Form Of Viral Hepatitis Research Articles

Chemotherapeutic agents and hepatotoxicity.

T HERE ARE THREE major questions to be addressed regarding chemotherapeutic agents and hepatotoxicity. What is the spectrum of hepatotoxicity? Which drugs should be avoided in patients with pre-existing liver disease? And what dosage modifications should be made when faced with abnormal liver function tests? Several recent articles have reviewed this subject.1-5 In the population being considered for chemotherapy, there are multiple other potential causes of abnormal liver function tests that must be considered (Table 1). Patients with metastatic disease may have known or occult hepatic metastases. All patients may have been exposed to hepatotoxins, including other medications, alcohol, chemicals. They may have other coexisting medical conditions that affect the liver or, because of their immunocompromised state, be prone to infectious complications, including the several forms of viral hepatitis. Baseline evaluation of patients about to undergo chemotherapy should therefore always include liver function tests, and when clinically indicated, hepatic imaging.6 The spectrum of hepatic toxicities ranges from the (usually) incidental elevations of transaminases observed with the nitrosoureas to life-threatening massive hepatic necrosis observed with dacarbazine. For the most part, pure single-drug toxicity is observed less often as the emphasis in chemotherapy shifts to combination regimes. Furthermore, the increased use of high-dose regimens with autologous bone marrow or stem-cell support has complicated the picture by revealing toxicities at very high doses that are not observed with conventional doses. Combination chemotherapy has been implicated in the development of fatal hepatic necrosis after haloalkane anesthesia.7 Allopurinol, frequently administered before chemotherapy to prevent urate nephropathy and secondary gout, has also been linked to fulminant hepatic failure, presumably caused by a hypersensitivity reaction.8,9 There is also a report of allopurinol hepatotoxicity potentiated by tamoxifen, a possible drug interaction. lo Several instances of

Serologic diagnosis of viral hepatitis.

Serologic tests are the most accurate method of identifying a viral cause for a liver disorder and distinguishing between the different forms of viral hepatitis. Although such characteristics of viral hepatitis as route of transmission and incubation period may be helpful in differential diagnosis, they seldom are sufficient to make an exact diagnosis. Laboratory tests or liver biopsy may help to differentiate liver disorders but again usually do not identify the form of viral hepatitis that is present. However, liver biopsy is often of value in patients with chronic hepatitis to determine the severity of disease, aid in prognosis, and, in some cases, serve as a guide to antiviral therapy.

Viral hepatitis: A, B, C, D and E--infection.

Viral hepatitis is caused by at least five etiologically and immunologically distinct viruses: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). The clinical, epidemiologic, and immunologic features of these five forms of viral hepatitis may be similar or different. Hepatitis also may occur during the course of disease caused by cytomegalovirus, Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, adenoviruses, enteroviruses, rubella virus, arboviruses, and other agents.Hepatitis A is synonymous with

Viral Hepatitis: A, B, C, D and E—Infection

Viral hepatitis is caused by at least five etiologically and immunologically distinct viruses: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). The clinical, epidemiologic, and immunologic features of these five forms of viral hepatitis may be similar or different. Hepatitis also may occur during the course of disease caused by cytomegalovirus, Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, adenoviruses, enteroviruses, rubella virus, arboviruses, and other agents. Hepatitis A is synonymous with "infectious hepatitis," an ancient disease described by Hippocrates and formerly known as epidemic jaundice, acute catarrhal jaundice, and other designations. The fulminant form of the disease was called acute yellow atrophy of the liver. Hepatitis B is synonymous with "serum hepatitis," a disease with a more recent history. The first known outbreak occurred during 1883 among a group of shipyard workers who were vaccinated against smallpox with glycerinated lymph of human origin. Later, an increased incidence of the disease was observed among patients attending venereal disease clinics, diabetes clinics, and other facilities where multiple injections were given with inadequately sterilized syringes and needles contaminated with the blood of a viral carrier. The most extensive outbreak occured in 1942, when yellow fever vaccine containing human serum caused 28 585 cases of hepatitis B infection with jaundice among United Stated military personnel.

