Hepatitis virales / Viral hepatitis

En esta revisión se describen los virus hepatotropos actualmente conocidos, su epidemiología con referencia especial a los datos nacionales relativos a los virus A, B, C y E; su historia natural y sus aspectos clínicos más relevantes. Se enfatizan, además los diferentes marcadores virales serológicos, para el diagnóstico de infección aguda o crónica. Se incluyen también los diferentes tratamientos y las medidas de prevención (pasivas o activas) recomendadas actualmente

Comparison of clinical severity of hepatitis B and hepatitis D virus infections

This prospective study was done to assess the clinical severity of acute delta hepatitis as compared to acute HBV infection. A total of 51 HGsAg positive patients of acute viral hepatitis were admitted from October 1991 to July 1992. Among 51 HBsAg positive patients, 38 patients were anti-HD negative and 13 were anti-HD positive. The frequency of complications, particularly hepatic encephalopathy and bleeding diathesis were significantly higher in HDV infection [p< .05]. Mortality was higher in HDV infection [38.4%] as compared to HBV infection [21%]. These results show that HDV infection is more severe than HBV infection

Pattern of hepatitis delta virus infection in the Shaikh Zayed hospital, Lahore

Hepatitis delta virus [HDV] is a hepatotropic virus. It infects only in the presence of hepatitis B virus [HBV]. HBV infection in Pakistan is high; the infection with the delta virus, therefore, goes hand in hand with HBV infection. HDV coinfects in the presence of HBV or superinfects a carrier of HBsAg. Superinfection by HDV is generally more severe than HBV infection alone. Therefore, the purpose of this study was to evaluate the frequency of HDV in our patient population. Sera of 150 HBsAg positive patients were tested for anti-HDV. Twenty-five [16.67%] were found positive. Sera of these 25 patients were further tested for HBc-IgM antibodies. Six were found positive, indicating 24% of coinfection and 67% superinfection by delta virus. In as much as almost 17% of HBV infection had associated delta virus infection with reported high complications of fulminant hepatitis and chronicity, it is recommended that vaccination against HBV must be adopted as a universal policy

Fulminant hepatic failure: role of delta virus

A prospective study was carried out on all HBsAg positive patients [n=43] with fulminant hepatic failure admitted between March 1994 and November 1994 to the Department of Medicine, Nishtar Medical College, Multan, to assess the prevalence of delta markers. Of these, 19 [44.2%] were positive for hepatitis D virus [HDV] markers and 24 [55.8%] were negative. The frequency of severe encephalopathy [grade IV and V] was higher among anti-HD positive patients [79%] as compared to anti-HD negative patients [45.8%], and the difference was significant [p<0.5]. The mortality was also higher in the anti-HD positive group [57.9%] as opposed to anti-HD negative group [37.5%]. The fact that HBV and HDV infections are endemic in this region and that HDV markers are present in a significant number of HBsAg positive patients, emphasizes the need for development of effective strategies for prophylaxis against both infections

Frequency of hepatitis D virus [HDV] infection in Nishtar hospital, Multan

A prospective study was carried out to assess the frequency and pattern of hepatitis-D virus [HDV] infection among patients of acute viral hepatitis [AVH]. The study included all the admitted patients of AVH from October 1991 to July 1992. The sera of HBsAg positive patients of AVH were frozen at -20°C and were tested for antibodies against HDV in a single batch. During this period 111 patients of AVH were included in this study. Among these cases of AVH, 44 [39.6%] were positive for HBsAg and 12 of these 44 HBsAg positive patients [27.3%] were reactive for anti-D. The frequency of fulminant hepatitis and mortality was significantly higher in anti-D positive patients as compared to anti-D negative patients. The fatal outcome was seen in 5/12 [41.6%] patients with the anti-D positivity, while in anti-D negative group it was seen 8/32 [25%] cases. In conclusion HDV infection was found in a high ratio in AVH cases in Nishtar Hospital, Multan. Among these HDV positive patients, the development of hepatic encephalopathy and fatal outcome was greater as compared to HBsAg positive and anti-D negative group. There is need for effective strategies for the prophylaxis of HDV infection in high risk population in our country

Frequency and pattern of HDV infection in Shaikh Zayed hospital, Lahore

Hepatitis Delta virus [HDV] is a hepatotropic virus. It infects only in the presence of hepatitis B virus [HBV]. The incidence of HBV is high in Pakistan. The infection of delta virus, therefore, goes hand in hand with HBV infection. HDV co-infects the HBV or superinfects a carrier of HBsAg. Superinfection of HDV is generally more common and severe. Sera of 150 HBsAg positive patients were tested for anti-HD. Twenty five [16.66%] were found positive. Sera of these 25 patients, were further tested for HBc-IgM antibodies, six were found positive, indicating 24% of co-infection and 76% superinfection of Delta virus

