes keratitis, encephalitis and Keratoconjunctivitis.

Next-generation Sequencing Study of Pathogens in Serum from Patients with Febrile Jaundice in Sierra Leone

ObjectivePeople in Western Africa suffer greatly from febrile jaundice, which is caused by a variety of pathogens. However, yellow fever virus (YFV) is the only pathogen under surveillance in Sierra Leone owing to the undeveloped medical and public health system there. Most of the results of YFV identification are negative. Elucidation of the pathogen spectrum is required to reduce the prevalence of febrile jaundice. MethodsIn the present study, we used Ion Torrent semiconductor sequencing to profile the pathogen spectrum in archived YFV-negative sera from 96 patients in Sierra Leone who presented with unexplained febrile jaundice. ResultsThe most frequently identified sequencing reads belonged to the following pathogens: cytomegalovirus (89.58%), Epstein-Barr virus (55.21%), hepatitis C virus (34.38%), rhinovirus (28.13%), hepatitis A virus (20.83%), coxsackievirus (10.42%), Ebola virus (8.33%), hepatitis E virus (8.33%), lyssavirus (4.17%), leptospirosis (4.17%), chikungunya virus (2.08%), Crimean-Congo hemorrhagic fever virus (1.04%), and hepatitis B virus (1.04%). ConclusionThe distribution of sequencing reads suggests a broader spectrum of pathogens for consideration in clinical diagnostics and epidemiological surveillance in Sierra Leone.

Evidence of human leptospirosis cases in a cohort of febrile patients in Bangui, Central African Republic: a retrospective study, 2012\u20132015

BackgroundIn spite of a local favorable environment, leptospirosis has never been described in Central African Republic so far mainly because of the weakness of diagnostic tests and differential diagnostic strategy for febrile jaundice cases negative for yellow fever virus. Here we bring a complementary insight to conclusions of Gadia CLB et al. regarding the presence of leptospirosis in Central African Republic in YFV-negative febrile icteric patients.MethodsOur study included 497 individuals presenting with fever and jaundice but negative for yellow fever infection, retrospectively selected from the national surveillance biobank for yellow fever in Institut Pasteur de Bangui, Central African Republic.A combination of serological (ELISA, agglutination) and molecular biology techniques (quantitative real-time polymerase chain reaction) was used to identify Leptospira or the patient’s immune response to the bacteria. Statistical analyses were done using the non parametric Mann-Withney U test with a 5% statistical threshold.ResultsELISA test results showed 46 positive serum samples while 445 were negative and 6 remains equivocal. In addition, the reference microscopic agglutination test for leptospirosis diagnostic confirmed that 7 out of 32 samples tested were positive. Unfortunately, all 497 serum samples tested for leptospirosis were negative using the molecular techniques.ConclusionsUnlike Gadia et al., we confirmed that leptospirosis is circulating in Central African Republic and therefore may be responsible for some of the unexplained cases of febrile jaundice in the country. Thus, leptospirosis needs to be investigated to improve identification of aetiological pathogens. Our study also suggests a need to improve sample transportation and storage conditions.

Leptospirosis - A Case Report

Abstract Leptospirosis is a spirochaetal zoonosis, with a broad spectrum of clinical manifestations, ranging from mild (febrile illness) to fulminant forms (systemic disease with jaundice and kidney failure – Weil's disease). We present the case of a 62 year old patient, with no personal pathological incidents, brought to the emergency room for fever, chills, myalgia, nausea, vomiting, abdominal pain, for 14 days, with jaundice, shortness of breath, and confusion for 72 hours. Clinical examination revealed fever, confusion, jaundice, tachypnoea, tachycardia, irregular heart rhythm, hypotension, anuria, hepatomegaly, no clinical signs of liver cirrhosis or flapping tremor. Laboratory tests revealed leucocytosis with neutrophilia, hepatic cytolysis, renal failure, rhabdomyolysis, while the imagistic investigations were normal. Serological tests were performed for viral, drug induced hepatitis, autoimmune diseases, other infectious diseases (Elisa and ultramicroscopic agglutination tests were positive for leptospirosis). Later, the patient's condition worsened, resulting in intubation and mechanical ventilation, persistence of febrile syndrome and jaundice, bilateral lower limb petechiae with hepatic encephalopathy. Broad spectrum antibiotics (Ceftriaxone and Penicillin G), dialysis, hydroelectrolytic rebalancing, Dopamine support, antiarrhythmic drugs were administered, and the hepatic encephalopathy was also treated. The outcome was favourable (extubation, resolution of febrile syndrome, inflammation, jaundice and hepatic encephalopathy). This case is an example of atypical, monophasic leptospirosis which is common in Weil's disease (the most severe form of leptospirosis), with onset as a febrile illness leading to multiple system organ failure.

Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso.

