Hepatotrophic Viruses Research Articles

Chronic viral hepatitis accelerates lung function decline in smokers.

Although hepatitis B virus (HBV) and hepatitis C virus (HCV) are hepatotrophic viruses, they may affect pulmonary diseases. The purpose of this study was to assess whether chronic viral hepatitis (CVH) infection was associated with a rapid decline in lung function. Repeated measurements of lung function were obtained from a well-curated health check-up database. A case was defined as an individual positive for HBsAg or anti-HCV antibody. A control was randomly selected (from the same dataset) after 1:1 matching in terms of age, sex, height, the body mass index, and smoking status. Separate analyses of non-smokers and smokers were performed. A total of 701 cases were enrolled (586 with HBV and 115 with HCV). In cross-sectional analysis, both forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) decreased significantly only in smokers (smoking cases vs. smoking controls) (adjusted p = 6.6 × 10-5 and adjusted p = 2.2 × 10-3, respectively). In longitudinal analysis, smoking cases showed significantly greater FEV1 and FVC decline rates than did smoking controls (adjusted p = 8.5 × 10-3 and adjusted p = 1.2 × 10-5, respectively). Such associations were particularly high in smoking cases at intermediate-to-high risk of hepatic fibrosis, as evaluated by the non-invasive Fibrosis-4 index. In summary, CVH was associated with both decreased lung function and accelerated lung function decline in smokers. A non-invasive measurement of hepatic fibrosis may be useful in predicting rapid lung function decline in smokers with CVH.

P-50 PREVALENCE OF HEPATITIS AMONG STUDENTS AND HEALTH PROFESSIONALS AT THE FEDERAL UNIVERSITY OF BAHIA

Hepatitis A virus (HAV) is a hepatotrophic virus of fecal-oral transmission. Occupational exposure in the health area is not considered a risk of HAV contagion. Adults are more likely to develop fulminant hepatitis. In Brazil, those over 20 years of age have a high prevalence of anti-HAV antibodies (IgGHAV). To study the prevalence of IgGHAV in college students (group 1) and professionals (group 2) of the health area of the Federal University of Bahia. The sample consisted of 335 individuals who completed an epidemiological questionnaire and in whom IgGHAV was studied in sera. IgGHAV was present in 56.9% of all individuals, being 43.9% susceptible. IgGHAV was in 94.4% of group 2 and in 48.8% of group 1 (p = 0.000). There were no statistical differences between ethnicities. There was an association between professional category and report of exposure to biological material (p = 0.017), but not between seropositivity and report of this exposure. These data reflect both occupational and environmental exposure. Greater seropositivity in older professionals can also mean greater environmental exposure throughout life. In this study, curiously, greater exposure to biological material did not have a significant association with seropositivity for HAV, recalling the importance of exposure also in the extra-academic community. This study showed that 43.9% of the individuals who start studies in the health area of our university are susceptible to contracting HAV infection, which generates an epidemiological reconsideration of the need for vaccination in this population in the vaccine calendar from Brazil concerning the last VHA outbreaks in special population as MSM. CAPES and CNPq.

Hepatitis A Virus Prevalence among Healthcare Students and Profissionals of Federal University of Bahia, Brazils

Introduction: Hepatitis A Virus (HAV) is a hepatotrophic virus with oral-fecal transmission. Occupational exposition to the virus is not common in the health practice and this way of contagious is not considered as a risk of infection. Adults have more probability to have fulminate clinical manifestations and in Brazil, the most of population older than 20 years have had contact with this virus. Aim: to study the prevalence of antibodies anti A virus (IgGHAV) in students (group 1) and professionals (group 2) of the health area of the Federal University of Bahia (UFBA). Methods: was studied IgGHAV in 335 seras from volunteers who had completed an epidemiological questionnaire. Results: Antibodies IgGHAV+ in 56, 1% of the sample and 43,9 % of the individuals were susceptible to the infection. 94, 4% of the professional had IgGHAV+ and 48, 8% of the students had IgGHAV+ (p=0,000). There was an association between professional category and history of exposition to biological material (p=0,0017). There was not association between IgGHAV+ and history of exposition to biological material. This result could show the environment and occupational exposition to this virus. The more prevalence of IgGHAV titers in the professional individuals who were older shows the spread of the infection life through. Conclusion: this study showed that 43,9 % of the individual who start to work in contact with biological material are susceptible to the hepatitis A infection, this generate an new epidemiological reconsideration about the practice of vaccination in this special population in Brazil.