Hepatitis delta virus Antigenemia in all children after induction chemotherapy

Hepatitis delta virus [HDV] is a defective virus which requires hepatitis B virus as a helper virus. The present study was carried out on sera of 58 ALL children after induction chemotherapy for the detection of HBV markers and HDV antigen by enzyme linked immunosorbant assay [ELISA] technique. Of the 58 ALL cases, with a mean age of 5.8 years, 34 were positive for one or more of the HBV markers, 22 were positive for HBsAg, 13 were positive for HB anti- core IgM, 10 were positive for anti-HBs and 9 were positive for HbeAg. Of these 34 patients, 7 were found to be positive for HDV antigen. ALL 7 children showed elevated ALT levels, which was statistically significantly different when compared to HDAg negative children. On the other hand, 24 ALL children were negative for all HBV markers and were also negative for HD antigen. Co-infection of HBV and HDV was the prominent pattern of infection in these patients. As these leukemic children had received multiple transfusions during induction therapy, they became liable to acquire both viruses from infected blood

El espectro creciente de las hepatitis virales / The growing spectrum of viral hepatitis

El conocimiento de las hepatitis se remonta por lo menos al siglo VIII, pero éste ha avanzado vertiginosamente en los últimos 30 años gracias a factores como la aplicación de técnicas de inmunoquímica, microscopía electrónica, estudios epidemiológicos tanto clínicos como experimentales, técnicas de ingeniería genética, etc. Este trabajo revisa aspectos históricos de estas afecciones, las lateraciones histológicas hepáticas y manifestaciones clínicas que desencadenan. También describe las características principales de los virus A, B, C y E, la respuesta inmune que produce cada uno de ellos, su forma de infectar y la evolución, complicaciones y posibilidades de prevención de la enfermedad que desencadenan. Se comentan los resultados de los tratamientos con antivirales e interferón para las infecciones crónicas por virus B y C

Hepatitis viral de tipo delta: frecuencia en un Centro Médico / Delta virus hepatitis

Con objeto de conocer la frecuencia de infección con el virus de la Hepatitis tipo Delta en nuestra población derechohabiebte, se determinó la presencia de anticuerpos a este virus en 1012 personas con cuadros clínicos de hepatitis Viral Aguda ó Crónica, en las que se había encontrado la presencia de infección con el virus de la hepatitis Viral de tipo B, en el laboratorio Clínico del ospital de Infectología del Centro Médico Nacional "La Raza". Los resultados obtenidos mostraron una baja prevalencia de infección con este virus (1.58 por ciento), 16 de 1012 pacientes estudiados, lo que coloca a nuestro país dentro de los considerados como de bajo nivel de endemicidad. La forma clínica más observada fue la de Superinfección que dio lugar a cuadros clínicos que progresaron a Hepatitis Crónica (75.0 por ciento); el antecedente epidemiológico más frecuente fue el de hemotransfusión; en ningún caso se observó evolución a Hepatitis Fulminante. Su presentación clínica indistinguible de otras formas agudas o crónicas de Hepatitis dificultan su diagnóstico clínico.

Prevalence of hepatitis D virus in HBs Ag positive multitransfused children

Polytransfusion with blood or blood products places recipient children at considerable risk of exposure to hepatitis B virus and hepatitis D virus viral infections. To evaluate the current risk of hepatitis D virus infection, this study was conducted in 105 polytransfused children and 50 primary school pupils as controls, a full history and complete clinical examination were done for each child with screening all of them for HBs Ag. The HBs Ag positive members were screened for anti HDV. HDV +ve samples were also tested for HBe Ag, anti HBe and anti HBc IgM. The anti HBc IgM +ve cases were further tested for anti HBs. Liver function tests [total serum bilirubin-alanine aminotransferase ALT] were done for HBs Ag +ve children. The results revealed that anti HDV is significantly prevalent among HBs Ag carries 72% [18 out of 25 cases] a finding which indicates that delta hepatitis is endemic in our locality and this is related to endemicity of HB infection 23% [25 out of 105 cases]. There is significant increase in prevalence of anti HDV [93%] among polytransfused children with history of parental injection-history of jaundice. 16 out of 18 cases [88.88%] of HDV infections were due to superinfection [absence of anti HBc IgM marker], while 2 out of 18 cases [11.11%] were due to co-infection [presence of both anti Bc IgM and anti HDV markers]. There was also significant increase in prevalence of anti HBe [a markers of good prognosis] more than HBe Ag among anti HDV +ve polytransfused children [p <0.05], but the liver function tests showed significant alteration in patients positive for anti HBe than those with negative anti HBe [p <0.001]

