Pruebas de funcionalismo hepático en pacientes con infección viral aguda / Liver function tests in patients with acute viral infection / Testes de fungáo hepática em pacientes com infecgáo viral aguda

Las hepatitis víricas son producidas principalmente por virus de las hepatitis; sin embargo, otros virus han sido asociados a esta entidad clínica. Con el objeto de estudiar estas alteraciones hepáticas se estudiaron 130 pacientes con síntomas de infección viral aguda. Se les realizó una historia clínica y sus muestras de suero fueron procesadas por técnicas inmunoen-zimáticas y espectrofotométrícas para la determinación de anticuerpos específicos de los distintos virus y para pruebas de funcionalismo hepático. Se confirmó infección viral en 68 pacientes: 22 casos (32,4%) por virus dengue (VD); virus de varicela zoster (VVZ) 11(16,2%), virus de parotiditis (VP) 9 (13,2%); infección por citomegalovirus (CMV) 7 (10,3%), virus Epstein Barr (VEB) 4(5,9%), 13(19,1%) por virus de hepatitis A (VHA), 1 (1,5%) por virus de hepatitis B (VHB) y 1 (1,5%) por virus de hepatitis C (VHC). En todas las infecciones virales se observó aumento de ambas transaminasas; en la infección por virus de hepatitis predominó alaninaaminotransferasa (ALT) (p < 0,05). El resto de las infecciones estudiadas fue a expensas de aspartatoaminotransferasa (AST). La hiperbilirrubinemia producida por VHA fue estadísticamente significativa (p < 0,05) con respecto al resto de las infecciones. La fosfatasa alcalina (FA) y la gammaglutamiltranspeptidasa (GGT) también estuvieron alteradas y se destacó la hipoproteinemia en la infección por VD. Este estudio sugiere que las pruebas bioquímicas que miden el funcionalismo hepático, no sólo evalúan severidad y evolución de la enfermedad, sino que además pueden orientar sobre la etiología de la infección viral aguda.

Viral hepatitis is mainly caused by the hepatitis virus, but other viruses have been associated with this clinical entity. In order to study these liver disorders, 130 patients with symptoms of acute viral infection were analized. A complete medical history and serum samples were assayed by enzyme-linked immunoassay and spectrophotometer techniques for the determination of antibodies specific to different viruses and liver func-tion tests. Viral infection was confirmed in 68 patients: 22 cases (32.4%) for dengue virus (DV) 11 (16.2%) varicella zoster virus (VZV), 9 (13.2%) mumps virus (VP), 7 (10.3%) cytomegalovirus (CMV), 4 (5.9%) Ep-stein- Barr virus (EBV), 13 (19.1%) patients with hepatitis A virus (HAV), 1 (1.5%) infected with hepatitis B virus (HBV) and 1 (1.5%) with hepatitis C virus (HCV). All viral infections showed an increase in both transaminases; in hepatitis virus infection, alanineaminotransferase (ALT) (p < 0.05) predominated. The rest of the infections studied were at the expense of aspartate aminotransferase (AST). HAVhyperbilirubine-mia was statistically significant (p < 0.05) compared with other infections. Alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) were also affected, and hypoproteinemia was stressed in DV infection. This study suggests that the biochemical tests that measure liver function, not only assess the severity and progression of the disease, but can also shed light on the cause of acute viral infection.

