Manifestations Of Acute Hepatitis Research Articles

Hepatitis of Unknown Origin and Etiology (Acute Non HepA-E Hepatitis) among Children in 2021/2022: Review of the Current Findings

Several clusters and individual cases of acute hepatitis have been reported in the US, Europe and recently in Asia and Central America since October 2021. A laboratory investigation of the common viral hepatitis agents (HAV, HBV, HCV, HDV and HEV) yielded negative results prompting the use of the term “acute non HepA-E hepatitis” to describe this condition. The cases were characterized by the manifestations of acute hepatitis (abdominal pain, vomiting, diarrhea, jaundice and very high levels of liver enzymes) affecting children with a median age of 3–4 years. The exact underlying etiology has not been revealed yet; however, a leading hypothesis is that an infectious agent is the culprit, underlying cause or a risk factor for acute non HepA-E hepatitis occurrence. So far, laboratory testing has shown the presence of the group F human adenovirus serotype 41 (HAdV-F41) in about three-fourths of the investigated cases. As of 13 May 2022, more than 450 cases were reported worldwide, the majority of which were in the UK (n = 176), the US (n = 109), 13 European countries (at least 103 cases) and in Argentina, Brazil, Canada, Costa Rica, Indonesia, Israel, Japan, Palestine, Panama, Singapore and South Korea. Vigilant surveillance and epidemiologic investigations to identify further cases are warranted to delineate the features of this emergent public health issue. The possible role of environmental and toxic agents including foodborne toxins should also be considered. Specific guidelines for identification of further cases are necessary, particularly in low-income settings where testing for adenoviruses is not considered routinely. A genetic analysis of HAdV-F41 isolates is recommended to assess the potential changes in the virus genome with subsequent possible altered virus behavior. Immunopathogenesis is another possibility that should be evaluated considering the lack of viral structures in liver biopsies of the affected children in the US.

STUDY OF ACUTE HEPATIC DYSFUNCTION ASSOCIATED WITH DENGUE FEVER IN NORTH WEST ZONE OF RAJASTHAN

Background: Atypical manifestations of dengue viral fever have been described in recent past, including involvement of the central nervous system, cardiac alterations, and elevations in aminotransferase levels, with reactive hepatitis. Hepatic involvement can be characterized by manifestations of acute hepatitis, with pain in the right hypochondrium, hepatomegaly, jaundice, and raised aminotransferase levels. Although the liver is not the directly targeted organ for dengue virus, histopathological findings, including centrilobular necrosis, fatty alterations, hyperplasia of the Kupffer cells, acidophil bodies and monocyte infiltration of the portal tract have been detected in patients with dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). In most cases, hepatic involvement prolongs the clinical course of this self-limiting viral infection, but it does not constitute a sign of worse prognosis.
 Methods: Hundred confirmed diagnosed inpatient cases of dengue fever were included. Clinical examination and laboratory investigations including liver function tests and serum electrolyte levels were performed regularly at appropriate interval. Viral hepatitis testing was also performed to check for any co-infection or pre-existing viral hepatitis. On the basis of increase in serum aminotransferase levels, patients were divided into two groups; Mild (up to 5 times normal) to Moderate (5- 10 times) acute hepatitis: AST or ALT 45-300 IU/L and severe acute hepatitis: AST or ALT > 300 IU/L or ? 10 times. On basis of serum protein levels, the patients were grouped in two groups, one with hypoalbuminemia; serum albumin <3.0 g/dL and without hypoalbuminemia
 Results: In this study out of total 100 patients 67 were men (67%) and 33 were women (33%). The mean age of the patients was 39 ± 3.1 years. The patients were in the range of age 22-54 years. Maximum number of patients were in third decade of life. All the patients were tested positive for NS1 antigen test. Fever was the most common presenting complaint with mean duration of fever was 6 ± 3.27 days with mean temperature of 38.5 ± 1°C, 21% had abdominal pain, 17% had rash, 3% had jaundice. Liver function tests (LFTs) show the median ALT of 88.50 IU/L with range from 43.25-317.22 IU/L, median AST of 174 IU/L with range from 47-371.5 IU/L. 91% of the patients had elevated AST levels and almost 79% patients had elevated ALT (hepatitis). Normal levels of serum aminotransferase AST and ALT levels were seen in 9% and 21% patients respectively. Mild to moderate increase in AST and ALT levels were seen in 84% and 75% of cases respectively whereas more than 10-fold increase in AST and ALT levels were seen in 7% and 4% patients respectively as shown in Table 1. Mortality was 2% in our study.
 Conclusions: Dengue viral fever contributes significantly to the disease burden in developing countries. Although the disease is self-limiting, but a significant number of cases show signs of organ dysfunction including liver dysfunction. The diagnosis of Dengue may be difficult in some cases due to false negative reports in first few days. It is thus important to investigate all suspected dengue patients with liver function test (serum transaminases levels), so that liver dysfunction can be detected early and proper management can be initiated.
 Keywords: Dengue Viral Fever, Immune Hepatitis, Serum Aminotransferases, Hepatic Dysfunction.