Old dietary cultural practices leading to suboptimal nutritional intake of calories in children with acute viral hepatitis

Background: Acute viral hepatitis (AVH) is one of the common infections in developing nation. Hepatotrophic virus causes AVH and most of the time it has self-limiting course. HAV is most common cause of AVH. Suboptimal dietary cultural practices are common in our nation. This study was done to know the impact of suboptimal dietary practices done in AVH.Methods: Observational study conducted with 50 children with AVH. Dietary assessment was done at three point of time. First During AVH, second, pre illness and then two weeks after nutritional counselling. Data of dietary modification done by parents/caregiver during AVH recorded. History of herbal medicine taken for treatment of AVH enquired.Results: HAV positive was (72%), HEV positivity was in 8 (16%) cases, hepatitis B was positive in 4 (8%) children and dual infection HAV+HEV was detected in 2 (4%) children. Many parents did dietary modification due to AVH and also by some local treating physicians, 18 (36%) patients were also on herbal medication for treatment of AVH. During AVH the mean calorie and protein requirement decreased from 96% to 54% and 92% to 43% respectively. Two weeks after nutritional counseling the mean calorie and protein intake increased from 54% to 88% and 43% to 84% respectively. This change in calorie and protein was statistically significant (p<0.01) Non-vegetarian diet preference was restarted in many of them after nutritional counseling.Conclusions: This observational study revealed that suboptimal dietary cultural practices are prevalent in India. Majority of children were on bland diet and receiving inadequate proteins and calories.

Acute Viral Hepatitis with Epidemiological Focus on Hepatitis A Virus Infection and Its Clinical Course in Adults

In this prospective study, two hundred and fifty four patients diagnosed to be having AVH were analyzed with reference to clinical profile & viral markers and statistical analysis was done. Isolated viral infection was documented in 102 (40.1%) patients where as more than one hepatotrophic viruses caused AVH in 27(10.6%) patients. Non A-E Virus was the major case of sporadic AVH (40.1%), HBV & HEV were the etiological agent in 23.6% & 25.1% respectively. HAV was detected in 16.5% of the patients and the HCV was incriminated rarely as cause of sporadic AVH. The demographic, clinical and biochemical profile amongst isolated & mixed viral infection were found to be similar. However, HBV-AVH had significant prolonged course (p<0.001) and HAV-AVH was found to have significantly higher number of patients pursing a course of relapsing hepatitis. However HAV infection amongst adults in the present study was not found to cause severe liver disease except in few cases.

Acute on chronic liver failure - Clinical profile, precipitating factors, outcome and predictors of mortality

