Hepatitis A-anticuerpos IgM / IgM antibody to hepatitis A (IgM anti-HAV)

Código SCPC (Sociedad Colombiana de Patología Clínica): 58200. Código CUPS (Codificación Única de Procedimientos en Salud): 906218. Sección: Infecciosas. Nivel de complejidad: alto. Metodología: inmunoanálisis quimioluminiscente de micropartículas (CMIA). Sinónimos: HAVAb-IgM, HAV IgM. Definición El ensayo ARCHITECT HAVAb-IgM es un inmunoanálisis quimioluminiscente de micropartículas (CMIA) para la detección cualitativa de anticuerpos IgM frente al virus de la hepatitis A (IgM anti-VHA) en suero y plasma humanos, útil en el diagnóstico de las infecciones agudas o recientes por el virus de la hepatitis A. Espectro clínico de aplicación El virus de la hepatitis A (VHA) tiene un genoma tipo ARN, pertenece a la familia Picornaviridae, género Hepatovirus, especie Hepatitis A virus, del cual se conoce un solo serotipo y es el agente causal de la hepatitis A, una de las infecciones de transmisión alimentaria más frecuentes, estrechamente asociada a la falta de agua potable, saneamiento deficiente y mala higiene personal. Los seres humanos son reservorios del virus de la hepatitis A y en raras ocasiones los chimpancés y otros primates no humanos. La hepatitis A es una infección viral común en la población infantil, con frecuencia subclínica, que en ocasiones cursa con manifestaciones clínicas sugestivas del diagnóstico; sin embargo, la confirmación solo se puede realizar mediante pruebas de laboratorio. Esta enfermedad causa una elevada morbilidad en la población adulta y ocasionalmente puede llegar a tener consecuencias graves, como insuficiencia hepática aguda de evolución fatal. El virus de la hepatitis A persiste en el medio y puede resistir los procesos de producción de alimentos usados habitualmente para inactivar y controlar las bacterias patógenas. (AU)

Two Cases of Acute Renal Failure Associated with Non-fulminant Acute Hepatitis A / 대한소화기학회지

Hepatitis A is generally regarded as a mild, self-limiting disease of the liver. Acute renal failure has rarely been reported in association with non-fulminant acute hepatitis A. Acute tubular necrosis is the most common form of renal injury in such patients. We recently experienced two cases of hepatitis A in which acute renal failure occurred early in the course of the illness and had a clinical course suggestive of acute tubular necrosis. In both patients, the clinical course of renal dysfunction was almost parallel to that of hepatic dysfunction. Hemodialysis was performed in patient 1 because of severe uremia despite maintaining urine output more than 2,000 mL per day. On the other hand, hemodialysis was not performed in patient 2 who showed a rapid recovery of renal dysfunction. The renal biopsy of patient 1 demonstrated typical findings of acute tubular necrosis on microscopy.

The changing epidemiology of hepatitis A in children and the consideration of active immunization in Korea

Currently, Korea is a low endemicity country for HAV, especially in children. However, recent reports of hepatitis A outbreaks show that there has been a shift of disease incidence to adolescents and young adults, with 2 cases of acute liver failure in one reported outbreak. We need to study the immune status for HAV in order to provide information for the establishment of preventive measures and possible consequences of HAV in Korea. A total of 334 infants, children and adolescents less than 20 years of age living in rural areas of Kyonggi Province, Korea were evaluated for anti-HAV immune status in 1996. Five hundred and eighty-four primary school children living in the same area were separately evaluated for the natural seroconversion rate between 1993 and follow-up samples taken in 1996. Anti-HAV IgG antibody was measured by enzyme immunoassay (HAVAB EIA kit, Abbott Laboratories, Chicago, Illinois, USA). In comparison with previous reports of seroprevalence rates, our data confirmed a dramatic drop in seroprevalence rates among children and adolescents under 20 years of age living in rural areas, from over 63.8% two decades ago to 4.6% in 1996. Natural acquisition of HAV antibody in primary school children rarely occurs, registering only 0.5% during three years. Several outbreaks in young adults during 1996-1998 suggested that immunity against HAV in this population is so low that massive outbreaks are unavoidable. Teenagers and young adults, especially soldiers, who are likely to be exposed to contaminated food or water, would also have a greater risk of hepatitis A. Immunizing children with HAV vaccine as a routine schedule should also be considered in Korea in the future, particularly if the disease burden could be estimated and the cost-effectiveness of the vaccine could be proved.