Clinical Characteristics of Primary Epstein Barr Virus Hepatitis with Elevation of Alkaline Phosphatase and gamma-Glutamyltransferase in Children

PURPOSE: The aim of the present study was to evaluate the clinical characteristics of the primary Epstein-Barr virus (EBV) hepatitis with elevation of both serum alkaline phosphatase (ALP) and gamma-glutamyltransferase (gamma-GT) levels in children. MATERIALS AND METHODS: A retrospective study was performed by reviewing of the medical records of 36 patients who were diagnosed with primary EBV hepatitis. The patients were divided into 2 groups: patients with elevated serum ALP and gamma-GT levels (group 1) and patients without (group 2). RESULTS: The classic features of infectious mononucleosis (fever, pharyngitis and/or tonsillitis, and cervical lymphadenitis) were seen in 20 (57.1%) of group 1 patients and 18 (50.0%) of group 2 patients. Hepatitis with elevated serum ALP and gamma-GT levels were present in 14 (38.9%) of the all patients. Of these patients, Jaundice occurred in only 2 (5.6%). The mean levels of aspartate aminotransferase and alanine aminotransferase (ALT) as well as the number of patients with ALT greater than 400 IU/L were significantly different between the groups (177 IU/L vs. 94 IU/L, 418 IU/L vs. 115 IU/L, and 50.0% vs. 13.6%; p=0.001, p=0.001, p=0.026, respectively). The mean duration of elevated serum ALT levels was 17.5 days in group 1 and 9.0 days in group 2 (p=0.013). All patients recovered fully without any chronic or serious complications. CONCLUSION: Primary EBV hepatitis with predominant biochemical abnormalities of the elevation of ALP and gamma-GT is frequent and mostly anicteric. This may represent a benign disease, but a delay in recovery of liver function as well.

Study of Cytochrome P450 2E1 and its allele Variants in Liver Injury of Nondiabetic, Nonalcoholic Steatohepatitis Obese Women

CYP2E1 enzyme is related to nonalcoholic steatohepatitis (NASH) due to its ability for reactive oxygen species production, which can be influenced by polymorphisms in the gene. The aim of this study was to investigate hepatic levels, activity, and polymorphisms of the CYP2E1 gene to correlate it with clinical and histological features in 48 female obese NASH patients. Subjects were divided into three groups: (i) normal; (ii) steatosis; and (iii) steatohepatitis. CYP2E1 protein level was assayed in microsomes from liver biopsies, and in vivo chlorzoxazone hydroxylation was determined by HPLC. Genomic DNA was isolated for genotype analysis through PCR. The results showed that liver CYP2E1 content was significantly higher in the steatohepatitis (45 percent; p=0.024) and steatosis (22 percent; p=0.032) group compared with normal group. Chlorzoxazone hydroxylase activity showed significant enhancement in the steatohepatitis group (15 percent, p=0.027) compared with the normal group. c2 rare allele of RsallPstl polymorphisms but no C allele of Dral polymorphism was positively associated with CHZ hydroxylation, which in turn is correlated with liver CYP2E1 content (r=0.59; p=0.026). In conclusion, c2 allele is positively associated with liver injury in NASH. This allele may determine a higher transcriptional activity of the gene, with consequent enhancement in pro-oxidant activity of CYP2E1 thus affording liver toxicity.

Antioxidant enzymes activity and neutrophil phagocytic function in patients with acute and chronic viral hepatitis

A disturbance in the delicate oxidant-antioxidant balance results in many pathophy-siologic conditions. In an attempt to clarify the antioxidants status in cases with viral hepatitis, we have measured the activity of 2 important antioxidant enzymes namely superoxide dismutase [SOD] and glutathione reductase [GR] in erythrocytes and investigated the neutrophil phagocytic function [phagocytic and lytic indices] in 23 patients with acute viral hepatitis, 21 patient with chronic viral hepatitis and twelve healthy subjects with matched age and sex. Patients with hepatitis showed a significantly decreased activity of both SOD and GR when compared to the control. Furthermore, the activity of these enzymes in acute hepatitis was significantly lower than in chronic hepatitis. The neutrophil phagocytic function was significantly suppressed in both groups of patients when compared to control. Results might point to a relationship between accumulation of free radicals and hepatitis