INTRODUCTION : Liver failure can develop acutely in a patient with no preexisting liver disease (Acute Liver Failure) or as an acute decompensation of a chronic liver disease. Recently it has been noted that a subgroup of patients develops acute deterioration in previously compensated cirrhosis and are considered to have acute on chronic liver failure (ACLF). This deterioration is secondary to an acute event and multi organ failure leading to increased mortality at three months. In contrast to chronic liver disease these patients have a rapid downhill course with the development of multiorgan failure and high short term mortality. One important concept in this group of patients is the potential reversibility. The term reversibility does not mean that underlying chronic liver damage is reversible, but rather the acute deterioration of the liver function due to the precipitating event is reversible. The pathophysiological basis ACLF was initially described by Jalan [et al.]. There is no clear cut definition of ACLF in the western literature. Asia Pacific association of study of liver (APASL) has defined it as acute hepatic insult manifested by jaundice and coagulopathy complicated within four weeks by ascites or encephalopathy. The cause for acute deterioration can vary from infectious causes like sepsis, viral hepatitis and non hepatotrophic viruses’ infection or noninfectious causes like alcohol, drugs, gastrointestinal bleeding, toxins and surgery. There is controversy 2 regarding whether sepsis can precipitate ACLF or it is the result of ACLF. Though numerous studies have been published in western literature on cirrhotic patients admitted to ICU, most of them have not differentiated organ failure as part of progressive worsening in end stage cirrhosis from acute on chronic liver failure. There are very few studies from India in this subject. H Garg [et al.] have recently published a prospective study on ACLF patients. Etiology of chronic liver disease and the acute precipitants differ between various geographical locations. AS ACLF carries a high mortality it is essential to identify prognostic factors. In general it has been noted that score evaluating the severity of disease like APACHE and SOFA score are better than liver specific score like Child Pugh score. Management of ACLF requires good intensive care to prevent the development of organ failure or to support the failing organs. Use of various extracorporeal liver support systems have been studied in various studies. Even though there is an improvement in biochemical parameters and in hepatic encephalopathy ,there is no significant survival benefit. Liver transplantation is the only curative treatment. This prospective study aims to look at the clinical profile, precipitating factors, outcome prognostic factors in ACLF admitted in a tertiary care hospital. AIM OF THE STUDY : The aims of the study are as follows, 1. To study the clinical profile of patients with acute on chronic liver failure, 2. To study the underlying chronic aetiology and acute precipitants, 3. To study the 30 day and 90 day mortality, 4. To study the various predictors of mortality. CONCLUSION : Acute on chronic liver failure is a unique entity. It is characterized by rapidly deteriorating course in a previously diagnosed or undiagnosed chronic liver disease with a potential for reversibility. Our study shows that it has high short term mortality (44%). Most common aetiology for underlying chronic liver disease in our centre is alcoholic liver disease (64.5%) followed by hepatitis B (20%) and other causes. The most common acute precipitant is super added alcoholic hepatitis (82%) in alcoholic liver disease and reactivation of hepatitis B (66%) in chronic hepatitis B. Other causes of acute worsening include acute hepatitis E and drug induced liver injury. Most common cause of death is the multi organ failure. Increasing number of organ failures is associated with increasing risk of death. High serum bilirubin, high INR, renal failure, low sodium, and high CRP are all poor prognostic markers. SOFA and MELD are better predictors of mortality than Child score. Early referral for liver transplantation is essential in patients at high risk of death. Acute on chronic liver failure is a disease which is still being defined and large prospective studies are needed to better delineate the acute precipitants and the prognostic markers.

Unilateral nevoid telangiectasia, diagnostic and therapeutic challenge

The Unilateral Nevoid Telangiectasia consists of a rare vascular dermatitis whose etiology remains undefined making it difficult to treat Due to the scarcity of data in the literature its diagnosis and its treatment represent a challenge There is a predominance of this pathology in females in the proportion of The main hypothesis for its etiopathogeny is hyperestrogenism This justifies the performance of pregnancy tests dosage of liver enzymes or serologies for hepatotrophic viruses to investigate situations that raise estrogen The diagnosis is exclusively clinical The therapeutic modality instituted is laser therapy Both the Nd YAG nm long pulse laser and pulsed dye laser are effective for the treatment of vascular lesions

Fowl adenovirus serotype 4-induced apoptosis, autophagy, and a severe inflammatory response in liver

Fowl adenovirus serotype 4 (FAdV-4) is a hepatotrophic virus that causes severe liver diseases. Upon histological examination, the most remarkable findings in the liver are small multifocal areas of necrosis and mononuclear cell infiltration, including basophilic intranuclear inclusion bodies in hepatocytes surrounded by a clear halo or which fill the entire nucleus. Here, we examined the mechanism responsible for FAdV-4-mediated hepatocyte damage in vivo and in vitro. The results showed that FAdV-4 impaired liver integrity and function, which decreased albumin and blood glucose concentrations and increased the plasma activity of aspartate aminotransferase and lactate dehydrogenase, compared with a non-infected control group (P<0.05). FAdV-4 induced hepatocyte apoptosis in a time-dependent manner in vivo and in vitro. Additionally, we found that FAdV-4 also induced the autophagy of hepatocytes, which promoted the conversion of microtubule-associated protein light chain 3 (LC3-I) to LC3-II, which is a hallmarks of autophagy. Furthermore, the mRNA expressions of interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α in vivo and in vitro showed a statistically significant increase (P<0.05) compared to that of the control group. However, the molecular mechanisms underlying the FAdV-4-induced apoptotic and autophagic cell death remain unclear. In summation, our observations suggested that FAdV-4 induced liver injury via apoptosis, autophagy, and a severe inflammatory response.