The A, B, C, D and E of viral hepatitis: new agents for old diseases

This editorial will focus on the features of more recently identified forms of viral hepatitis, types C, D and E

Serum levels of soluble interleukin-2 receptors in acute and chronic viral hepatitis

To analyze interleukin-2-dependent immunoregulatory function in hepatitis B virus infection and in other forms of viral hepatitis, levels of soluble interleukin-2 receptors (sIL-2R) were measured by an enzyme-linked assay in sera from patients with acute and chronic viral hepatitis of different etiology. Increased sIL-2R levels were detected in the early phase of acute hepatitis type A and type B, but not during acute non-A, non-B hepatitis. Among 46 patients with chronic hepatitis B virus infection, levels of sIL-2R were significantly increased only in cases with chronic active hepatitis, while they were about normal in chronic persistent hepatitis or in healthy carriers of the infection. These differences were independent of virus replication, being maintained when patients were stratified according to HBeAg/anti-HBe status and to serum HBV-DNA. Nine patients with chronic active hepatitis type B and high sIL-2R levels at presentation were followed prospectively for two to eight years, and in HBeAg-positive patients, the behavior of receptor levels closely paralleled disease activity. These results, which may reflect increased shedding of IL-2R by activated T lymphocytes in patients with active destruction of HBV infected hepatocytes, indicate the usefulness and potential prognostic importance of serum sIL-2R determination in patients with chronic viral hepatitis. Patients with chronic non-A, non-B hepatitis had much lower sIL-2R levels, although their liver disease was similar to hepatitis B cases, suggesting that different pathogenetic mechanisms operate in these patients.

Clinic and outcomes of viral hepatitis A and B with parenteral transmission

Viral hepatitis A or B is one of the least studied. Its incidence varies in Europe from 14 to 40%. In Moscow, according to the Institute of Virology named after D.I. Ivanovsky of the USSR Academy of Medical Sciences, it accounts for 15-20%. The term "viral hepatitis neither A nor B" is usually used to refer to a disease caused by an agent having no serological similarity with the causative agent of viral hepatitis A or B. However, all nosological forms of viral hepatitis are characterized by similar clinical symptoms of biochemical changes, which makes their identification difficult.

Electrophoresis of human concentrated leukocyte interferon in the treatment of jaundice-free forms of viral hepatitis A in children

Interferons as the most important factors of nonspecific reactivity of the organism perform a variety of control-regulatory functions aimed at preserving cellular homeostasis. The main of these functions are antiviral, antiproliferative, immunomodulatory and radioprotective. In recent years there have been reports on the use of interferon in various diseases, including viral hepatitis. Massive doses of interferon and repeated prescriptions are used for basic intramuscular administration.

Viral Hepatitis

Recent research has led to a greater understanding of the mechanisms and management of the various forms of viral hepatitis. The clinician can rapidly arrive at a precise diagnosis using serologic markers to complement epidemiologic data. In addition, effective immunoprophylaxis is possible; thus, disease spread can be minimized.

Outcomes of viral hepatitis A and B in adults

The aim of this study was to investigate the outcomes of viral hepatitis A and B at early (after 1 month) and late (after 1 year) periods after hospital discharge. One month after discharge from hospital 217 patients with mild and moderate forms of viral hepatitis A and B were examined. There were 166 recurvalescents of viral hepatitis A aged 17 to 30 years old, 83 of whom had had a mild form of the disease and 83 a moderate one. There were 51 reconvalescents of viral hepatitis B at the age of 22-60, who had a moderate form of the disease.

Viral Hepatitis

Recent research has led to a greater understanding of the mechanisms and management of the various forms of viral hepatitis. The clinician can rapidly arrive at a precise diagnosis using serologic markers to complement epidemiologic data. In addition, effective immunoprophylaxis is possible; thus disease spread can be minimized.

The Leeuwenhoek lecture, 1985. A molecular biologist's view of viral hepatitis.

Three forms of viral hepatitis can be distinguished serologically. Hepatitis A virus is a picornavirus, which is being studied increasingly after its propagation in cell cultures. The B virus (HBV) is the prototype of a family now termed hepadna viruses and is by far the best understood. The third, by exclusion, is non-A non-B, about which little else is known. Molecular cloning methods enable copies of viral genes to be propagated and analysed quite readily and provide the means for isolation and expression of individual genes in microbial and animal cells. Determination of the nucleotide sequences of HBV DNA revealed its genetic organization and so guided studies of the mechanism of gene expression both in infected animals and cultures of transformed cells. Replication of the viral genome has also been studied in natural infections, particularly with duck HBV, but also with the human virus. Expression of HBV genes in microbial cells is valuable as a source of antigens for diagnostic reagents and vaccine preparations, but has also been of consequence for the identification of viral gene products not previously recognized and which are of considerable current interest. The methods and materials now available provide additional opportunities for inquiring into the course of viral infection, replication of the virus and, for HBV, the possible role in the development of hepatomas of integration of the viral genome into the host chromosome.