As hepatites virais sáo produzidas principalmente por virus das hepatites; entretanto outros virus tem sido associados a esta entidade clínica. Com o objetivo de estudar estas alteragóes hepáticas foram estudados 130 pacientes com sintomas de infecgáo viral aguda. Foi realizado um prontuário clínico e suas amostras de soro foram processadas por técnicas imunoenzimáticas e espectrofotométrícas para a determinagáo de anticorpos específicos dos diferentes virus e para testes de fungáo hepática. Confirmou-se infecgáo viral em 68 pacientes: 22 casos (32,4%) por virus dengue (VD); virus de varicela zoster (VVZ) 11(16,2%), virus de parotidite (VP) 9 (13,2%); infecgáo por citomegalovírus (CMV) 7(10,3%), virus Epstein Barr (VEB) 4(5,9%), 13 (19,1%) por virus de hepatite A (VHA), 1 (1,5%) por virus de hepatite B (VHB) e 1(1,5%) por virus de hepatite C (VHC). Em todas as infecgóes virais foi observado aumento de ambas as transaminases; na infecgáo por virus de hepatite predominou alanina aminotransferase (ALT) (p < 0,05). O resto das infecgóes es-tudadas foi as expensas de aspartato aminotransferase (AST); a hiperbilirrubinemia produzida por VHA foi estatisticamente significativa (p< 0,05) com relagáo ao resto das infecgóes. A fosfatase alcalina (FA) e a gamaglutamiltranspeptidase (GGT) também estiveram alteradas e se destacou a hipoproteinemia na infecgáo por VD. Este estudo sugere que os testes bioquímicos que medem a fungáo hepática, náo só avaliam severidade e evolugáo da doenga, mas também podem orientar sobre a etiologia da infecgáo viral aguda.

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.

High prevalence of HGV coinfection with HBV or HCV among northeastern Thai blood donors.

Hepatitis G viral (HGV) infection among northeastern Thai blood donors was determined by the nested RT-PCR technique. HGV RNA was amplified by the degenerated helicase primers for a product of the expected size of 83 base pairs were used in this study. Serum samples from 322 of three different categories of northeastern Thai blood donors were included in this study. There were 104 HBsAg and Anti-HCV seronegative blood donors (control group), 100 samples of HBs Ag seropositive blood donors (HBV infected group) and 118 serum samples from anti-HCV seropositive blood donors (HCV infected group). The results demonstrated that HGV RNA was not detected in the control group but was found in 10 individuals (10%) in the HBV infected group and 13 (11%) in the anti-HCV positive blood donors. The prevalences of HGV in both seropositive groups were significantly different from the control group (p = 0.001). HGV co-infection is highly prevalent among northeastern Thai blood donors who are infected with HBV or HCV. The results also reveal that blood donors seronegative for HCV and HBV are a low risk group for HGV infection.

Molecular epidemiology and genotyping of TT virus isolated from Saudi blood donors and hepatitis patients

In Saudi Arabia, the epidemiology and clinical significnance of Torque Teno virus [TTV] infection alone and in patients with hepatitis virus infections have not been determined in a single study. In this paper, we molecularly investigated the rate and genotypes of TTV infection among Saudi Arabian blood donors and patients with viral hepatitis. The effect of TTV coinfection on viral hepatitis was also examined. DNA was extracted from the sera of 200 healthy blood volunteers, 45 hepatitis B virus patients, 100 hepatitis C virus patients, 19 hepatitis G virus patients, and 56 non-A-G hepatitis patients. TTV DNA was amplified using primers derived from the ORF1 and 5'UTR regions. The alanine aminotransferase [ALT] level was determined for each specimen. Sequencing of ORF1 amplicons was carried out to investigate TTV genotypes. Using primers derived from ORF1 and 5'UTR, TTV DNA was detected in 5.5% and 50.5%, respectively, of healthy blood donors, in 2.2% and 88.8% in hepatitis B patients, in 2.0% and 70% of hepatitis C patients, in 15.8% and 100% of hepatitis G patients, in 5.4% and 12.5% of non-A-G hepatitis patients and in 4.8% and 56.4% overall. No detrimental effect of TTV coinfection in viral hepatitis patients was noted. An overall prevalence of 4.8% and 56.4% was established. Phylogenetic analysis indicated that the most common genotype of TTV among Saudis is 2c. The rate of TTV infection among Saudi Arabians seems to be lower than that stated in previous reports on Saudi Arabia and in some other countries. The virus does not seem to worsen the status of those who are suffering from viral hepatitis infection