“STUDY OF SERUM AMINOTRANSFERASE LEVELS IN DENGUE FEVER”

Dengue infection, an arthropod-borne viral hemorrhagic fever, continues to be a major challenge to public health, especially in South-East Asia. It has a wide geographical distribution and can present with a diverse clinical spectrum. The liver dysfunction could be a direct viral effect or an adverse consequence of dysregulated host immune response against the virus. Hepatic involvement can be characterized by manifestations of acute hepatitis, with pain in the right hypochondrium, hepatomegaly, jaundice, and raised aminotransferase levels. Several outbreaks of dengue infection have been reported from India. However, large clinical studies documenting hepatic involvement in dengue infection, especially in adults, are scarce.

Prolonged Cholestatic Jaundice as an Atypical Manifestation of Acute Hepatitis A Virus (HAV) Infection in Children

This article reports two cases of prolonged cholestatic type hepatitis A, a rare clinical manifestation of hepatitis A virus infection in children. Acute hepatitis A virus infection typically resolves spontaneously in 90% of the cases. In children, complete recovery usually occurs in most of the cases within two months. Occasionally, the cholestatic variety may persist for several months, characterized by intense pruritus and prolonged conjugated hyperbilirubinemia. The diagnosis is based on the presence of IgM anti-HAV, symptoms longer than 8 weeks, bilirubin concentration >10 g/dL in the absence of substantial hepatocellular and biliary damage. Use of only ursodeoxycholicacid (UDCA) rather than the combined use of UDCA and corticosteroid is sufficient.

Acute onset distal symmetrical vasculitic polyneuropathy associated with acute hepatitis B

Hepatitis B can have varied extrahepatic manifestations involving the skin, renal, haematological and nervous systems. Neurological manifestations in hepatitis B may take the form of Guillain-Barré syndrome and secondary systemic vasculitis-related mononeuritis multiplex. The clinical course of hepatitis B-related, vasculitis-related neuropathy is usually subacute to chronic and clinical evolution is relatively benign. To our knowledge, acute hepatitis B-associated vasculitis manifesting as acute distal symmetric polyneuropathy has not been reported. We report a 60-year-old man who presented with fever, mild hepatomegaly, skin lesions in the form of non-palpable purpura and acute onset distal symmetric sensorimotor polyneuropathy. Serum transaminase levels were raised and viral serological markers revealed acute hepatitis B. The patient remained anicteric throughout his clinical course. Nerve conduction studies showed severe axonal sensorimotor polyneuropathy and histopathological examination of sural nerve biopsy was suggestive of vasculitic neuropathy. The patient was first given a course of intravenous immunoglobulin with the antiviral drug entecavir. The fever subsided after 1week of treatment. The patient was started on prednisolone in addition to the entecavir, and showed significant improvement in motor power and marked resolution in paresthesia after 2weeks of treatment. Thus, acute onset distal symmetric sensorimotor polyneuropathy of vasculitic etiology can be a manifestation of acute hepatitis B.

Urticaria and Periorbital Edema as Prodromal Presenting Signs of Acute Hepatitis B Infection

A 34-year-old patient presented with giant, transient urticarial skin lesions and periorbital edema after a 3-month stay in DR Congo. Retrospective analysis of stored samples revealed that these signs were prodromal manifestations of acute hepatitis B infection. The hepatitis B infection was spontaneously cleared; the skin lesion did not recur.

Thrombocytopenia: an unusual manifestation of acute hepatitis B infection

Thrombocytopenia: an unusual manifestation of acute hepatitis B infection

Thrombocytopenia: an unusual manifestation of acute hepatitis B infection

Thrombocytopenia: an unusual manifestation of acute hepatitis B infection

Immunogenicity and efficacy of a killed hepatitis A vaccine in day care center children.

The objective of this study was to characterize the immune response of children after the use of two different vaccine doses and to evaluate whether vaccination benefits children attending day care centers in areas with high anti-HAV seroprevalence. The study was conducted in a day care center with a stable population in São Paulo, Brazil. Two groups of 20 children, all seronegative for hepatitis A antibodies, were assigned randomly to receive three times 0.5 and 1.0 ml of the vaccine, the second and third dose 1 and 6 months after the first dose, respectively. There were 27 children in the control group. All children in both vaccinated groups had protective levels of antibodies in the serum after two inoculations, and serious adverse reactions were not observed. In the eighth month of follow-up, a hepatitis A outbreak occurred in the day care center. Five children in the control group had high titers of IgM class anti-HAV, four with clinical manifestations of acute hepatitis. None of the vaccinated children developed symptoms or signs of hepatitis (P = 0.0125), and the estimate of vaccine efficacy was 100%. Two nonstudy children from the center also had clinical and serological evidence of acute hepatitis A. It is concluded that vaccination represents an important method for prevention of hepatitis A transmission in day care centers. The results of this pilot study justify further testing in larger groups.

Thrombocytopenic Purpura as a Manifestation of Acute Hepatitis A

Extrahepatic autoimmune manifestations are rare in patients with acute hepatitis A infection. We describe a 34-year-old man in whom severe autoimmune thrombocytopenic purpura developed as the manifestation of acute hepatitis A infection. Thrombocytopenic purpura is rarely described in association with hepatitis A, but to our knowledge has never been reported as a manifestation of acute hepatitis A.