Acute Viral Hepatitis E Infection With Conjugated Hyperbilirubinemia In 9-Year Boy

Hepatitis E virus (HEV) infection is most common among acute viral hepatitis (AVH) infections in developed countries. It is an enteric virus which usually causes a self-resolving hepatitis. We report the case of a 9-year old boy who presented with anorexia, fever, pain in abdomen and jaundice. Ultrasound revealed no signs of cholestasis. Laboratory findings revealed conjugated hyperbilirubinemia, transaminitis, and bilirubinuria. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin M to HEV suggestive of acute origin of disease. The jaundice resolved slowly after a period of 2 months. Hepatitis E virus RNA was not detectable in the convalescent serum. This case is an example of conjugated hyperbilirubinemia seen in acute phase of viral hepatitis caused by HEV.

Abnormal findings on dipstick urinalysis of out-patient with malaria in Abakaliki, Nigeria.

Background & objectives: Malaria, one of the major health challenges of the tropics affecting about 500 million people, particularly the children and pregnant women have been associated with changes in urine compositions. The present study was undertaken to document the urinary abnormalities in malaria patients based on malaria species and the level of malaria parasitaemia. Methods: Febrile patients (n = 365) with positive Giemsa-stained blood films for malaria recruited from Outpatient Department of Ebonyi State University Teaching Hospital, Abakaliki participated in the study. Patients were classified into two categories (+ and ++) based on parasite density. Apparently healthy individuals (n = 81), without malaria parasite on both thick and thin films of comparable age and gender acted as control group. Urine sample (10 ml) was collected from each participant and analysed using standard laboratory methods and techniques. Results: Seventy-four (20.3%) of the patients had Plasmodium falciparum malaria. Although all the urine parameters were higher in the malarial patients in comparison to the control, only bilirubinuria and urobilinogenuria were statistically significant (p <0.05). Also, bilirubinuria, urobilinogenuria, haematuria and proteinuria were significantly (p <0.05) higher in P. falciparum infection than in infections with other malaria species, but only in P. falciparum infection, bilirubinuria and urobilinogenuria were significantly (p <0.05) higher at higher parasitaemia. Conclusion: Even though positive blood film for malaria parasite remains the gold standard for the diagnosis of malaria, urinary abnormalities, such as bilirubinuria, urobilinogenuria, proteinuria and haematuria may aid in identifying patients with severe malaria parasitaemia, especially the falciparum malaria.