Markers of viral hepatitis in haemophiliacs

Seroprevalence of Hepatitis B surface antigen [HbsAg] and anti-HCV IgG was determined in 100 persons with Haemophilia [PWH], registered with Haemophilia Patient Welfare Society [HPWS], Lahore Zone, Pakistan. The study shows that 4% were positive for HBsAg. However, there was a high level of anti-HCV seropositivity [56%] in our PWH, including many patients in younger age groups. When compared with figures from PWH in other regions of Asia like 23% in Western India, 33% in Sri Lanka and 1 5% of those in Iran, this figure is one of the highest. This rate is a reflection of the same rising trend in our population that is now exceeding 10%. The practice of unscreened blood/blood-products transfusions in the backdrop of high prevalence of HCV in our population is responsible for high figures seen in PWH. The need is to increase awareness amongst the patients, health care workers and policy makers about the transfusion associated viral infections in a group of patients who already had a hereditary disorder of severe nature

Serum lipoprotein (a) levels in liver diseases caused by hepatitis.

Lipoprotein (a) [LP(a)] is a genetic variant of low density lipoprotein (LDL) and is mainly synthesized in liver. We conducted a study to evaluate the association of serum [Lp(a)] level with hepatitis viral infections. A total of 130 patients including 50 patients with acute viral hepatitis (AVH), 30 with chronic active hepatitis (CAH), 30 with cirrhosis of liver and 20 patients with fulminant hepatic failure (FHF) were analysed for different hepatitis viral markers and Lp(a) level in their serum samples. For comparison, 50 healthy persons were also tested for Lp(a) level. Serum Lp(a) level in patients in all the disease groups was significantly reduced compared to that observed in controls. Lp(a) level could not be detected in 40 per cent cases with AVH, 46.6 per cent with CAH, 70 per cent with cirrhosis and 80 per cent of FHF patients. On correlating Lp(a) level to viral etiology in these patients, it was found that the extent of diminution in Lp(a) level did not follow any trend with some particular viral infection and was recorded nearly same in all the infections. The findings of this study suggested that serum Lp(a) level was significantly (P<0.001) reduced in patients with liver diseases irrespective of the viral etiology.

Plasma vitamin 'A' levels in hepatitis and cirrhosis

Plasma vitamin A carotene levels were estimated in 46 normal healthy adults, 34 patients with acute viral hepatitis and 12 patients with cirrhosis. Low vitamin A levels were observed in 16 [48 percent] cases of hepatitis and 9 [75 percent] cases of cirrhosis. Significant [P = 0.05] lowering of plasma vitamin A was observed in both the conditions. Carotene levels were normal in all the cases

Etiology of endemic viral hepatitis in urban North India.

This study was carried out to determine the presence of markers of hepatitis viruses in patients with acute liver disease. Coinfection of HAV, HBV, HCV, and HEV was studied. Sera from 306 patients with a clinical diagnosis of acute liver disease were tested for the presence of anti-HAV antibody, HBsAg, anti-HBc antibody, anti-HBs antibody, anti-HCV antibody and IgM anti-HEV antibody by ELISA. Liver function tests were correlated with the presence of infection. Of the 306 cases, 7 (2.3%) had IgM anti-HAV, 9 (2.9%) had IgM anti-HBc, 37 (12.1%) had HBsAg, 84 (27.4%) had anti-HBs, 10 (3.3%) were HCV infected and 63 (20.6%) had IgM anti-HEV. There was no significant difference in the clinical and liver function profiles of infected and uninfected patients. Similarly, no difference was observed in cases coinfected with more than one virus compared with those infected with a single pathogen. HEV had the highest prevalence amongst our cases. There was no difference in the clinical profiles of patients with non-A, non-B, non-C, non-E hepatitis by antibody assays and testing for viremia could be helpful in making the correct diagnosis.