Liver biopsy interpretation in hepatitis: Part II: Histopathology and classification of acute and chronic viral hepatitis/differential diagnosis

The morphological classification of acute and chronic viral hepatitis has been subject of considerable controversy. Main problems in nomenclature have arisen from the confusion of pathologically defined lesions with purely clinical designations. The classification used in this article is based on a number of recent reviews in which a certain measure of agreement has been reached between clinicians and histopathologists. As a general rule, in acute forms of hepatitis diffuse lobular changes predominate over portal lesions while chronic hepatitis is characterized by conspicuous alterations of portal (and periportal) areas. This report will merely summarize main diagnostic features of the different forms of viral hepatitis. For more detailed information the reader is referred to several leading articles discussing in detail morphology, and putting emphasis on pathogenesis. An exact "staging" of viral hepatitis by histologic criteria is an important tool in the evaluation of prognosis, indication and control of therapy as well as for comparison with immunologic findings.

Histologic observations in human hepatitis non-A, non-B.

Specimens from 57 patients with acute or chronic hepatitis non–A, non–B (HNANB), mostly mild to moderate, were studied by light and, in 22 instances, by electron microscopy. They were compared to specimens of hepatitis A and hepatitis B on file or obtained simultaneously with the HNANB cases. In the HNANB material, two types of light–microscopic lesions were noted in the lobular parenchyma singly or in combination. One was an eosinophilic alteration of the hepatocytic cytoplasm associated with many acidophilic bodies. Conspicuous alteration were often accompanied by microvesicular steatosis. This lesion was associated with nuclear particles detectable by electron microscopy. The second lesion consisted of sinusoidal cell activation which was prominent in some cases. From experiences with chimpanzees, these features were tentatively considered to be stages of the same process. Both lesions were associated with portal and usually mild periportal inflammation which was not related to the degree and type of parenchymal reaction. They were also observed in chronic stages, making the differentiation between acute and chronic HNANB difficult. Active hepatitis B seems to differ from HNANB primarily by the conspicuous presence of lymphocytes in the lobular parenchyma often in contact with hepatocytes, acidophilic bodies, and a more uniform portal inflammatory reaction. In hepatitis A, hepatocellular injury was conspicuously periportal. In HNANB, a cytopathic effect rather than lymphocytic immune attack appears to be of greater significance than in the other forms of viral hepatitis. The recurrence of lobular mainly eosinophilic changes may explain chronicity.

Etiology of viral hepatitis in American soldiers.

To define better which types of hepatitis are prevalent among American soldiers, the authors studied 413 separate episodes of acute viral hepatitis among 412 soldiers admitted to US Army hospitals during 1978-1979. Most soldiers (68.8%) had acute hepatitis B (estimated annual hospitalization rate: 5.41/1000 soldiers in West Germany, 2.51/1000 in South Korea, less than 1/1000 in the United States). Subtype ayw was predominant in Germany, whereas adr was predominant in South Korea. Hepatitis B was more often associated with contact history or parenteral use of drugs in West Germany than in South Korea (p less than 0.001). Non-A, non-B hepatitis accounted for 27% of cases in West Germany (2.16/1000), but only 3% in South Korea (0.11/1000); hepatitis A only 15% in South Korea (0.48/1000) and 1% in West Germany (0.08/1000). These findings indicate that hepatitis B is the most prevalent form of viral hepatitis among US soldiers worldwide but also suggest substantial differences in the epidemiology of this infection in South Korea and West Germany. Such data will be useful in developing hepatitis B immunization policy within the military.

Viral hepatitis: a review of clinical, laboratory and research aspects

The nature and the diagnosis and prognosis of the two forms of viral hepatitis is discussed. The possibility of transmission of these diseases during dental treatment to other patients or to dentists or their staff is considered and measures to reduce this risk are suggested.

Epidemiology of Infectious Hepatitis

Viral hepatitis continues to present many intriguing and perplexing questions. Forms of Hepatitis. —Several currently accepted findings in the differentiation of two forms of viral hepatitis, ie, infectious hepatitis (IH) and serum hepatitis (SH), should be reexamined in the context of recently acquired relevent data since the Second WHO Expert Committee report on hepatitis of 1963. 1 Krugman et al 2 have confirmed the observations of several (Findlay et al, 3 Propert, 4 Mirick and Shank 5 ) and demonstrated in a series of experiments that the MS-2 type is also moderately contagious and infectious orally and through person to person contact. In contrast to older opinions that considered most transfusion-associated hepatitis as serum hepatitis, recent studies have suggested that infectious hepatitis may be transmitted parenterally as frequently as serum hepatitis (Shimizu and Kitamoto, 6 NCDC Reports 7 ). Communicability. —The fecal-oral spread, mostly by person to person contact, remains the most

When To Hospitalize the Hepatitis Patient

Unless the patient falls into a high-risk category or poses special problems of differential diagnosis and/or treatment, home care may be adequate for the treatment of the benign forms of viral hepatitis. For patients with the atypical and fulminant forms, however, hospitalization is mandatory and may prove lifesaving. Dr. Tisdale describes the typical clinical sequences and indications in each group.