Hepatitis B Virus Infection and Oral Lichen Planus: A Report from Northeast of Iran

Introduction: Lichen planus is a chronic inflammatory disease in oral mucosa and skin. Recently, reports have demonstrated a possible relationship between lichen planus and liver diseases. During the past decade, there has been a hypothesis regarding viral etiological agents that have been found to be in association with hepatotrophic viruses known as Hepatitis B and C with LP. This research was studied in Mashhad, northeast of Iran, to find a relationship between OLP and HBV infection. Methods: Age and gender of 134 patients (with OLP) and 134 controls (without OLP) were not matched and their serum samples were respectively screened for HBsAg by ELISA (third generation) and polymerase chain reaction (PCR) for HBV-DNA. Results: Tests were positive (for both HBsAg and HBV-DNA) for 9 patients (6.71%) with OLP and 2 healthy individuals (1.49%) infected with HBV (P=0.03). Conclusion: There was a relationship between HBV and OLP in our population. Based on our findings, it is recommended that viral serology for Hepatitis B and OLP patients be conducted as a routine screening process.

A Young Man Dying Of Fulminant Hepato-Renal Syndrome The Tagging To Alcohol Addiction Obscured the Diagnosis and Precluded the Treatment of Chronic Viral Hepatitis (HBV, HCV, HDV) As the Cause of His Liver Cirrhosis

Discourse: The present report describes a 47-year-old man who was referred to hospital due to liver cirrhosis and acute hepatorenal syndrome (HRS) that rapidly progressed, and of which he died within two months. As a result of a sequence of unfortunate events in his management, including an inaccurate and in part erroneous record of the patient’s past history, alcohol was considered as the sole cause of the liver failure (ALD), importantly, without taking a liver biopsy. The patient was ranked outside curative therapy, including renal replacement therapy (RRT) as the bridge to eventual liver transplantation. Instead, he received two courses of corticosteroids (for ALD). The negative serology for hepatitis viruses was not controlled, until in the other hospital during the final days before death, when the patient tested positive for HBV (HBsAb). Autopsy: At autopsy, the liver was large (2.800 g) with micronodular cirrhosis but no typical signs of ALD. When examined using immunohistochemistry (IHC), liver cells were extensively loaded with HBV, HCV and HDV, implicating an activation of a latent chronic viral hepatitis during the hospitalization, and massive replication of all three hepatotrophic viruses. This activation, remaining unnoticed by the clinicians, obviously resulted in acute-on-chronic fulminant viral hepatitis with rapid and fatal liver failure. Conclusions: By labeling the patient’s liver failure as ALD obscured adequate search for other potential causative factors for the patient´s HRS. This is most unfortunate, because standard curative medical treatments (DAA, direct acting antivirals) are available for viral hepatitis, and their diagnosis by biopsy should be straightforward. In contrast, treatment with steroids is contraindicated in viral hepatitis.

International therapeutic guidelines for patients with HCV-related extrahepatic disorders. A multidisciplinary expert statement.

Hepatitis C virus (HCV) is both hepatotrophic and lymphotropic virus that causes liver as well extrahepatic manifestations including cryoglobulinemic vasculitis, the most frequent and studied condition, lymphoma, and neurologic, cardiovascular, endocrine-metabolic or renal diseases. HCV-extrahepatic manifestations (HCV-EHMs) may severely affect the overall prognosis, while viral eradication significantly reduces non-liver related deaths. Different clinical manifestations may coexist in the same patient. Due to the variety of HCV clinical manifestations, a multidisciplinary approach along with appropriate therapeutic strategies are required. In the era of interferon-free anti-HCV treatments, international recommendations for the therapeutic management of HCV-EHMs are needed. This implies the need to define the best criteria to use antivirals and/or other therapeutic approaches. The present recommendations, based on qualified expert experience and specific literature, will focus on etiological (antiviral) therapies and/or traditional pathogenetic treatments that still maintain their therapeutic utility.

Toll-like receptor-2 exacerbates murine acute viral hepatitis.