Tuberculosis infantil / Infantile tuberculosis

La frecuencia y factores de riesgo de alteraciones hepáticas fueron evaluados en 100 niños que recibieron tratamiento para tuberculosis en el Hospital Belén de Trujillo, y se propone una posología adecuada que previene al daño hepático en este Hospital. Los esquemas terapéuticos incluyeron INH, INH + RFP e INH + RFP + PZA. 60 por ciento de los pacientes tuvieron alteraciones hepáticas, TSGO* 50 UK/ml (24.1 UI) y de éstos, 25 por ciento fueron sintomáticos. La desnutrición grave y altas dosis de droga fueron factores de riesgo, p< 0.005; mientras la edad, sexo y asociación de drogas a dosis adecuadas no significaron riesgo, p> 0.10. Hepatitis tóxica se observó en 6 por ciento de pacientes y las manifestaciones clínicas de anorexia, náusea, vómitos, ictericia, hepatomegalia se presentaron en promedio de 23.8 días, p< 0.05; la bilirruninemia directa fue de 5.95 mg/100 ml de promedio, p< 0.05 y la TSGO de 161.33 UK/ml, p> 0.10 comparados con la hepatitis granulomatosa tuberculoide. Lesión combinada hepatocelular aguda colestásica y lesión hepatocelular aguda tipo hepatitis viral se encontró en la biópsia. Se determinó que 7*10 mg/k/d de INH*RFP y 20 mg/k/d de PZA, son dosis adecuadas para tratar la tuberculosis infantil y que previenen lesiones hepáticas en este Hospital

Aetiology of acute hepatitis in Malaysia.

Icteric patients with clinical and biochemical evidence of liver disease, admitted into various hospitals in Malaysia, were investigated to determine the cause of their infection. Of these patients, 11.0% (16/145) were found positive for IgM anti-HAV (EIA), 4.1% (6/145) for IgM anti-HBc (EIA), 1.0% (1/102) for IgM anti-CMV (ELISA), 17.2% (16/64) for rising titres of leptospiral agglutinin, and none for heterophile antibody of EBV. Hepatitis NANB accounted for 67.9% of cases. The mean serum transaminases (ALT and AST) values in patients with hepatitis A and B were higher (more than 500IU) than in patients with leptospirosis or non-A, non-B hepatitis, whereas serum bilirubin levels were higher in patients with hepatitis A and leptospirosis than in patients with hepatitis B.

Ornitina carbamil-transferase: diagnóstico das hepatopatias; valor comparativo com as TGO e TGP / Ornithine carbamyl-transferase: diagnosis of liver diseases; comparative value with TGO and TGP

O autor estudou a atividade sérica enzimática da ornitina carbamil - transferase (OCT-S) em nosso meio, para o diagnóstico das hepatopatías. Procurou também fazer uma avaliaçäo comparativa do valor desta enzima com as transaminases glutâmico-oxaloacética e glutâmico pirúvica. A OCT foi escolhida por ser uma enzima do ciclo da ureogênse e, portanto, presumivelmente, muito específica do fígado. Foram selecionados 200 indivíduos, divididos e distribuídos igualmente em quatro grupos: normais, näo-hepatopatas, hepatopatas agudos e hepatopatas crônicos. Os resultados levam-nos a acreditar que a OCT é altamente específica para indicar lesäo aguda do hepatócito e menos sensível que as transaminases no diagnóstico das hepatopatias. A ornitina carbamil-transferase (OCT-S) é uma enzima que, por fazer parte do ciclo da uréia, é encontrada quase que exclusivamente no fígado. Desta forma, as elevaçöes das atividades séricas desta enzima devem traduzir, com grande especificidade, lesöes do hepatócito, especialmente as do tipo agudo, como foi verificado inicialmente por Reichard, em 1958, na Suécia20. Na determinaçäo das atividades séricas enzimáticas, dois fatores säo importantes para que seu uso seja útil no diagnóstico clínico: a. que a enzima seja sensível, ou seja, que seu nível de atividade sérica apresente alteraçöes significativas como conseqüencia de condiçöes patológicas que atingem órgäos ricos nesta mesma enzima. b. que ela seja tanto quanto possível específica para determinado órgäo. Por isso, em geral, usa-se a determinaçäo da atividade sérica enzimática de mais de uma enzima para se ter a indicaçäo segura do órgäo afetado