Patients in Burkina Faso who sought medical attention for febrile jaundice were tested for leptospirosis. We confirmed leptospirosis in 27 (3.46%) of 781 patients: 23 (2.94%) tested positive using serologic assays and 4 (0.51%) using LipL32 PCR. We further presumed leptospirosis in 16 (2.82%) IgM-positive specimens.

Identification of Dengue and Chikungunya Cases Among Suspected Cases of Yellow Fever in the Democratic Republic of the Congo.

For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done. The aim of this study was to test for other arthropod-borne viruses that can induce the same symptoms in patients enrolled in the yellow fever surveillance in the Democratic Republic of the Congo (DRC). Of 652 patients included in the surveillance of yellow fever in DRC from January 2003 to January 2012, 453 patients that tested negative for yellow fever virus (YFV) immunoglobulin M (IgM) antibodies were selected for the study. Real-time polymerase chain reaction was performed for the detection of dengue, West Nile, Chikungunya, O'nyong-nyong, Rift Valley fever, Zika, and YFV. The average age of patients was 22.1 years. We reported 16 cases (3.5%; confidence interval [CI]: 0.8-5.2) of dengue (serotypes 1 and 2) and 2 cases (0.4%; CI: 0.0-1.0) of Chikungunya. Three patients were co-infected with the two serotypes of dengue virus. Three cases of dengue were found in early July 2010 from the city of Titule (Oriental province) during a laboratory-confirmed outbreak of yellow fever, suggesting simultaneous circulation of dengue and yellow fever viruses. This study showed that dengue and Chikungunya viruses are potential causes of acute febrile jaundice in the DRC and highlights the need to consider dengue and Chikungunya diagnosis in the integrated disease surveillance and response program in the DRC. A prospective study is necessary to establish the epidemiology of these diseases.

Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008\u20132010

BackgroundFebrile jaundice results clinically in generalized yellow coloration of the teguments and mucous membranes due to excess plasma bilirubin, accompanied by fever. Two types are found: conjugated and unconjugated bilirubin jaundice. Jaundice is a sign in several diseases due to viruses (viral hepatitis and arbovirus), parasites (malaria) and bacteria (leptospirosis). In the Central African Republic (CAR), only yellow fever is included on the list of diseases for surveillance. The aim of this study was to identify the other pathogens that can cause febrile jaundice, for better management of patients.MethodsBetween 2008 and 2010, 198 sera negative for yellow fever IgM were randomly selected from 2177 samples collected during yellow fever surveillance. Laboratory analyses targeted four groups of pathogens: hepatitis B, C, delta and E viruses; dengue, chikungunya, Zika, Crimean–Congo haemorrhagic fever, West Nile and Rift Valley arboviruses; malaria parasites; and bacteria (leptospirosis).ResultsOverall, 30.9% sera were positive for hepatitis B, 20.2% for hepatitis E, 12.3% for hepatitis C and 8.2% for malaria. The majority of positive sera (40.4%) were from people aged 16–30 years. Co-infection with at least two of these pathogens was also found.ConclusionThese findings suggest that a systematic investigation should be undertaken of infectious agents that cause febrile jaundice in the CAR.

High Prevalence and Diversity of Hepatitis Viruses in Suspected Cases of Yellow Fever in the Democratic Republic of Congo.

ABSTRACTThe majority of patients with acute febrile jaundice (>95%) identified through a yellow fever surveillance program in the Democratic Republic of Congo (DRC) test negative for antibodies against yellow fever virus. However, no etiological investigation has ever been carried out on these patients. Here, we tested for hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV) viruses, all of which can cause acute febrile jaundice, in patients included in the yellow fever surveillance program in the DRC. On a total of 498 serum samples collected from suspected cases of yellow fever from January 2003 to January 2012, enzyme-linked immunosorbent assay (ELISA) techniques were used to screen for antibodies against HAV (IgM) and HEV (IgM) and for antigens and antibodies against HBV (HBsAg and anti-hepatitis B core protein [HBc] IgM, respectively), HCV, and HDV. Viral loads and genotypes were determined for HBV and HVD. Viral hepatitis serological markers were diagnosed in 218 (43.7%) patients. The seroprevalences were 16.7% for HAV, 24.6% for HBV, 2.3% for HCV, and 10.4% for HEV, and 26.1% of HBV-positive patients were also infected with HDV. Median viral loads were 4.19 × 105 IU/ml for HBV (range, 769 to 9.82 × 109 IU/ml) and 1.4 × 106 IU/ml for HDV (range, 3.1 × 102 to 2.9 × 108 IU/ml). Genotypes A, E, and D of HBV and genotype 1 of HDV were detected. These high hepatitis prevalence rates highlight the necessity to include screening for hepatitis viruses in the yellow fever surveillance program in the DRC.

Two cases of Kawasaki disease presented with acute febrile jaundice

Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.