SummaryViral replication in the liver is generally detected by cellular endosomal Toll‐like receptors (TLRs) and cytosolic helicase sensors that trigger antiviral inflammatory responses. Recent evidence suggests that surface TLR2 may also contribute to viral detection through recognition of viral coat proteins but its role in the outcome of acute viral infection remains elusive. In this study, we examined in vivo the role of TLR2 in acute infections induced by the highly hepatotrophic mouse hepatitis virus (MHV) type 3 and weakly hepatotrophic MHV‐A59 serotype. To address this, C57BL/6 (wild‐type; WT) and TLR2 knockout (KO) groups of mice were intraperitoneally infected with MHV3 or MHV‐A59. MHV3 infection provoked a fulminant hepatitis in WT mice, characterized by early mortality and high alanine and aspartate transaminase levels, histopathological lesions and viral replication whereas infection of TLR2 KO mice was markedly less severe. MHV‐A59 provoked a comparable mild and subclinical hepatitis in WT and TLR2 KO mice. MHV3‐induced fulminant hepatitis in WT mice correlated with higher hepatic expression of interferon‐β, interleukin‐6, tumour necrosis factor‐α, CXCL1, CCL2, CXCL10 and alarmin (interleukin‐33) than in MHV‐A59‐infected WT mice and in MHV3‐infected TLR2 KO mice. Intrahepatic recruited neutrophils, natural killer cells, natural killer T cells or macrophages rapidly decreased in MHV3‐infected WT mice whereas they were sustained in MHV‐A59‐infected WT mice and MHV3‐infected TLR2 KO. MHV3 in vitro infection of macrophagic cells induced rapid and higher viral replication and/or interleukin‐6 induction in comparison to MHV‐A59, and depended on viral activation of TLR2 and p38 mitogen‐activated protein kinase. Taken together, these results support a new aggravating inflammatory role for TLR2 in MHV3‐induced acute fulminant hepatitis.

Hepatitis C virus hijacks host microRNAs to dampen antiviral interferon signaling

Abstract Hepatitis C virus (HCV) is a hepatotrophic ssRNA virus that infects over 160 million people worldwide and 60–80% of HCV cases will persist to a chronic infection, a serious risk factor for liver diseases. We recently discovered that HCV infection of hepatocytes induces expression of two microRNAs (miRNAs), miR-208b and miR-499a-5p. We found that these miRNA are capable of decreasing IFNL2 and IFNL3 expression to aid viral replication. Here we show that miR-208b and miR-499a-5p block type I IFN signaling in HCV-infected hepatocytes by directly targeting and down regulating the interferon (alpha, beta and omega) receptor 1 (IFNAR1) mRNA. Inhibition of these miRNAs during HCV infection of hepatoma cells rescued expression of IFNAR1 and improved the antiviral response to exogenous type I IFN. Interestingly, prolonged treatment of HCV-infected hepatocytes with type I IFNs led to a synergistic induction of miR-208b and miR-499a-5p, suggesting a critical role for type I IFN in the regulation of these miRNAs. As miR-208b and miR-499a-5p can target and suppress the IFNL3 risk allele, it is possible that increased miRNA expression following IFN treatment may partly explain why this genotype associates with poor response to IFN based therapies. Collectively these data define a new role for miR-208b and miR-499a-5p as HCV-induced suppressors of type I IFN signaling and add to our understanding of HCV immune evading strategies.

Chronic hepatitis C virus infection and lipoprotein metabolism.

Hepatitis C virus (HCV) is a hepatotrophic virus and a major cause of chronic liver disease, including hepatocellular carcinoma, worldwide. The life cycle of HCV is closely associated with the metabolism of lipids and lipoproteins. The main function of lipoproteins is transporting lipids throughout the body. Triglycerides, free cholesterol, cholesteryl esters, and phospholipids are the major components of the transported lipids. The pathway of HCV assembly and secretion is closely linked to lipoprotein production and secretion, and the infectivity of HCV particles largely depends on the interaction of lipoproteins. Moreover, HCV entry into hepatocytes is strongly influenced by lipoproteins. The key lipoprotein molecules mediating these interactions are apolipoproteins. Apolipoproteins are amphipathic proteins on the surface of a lipoprotein particle, which help stabilize lipoprotein structure. They perform a key role in lipoprotein metabolism by serving as receptor ligands, enzyme co-factors, and lipid transport carriers. Understanding the association between the life cycle of HCV and lipoprotein metabolism is important because each step of the life cycle of HCV that is associated with lipoprotein metabolism is a potential target for anti-HCV therapy. In this article, we first concisely review the nature of lipoprotein and its metabolism to better understand the complicated interaction of HCV with lipoprotein. Then, we review the outline of the processes of HCV assembly, secretion, and entry into hepatocytes, focusing on the association with lipoproteins. Finally, we discuss the clinical aspects of disturbed lipid/lipoprotein metabolism and the significance of dyslipoproteinemia in chronic HCV infection with regard to abnormal apolipoproteins.