Hepatitis viral delta

The etiologic agent of this severe form of hepatitis was identified by Rizzetto et al in Italy in 1977. The Delta virus resembles satellite viruses of plants which can not replicate without another specific virus. In this particular case hepatitis B virus is the helper agent. Clinically this form of hepatitis is characterized by two presentations: coinfeccion, which means simultaneous infection of a host with hepatitis B virus and hepatitis D virus. This variety of hepatitis can present with two distinct peaks of transaminases and usually resolves completely in most of the cases, however 0-4 percent can evolve to chronic hepatitis and 25 percent of the cases of fulminant hepatitis are due to this viral association. The diagnosis can be established demonstrating anti-HDV IgM or HDV-RNA or HDV antigen in the serum. In essence coinfection makers acute hepatic failure more common and the mortality is significantly higher than hepatitis B infections by itself. The second type of clinical presentation is superinfection, which means infection with the Delta virus of a patient previously infected with the hepatitis B virus (healthy carrier). Initially the patient develop a typical acute viral hepatitis in 50-70 percent of the cases, and 30-50 percent can have asymptomatic infection. The real problem with this presentation is that 20-90 percent of the cases evolved to chronicity: chronic active hepatitis and cirrhosis. The diagnosis can be made demonstrating anti-HDB IgM and anti-HDV IfG, although this last one is usually transitory. A liver biopsy can show HDV RNA or HDV antigen using special immunostainings...

Hepatitis fulminante en la Sierra Nevada: una forma de superinfección del virus delta con el virus de la hepatitis B / Fulminant hepatitis in La Sierra Nevada: a type of Delta superinfection with hepatitis B virus

Durante septiembre de 1980 a octubre de 1983, se realizó un estudio seroepidemiológico para hepatitis A y B, en 258 personas en una ciudad (Santa Marta) población de 250.000 y tres pequeños municipios (Santa Rosalía, Julio Zawady y Aracataca), poblaciones de 768.800 y 5.000 habitantes respectivamente. La presencia de hepatitis A se encontró en un 77 a 93 por ciento (IgG Hepatitis A). Hbs Ag o Anti-Hbs Ag en 30.5 por ciento de la población en dos municipios (Santa Rosalía y Julio Zawady), en 2,5 por ciento en el municipio de Aracataca y 48.5 por ciento en la ciudad de Santa Marta. La presencia del agente Delta (Anti-Delta en el suero) se determinó también en estas mismas poblaciones, encontrándose ausente en la ciudad y uno de los municipios (Aracataca), en contraste con una prevalencia de 13,7 por ciento y 22 por ciento en Julio Zawady y Santa Rosalía (P:0.0001). Se escluyeron por historia clínica, antecedentes de drogadicción, transfusiones, o prácticas homosexuales, como mecanismos de transmisión de los virus B y delta. En veinte pacientes con diagnóstico histopatológico de hepatitis fulminante y en quienes se descartaron otras etiologías se demostró la presencia serológica de los virus de la hepatitis B y Delta. De estos veinte, diez provenían de Julio Zawady y los otros diez de Santa Rosalía. La evolución clínica de esta enfermedad fue indistinguible de otras causas de falla hepática aguda. La mortalidad de estas formas fulminantes de hepatitis alcanzaron hasta un 65 por ciento. Los corticoides no modificaron el curso de esta enfermedad. La población joven mostró mayor compromiso y peor diagnóstico (P: 0.033). La hepatitis fulminante de la Sierra Nevada de Santa Marta es el resultado de la superinfección con el virus Delta sobre la infección virus B. La aparición simultánea de casos intrafamiliares sugiere una relación importante entre los grupos comprometidos, aunque la forma exacta de transmisión permanece aún desconocida

Hepatite delta / Delta hepatitis

Os autores apresentam um histórico do chamado "agente Delta" e estudam a epidemiologia da hepatite causada pelo mesmo, sua morfologia, biologia, patogenia, histologia e imunofluorescência. Analisam, entäo, a evoluçäo clínica da "hepatite Delta", seu perfil imunológico e profilaxia