Freqüência e implicaçöes dos auto-anticorpos em hepatites agudas virais / Frequency and implications of autoantibodies in acute viral hepatitis

Existem interaçöes entre viroses hepatotrópicas e o sistema imunológico do hospedeiro que podem influenciar na patogenicidade da agressäo hepática. O objetivo deste trabalho foi investigar a freqüência de auto-anticorpos na fase aguda da hepatite viral, sua relaçäo com atividade bioquímica, gravidade da doença e cronicidade. Foram estudados 156 pacientes com hepatite aguda viral de 1992 a 2000. Destes, 32 por cento tiveram infecçäo por vírus A, 31 por cento por vírus B, 8 por cento por vírus C, 3 por cento tiveram hepatite E e 24 por cento näo A-E. Na fase aguda, 20,5 por cento apresentaram FAN e 14,8 por cento antimúsculo liso positivos. Na convalescença, 6,4 por cento persistiram com FAN e 3,9 por cento com antimúsculo liso positivos. Pacientes que persistiam com anticorpos detectáveis näo apresentavam níveis de transaminases e bilirrubinas significativamente diferentes daqueles com auto-anticorpos negativos. Concluindo, os anticorpos que aparecem na fase inicial da infecçäo säo transitórios e näo têm implicaçäo prognóstica

Spectrum of viral hepatitis in thalassemic children receiving multiple blood transfusions.

AIM: To investigate the prevalence of infection with hepatitis viruses in children with thalassemia receiving multiple blood transfusions. METHODS: Sera from 50 children with thalassemia aged 5-15 years (30 boys), who had each received over 80 units of blood, were evaluated for the presence of markers for hepatitis A virus (HAV; IgG and IgM anti-HAV), hepatitis B virus (HBV; HBsAg, and IgG and IgM anti-HBc), hepatitis C virus (HCV; IgG and IgM anti-HCV, and HCV RNA) and hepatitis E virus (HEV; IgG and IgM anti-HEV). IgM anti-hepatitis D virus (HDV) was looked for only in HBsAg or IgM anti-HBc positive sera. RESULTS: No child had evidence of recent HAV or HDV infection. IgG anti-HAV was positive in 12 children. One patient had acute HBV infection. Nine patients were HBsAg-positive. HCV infection was present in 15 cases; six of them were HCV RNA positive, and three had superinfection with hepatitis B. Recent HEV infection was present in 5 cases. CONCLUSION: Thalassemic patients receiving multiple blood transfusions often acquire hepatitis B (20%) and C (30%) infections. Recent hepatitis E infection was documented in 10% in this one-point study.

Protease inhibitor variants in healthy children and those with hepatitis

A study to assess the serum concentration and phenotypes of alpha-1 antitrypsin was conducted on 119 healthy school children and 28 children suffering from acute viral hepatitis. Serum alpha-1 antitrypsin was measured quantitatively by radial immunodiffusion where as phenotypes were determined by isoelectric focusing and further confirmation was done by immunofixation. Ten percent control and 15 percent of the children suffering from acute viral hepatitis had serum alpha-1 antitrypsin level below the normal range. MM was the most common in two groups. Deficiency variant MZ was found in two healthy controls while another variant FZ, associated with deficiency state in two patients with acute hepatitis. Genetic alpha-1 AT deficiency does exist in children but due to lack of facilities the deficiency in most of the cases remain undiagnosed

Viral hepatitis: recent experiences from serological studies in Bangladesh.

Infections due to hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV) and hepatitis E (HEV) viruses are the major causes of hepatitis and are associated with significant morbidity and mortality in developing countries like Bangladesh. The present study was carried out to determine the prevalence of HBsAg, anti-HCV antibody, anti-HAV antibody and anti-HEV antibody in patients suspected of having infection by HBV, HCV, HAV and HEV, respectively. Antibody to HAV was detected in 39% of subjects investigated. HBsAg was identified in 19% of subjects. Antibody to HCV and HEV was detected in 13% and 53% subjects, respectively. Infection with HAV was very high among children < or = 6 years of age (100%). On the contrary, exposure to HEV was higher in adult persons > or => 30 years of age (52%) compared to that in children < or = 6 years of age who had 0% incidence. Our study clearly indicates a high prevalence of those viruses, particularly of enterically transmitted HAV and HEV in Bangladesh, which appeared to be a serious health problem in this developing country. Control measures should be taken on an urgent basis to prevent the spread of infections by these viruses.