Immunochromatographic Testing Method for Hepatitis B, C in Blood Donors

Background: Hepatitis is an inflammatory condition of the liver and viral hepatitis is a conventional term used to denote hepatitis caused by hepatotrophic viruses (Hepatitis A-G). High prevalence of these viruses are reported in Nigeria. Hepatitis B and C may cause liver cirrhosis and they can be contacted through contaminated blood and blood products. Many blood banks in Nigeria screen for hepatitis B and C using immune-chromatographic screening method (Rapid test strip). This is because these strips are readily available in the market, cheap, requires no electricity for storage, special training or equipment before use. The intent of our study is to compare the sensitivity of this method using an advanced immunological method. Method: 660 potential donors are tested for hepatitis B surface antigen (HBs Ag) and hepatitis C virus antibody using immune-chromatographic test strip and ELISA methods. Result: We found out that 38 (5.7%) out of 660 subjects tested positive for HBS Ag using immunochromographic method while 71 (10.8%) were positive using ELISA. None is positive for hepatitis C antibody using immunochromatographic method while 4 (0.6%) subjects were positive using ELISA method. Conclusion: Immunochromatographic method is not good enough to screen blood donors for hepatitis B and C.

Correlation of hepatitis B surface antigen levels with HBV DNA on antiviral therapy

S 21 ANNUAL CONFERENCE —2013 V ra lH ep a itis not with bilirubin values (P <0.02). In acute heaptitis B LSM values had similar trend 14.3 kPa at entry, 12 kPa at 15 days but 6 out of ten cases had elevated kPa values (9.3 kPa) at time of complete recovery and on follow up showed gradual decline to normal in 4 cases alongwith HbsAg clearance. 2 out 6 cases had elevated kPa values (8.2 and 8.1 kPa) after six months with normal LFT. There was significant correlation with ALT (P <0.004) INR (P < 0.005) values but not with serum bilirubin. Conclusion: Liver stiffness values in acute hepatitis should be seen in context to ALT and INR values. In acute Hepatitis B persistent high LSM values with normal LFT may indicate progress towards chronic hepatitis. Larger studies are required Corresponding author. Punil Mehrotra. E-mail: punmel@yahoo.com ROLE OF THE BYSTANDER LIVER TISSUE IN DOCUMENTING OCCULT HEPATITIS B IN SURGICAL BIOPSY MATERIAL Kim Vaiphei Rajesh Kumar Department of Histopathology, Post Graduate Institue of Medical Education and Researc, Chandigarh, India Background: Hepatitis B virus (HBV) is important cause of chronic liver disease and one third world population is infected. A poorly recognised entity Occult HBV is presence of HBV DNA in liver or in serum in absence of detectable HBsAg in serum by current detectable assay. Objective: to study liver histology in biopsies detected to be HBV positive in patients with serology negative for HBsAg. Case selection criteria: Cases included in the study were those who were negative for serum HBsAg with no obvious clinical features of hepatitis and liver tissue was incidentally detected to be positive for HBV surface or/and core antigens by immunohistochemistry. Methods: Liver tissue obtained in resected specimen or in wedge biopsy in non-hepatitic conditions like extra-hepatic portal vein obstruction (EHPVO), hypersplenism, tumor metastasis, biliary obstruction or chronic cholecystitis. Sections bearing liver tissue were available for the study. Routine staining and immunohistochemistry were performed in all cases. Result: Forty three cases were studied.M: F=22:21,mean age inmale 43.3 and in female 40 years. All cases were positive for cytoplasmic HBcAg, 10 also showed nuclear HBcAg and 12 for HBsAg. Histological features: normal in 7, chronic hepatitis with activity in 22, metastasis in 14, changes consistent with EHPVO, 3 each of Budd Chiary and cholangitis, and 1 each of NCPF, HCC, granuloma and VOD. Histological features included steatosis, steatohepatitis, portal tract fibrosis with bridging, variable degree of portal tract inflammation, S64 interface hepatitis, lobular inflammation, cholangitis, angioma like portal vein and periductal fibrosis. Conclusion:Occult HBV cases exhibiting positivity for HB surface and/or core proteins with histological features of hepatitis is not a rare phenomenon. Hence, the present study further reiterates the statement of the noblest sample to document infection by hepatotrophic virus being the liver tissue itself. Corresponding author. Kim Vaiphei. E-mail: kvaiphei2009@gmail.com IL-28B GENOMIC POLYMORPHISM AS PREDICTOR OF TREATMENT RESPONSE TO INTERFERON BASED THERAPY FOR CHRONIC HCV INFECTIONEXPERIENCE FROM TERTIARY REFERRAL CENTRE FROM SOUTH INDIA K. A. Anoob John, S. Anil Kumar, P. Pradeep Kumar, Abhilash Haridas, N. Premletha, Vinayakumar Kattoor Ramakrishnan Department of Gastroenterology, Govt Medical College Trivandrum,