Toma de muestra en papel de filtro para la detección de anticuerpos IgM antivirus de la hepatitis A / Sample taking in filter paper for the detection of anti-HAV IgM antibodies

Se describe la utilidad de la toma de muestra total en papel de filtro para la detección de la IgM antivirus de la hepatitis A (VHA). Se compararon simultáneamente 168 muestras de suero y papel de filtro, en las 52 muestras que conformaron el grupo control, no se detectaron alteraciones en la especificidad del ELISA de captura de IgM, y en las 116 restantes, que procedían de pacientes con sospecha clínica de hepatitis viral aguda, se obtuvo una sensibilidad, una especificidad y una coincidencia de 100 porciento al comparar el papel de filtro con la dilución 1:500 y el suero. La correlación entre los valores de densidad óptica de los resultados positivos a la Igm anti-VHA entre el papel de filtro a la dilución 1:500 y el suero, fue de 0,895. Al aplicar este tipo de colecta de muestra en un grupo de enfermos hospitalizados, se obtuvo 100 porciento de coincidencia con la sospecha clínica; además, se demostró su utilidad en el diagnóstico de un brote de hepatitis viral. Nuestros resultados recomiendan la introducción de este tipo de recolección de muestras en el diagnóstico de la hepatitis A

Assessment of liver dysfunction in silica exposed workers

Seventy five silica exposed workers in sandbricks industry and twenty five controls were chosen for this study. Each individual was subjected to a questionnaire [for personal and medical histories] and clinical examination. Liver function tests, procollagen III peptide, alpha-I - antitrypsin, hepatitis markers [B and C], haematological tests for schistosomiasis, urine and stool analysis, abdominal sonography and chest X-ray were done for all chosen subjects. Environmental study was done for estimation of total and free crystalline silica. The results of environmental study showed higher concentration of total respirable dust and free crystalline silica than threshold limit values. Silica exposed workers had a significantly higher mean of gamma-glutamyl trans peptidase and procollagen III peptide than controls. These two parameters increased significantly in exposed workers [free from schistosomiasis and / or hepatitis markers] as chest grading of silicosis and time intensity factor increased. Gamma-glutamyl-trans peptidase and procollagen III peptide can be used for early detection of liver dysfunction in silica exposed workers. Also, in the pre-employment medical examination, individuals with previous liver affection [either due to schistosomiasis and / or hepatitis] should not be exposed to silica to avoid further deterioration of liver function

Study of serum prealbumin and serum alpha fetoprotein in cases of fulminant hepatic failure.

We studied serum prealbumin (SPA) and serum alpha fetoprotein (AFP) to assess liver cell injury and prognosis in patients with fulminant hepatic failure (FHF). We studied 21 patients of FHF of viral etiology, 10 acute viral hepatitis (AVH) and 10 healthy controls. Initial (on the day of admission) AFP levels were significantly elevated in FHF group (30.28 +/- 63.58 ng/ml, p < 0.01 compared to AVH and control group in whom it was undetectable. Serum AFP correlated well with deranged Liver Functions (LFT). In the Survivors (n = 4) of FHF, serial estimations (on Day 5 and Day 10 of admission) revealed declining AFP Levels, correlating with clinical recovery. SPA on admission was significantly reduced in FHF group (15.10 +/- 9 mg/dl p < 0.05) compared to AVH (37.0 +/- 9.34 mg/dl) and control group (40.25 +/- 5.92 mg/dl). Low SPA also correlated with deranged LFT. Serial estimations in the survivors (Day 5, Day 10) revealed rising SPA which correlated with clinical recovery.