Guillain–Barré syndrome associated with acute hepatitis E infection

Guillain–Barré syndrome (GBS) is a neurological emergency that warrants prompt diagnosis and treatment. Occasionally, the clinical, laboratory and electrophysiological features are neither typical nor diagnostic. It requires a high index of suspicion and clinical judgement for early diagnosis and commencement of treatment in those scenarios. Some pathogens are potential triggers of this serious neurological disease, including: Campylobacter jejuni, Mycoplasma pneumoniae and cytomegalovirus. Although uncommon, hepatotrophic viruses (hepatitis A, B and C) are increasingly recognized to be triggering microbes. Here, we report a patient with unusual GBS triggered by an atypical microbe, hepatitis E virus, in a Chinese patient, via a common route of transmission in this locality.

Case report: A case of light chain deposition disease involving liver and stomach with chronic hepatitis C virus infection and hepatocellular carcinoma

Light chain deposition disease (LCDD) is a rare, plasma cell proliferative disorder characterized by mainly abnormal light chain deposition in various organs. Hepatitis C virus (HCV) is a hepatotrophic and lymphotrophic virus and significantly related to B-cell proliferation. This is a case report of systemic LCDD involving liver, stomach, bone marrow, and probably kidney, in a patient with HCV-related hepatocellular carcinoma (HCC). A 62-year-old man with chronic HCV infection who presented with a small HCC in segment 8 of the liver and nephrotic syndrome showed kappa typed immunoglobulin light chain depositions in biopsy specimens of bone marrow, stomach, and non-tumorous liver parenchyma. After treatment of the HCC with transarterial chemoembolization, antiviral therapy for chronic hepatitis C was started. The patient showed early virologic response at 12 weeks of treatment; however, antiviral therapy was discontinued due to adverse effects and he was lost to follow-up. This is the first case of LCDD involving the liver and stomach in a patient with chronic HCV infection and HCC, which may represent LCDD as a rare HCV-associated B cell proliferative disease.

Seropositivity and pattern of viral hepatitis in clinically suspected cases of hepatitis in Dhaka city

An attempt was made to see the seropositivity and pattern of four common hepatotrophic viruses (HBV, HCV, HEV, HAV) in patients suspected to have been suffering from viral hepatitis. Blood samples from 2,995 cases of suspected HBV infection, 331 from HCV, 155 from HEV and 24 from HAV were tested for these viral markers. Of these a total of 245 (8.1%) were positive for HBsAg, 18 (5.4%) for HCV, 87 (56.1%) for HEV and 8 (33.3%) were positive for HAV infection. The predominant age group affected in HBV is 25-40 years, for HCV > 61 years, HEV 26-50 years and HAV under 11 years. Seropositivity for HBsAg was statistically higher (near double) in males than females (p < 0.05). HCV showed more seropositivity in males than females. HEV showed slight male preponderance and for HAV the female showed preponderance. The seropositivity rate was higher in Bangladesh in comparison to other developed and developing countries.

Fibrinogen Storage Disease Caused by Aguadilla Mutation Presenting With Hypobeta‐lipoproteinemia and Considerable Liver Disease

Fibrinogen Storage Disease Caused by Aguadilla Mutation Presenting With Hypobeta‐lipoproteinemia and Considerable Liver Disease