Clinical and serological events accompanying changes in hepatitis B viral replication: case reports

We measured serum markers of hepatitis B virus replication in two HBsAg-, HBeAg-positive hepatitis B carriers with chronic active hepatitis and cirrhosis. The first of these patients was HBsAg-, HBeAg-, HBV DNA- and HBV DNA polymerase-positive initially and spontaneously lost HBV DNA polymerase and HBV DNA. During the HBeAg-positive, DNA polymerase-negative "window phase", an increase in viral replication, characterized by the reappearance of HBV DNA and HBV DNA polymerase occurred, together with an aggravation of the underlying chronic hepatitis. In the second HBsAg-, HBeAg-positive carrier, spontaneous fluctuations in HBV replication were associated with clinical deterioration. Delta agent and hepatitis A virus superinfection were excluded. These observations suggest that spontaneous low-grade fluctuations of HBV replication accompanied by an increase in the biochemical activity of the underlying chronic hepatitis can be observed in certain HBV carriers.     

Endocrine changes in children with acute viral hepatitis

The paper is concerned with the results of hormonal studies on virus hepatitis in 84 children aged 2 to 14, of them 28 had a mild form of disease, 50--medium grave and 6--a severe form of disease. A study was made of the blood content of ACTH, STH, TSH, cortisol, aldosterone, T3, T4, prolactin, and alpha-fetoprotein. The hormones were determined by a radioimmunoassay using Sorin kits (France). A considerable increase in the blood content of ACTH, cortisol, aldosterone and a moderate increase in STH, TSH and T4 concentrations were noted at the height of virus hepatitis. The above changes were interpreted as a result of combined manifestation of a stress reaction and a decrease in the catabolism of some liver hormones. An assumption has been made of a possibility of the effect of late hormonal shifts on the outcome of virus hepatitis of development of chronic hepatitis.     

Etiologic spectrum of acute sporadic viral hepatitis in children in India

The relative magnitude by hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis Non-A, Non-B virus (HNANBV) was determined in 496 children from three different parts of India suffering from acute viral hepatitis by tests for specific IgM class anti-HAV and anti-HBV antibodies in the serum. HAV, HBV and NANB infections accounted for 55.8 per cent, 20.2 per cent and 23.2 per cent of cases respectively. Hepatitis A largely (59.5%) affected younger children of 1-5 yr. Nearly a third of children affected by NANB hepatitis were additionally positive for HBsAg. The proportions of HAV and HBV infected cases respectively decreased and increased with increasing age whereas the incidence of HNANBV infection remained almost constant throughout childhood. Acute NANB hepatitis, a major health problem in the adults of India is also common throughout childhood. This study suggests that this infection does not impart long lasting protective immunity.     

Herpes simplex viral hepatitis in adults: two case reports and review of the literature

Herpes simplex viral (HSV) hepatitis is uncommon in adults. Two new cases are reported herein; a literature review revealed an additional 33 patients. Ages ranged from 13 to 87 years; the mean age was 32.6 years, and the median was 28 years. HSV hepatitis usually occurs as part of disseminated HSV infection and is characterized by fulminant hepatic necrosis with serum transaminase levels frequently elevated 100- to 1,000-fold. Disseminated intravascular coagulation was present in 90% of the cases. Outcome was poor; 86% of the patients died. Eighty-six percent of the patients had an underlying condition associated with impaired host defenses. Renal transplantation (26%), steroid use other than in renal transplant patients (26%), and pregnancy (23%) were the most frequent underlying conditions. Early recognition and prompt initiation of antiviral therapy may offer a chance for improved survival rates.     

Long-term follow-up of e-antigen (HBeAg)-positive acute viral hepatitis

Eighteen consecutive patients with HBeAg in serum and histologically verified acute viral hepatitis were included in a follow-up study of the natural course of the disease. Five patients were followed up for from 2 to 6 months. Two of these healed clinically and cleared both HBeAg and HBsAg, while three were positive for HBeAg and HBsAg at the last control. Thirteen patients with a follow-up of from 27 to 102 months became HBeAg-negative during the time of observation. In all but one, progression of the liver disease stopped when HBeAg was cleared. The results further indicate a close association between the duration of HBe antigenemia and the severity of the liver disease.     

Mononeuritis in acute viral hepatitis

We describe the cases of 4 adults with acute viral hepatitis A or B in whom mononeuritis affecting a cranial nerve or a nerve of a limb developed. The features of this neuropathy were the following: (a) the prevalence of mononeuritis in patients with acute viral hepatitis was low; (b) this complication developed in the early phase of acute viral hepatitis in most of our patients; (c) the onset of mononeuritis was sudden in most of them; (d) the course of mononeuritis was protracted. Mononeuritis might be the consequence of ischemia resulting from vasculitis.     

Ribavirin in acute viral hepatitis

A double-blind, placebo-controlled trial using ribavirin (200 mg orally four times a day for two weeks) was conducted in 30 patients with acute uncomplicated viral hepatitis (excluding hepatitis B). Clinical and laboratory parameters were evaluated on days 5, 10 and 14 after starting treatment. Mean levels of ALT and AST were significantly lower in the ribavirin treated group as compared to the placebo group on days 5, 10 and 14; serum bilirubin levels were significantly lower in the ribavirin group on days 10 and 14. Ribavirin therapy was not associated with any significant side effects. We conclude that ribavirin therapy in acute uncomplicated non-B viral hepatitis leads to more rapid normalisation of biochemical parameters.     

Typhoid fever complicated by acute renal failure and hepatitis: case reports and review

Four cases of typhoid fever complicated by both acute oliguric renal failure and hepatitis are presented. Two patients had type II hepatitis according to criteria proposed by Khosla et al. (30) with hepatomegaly, hyperbilirubinaemia and markedly elevated asparate transaminase (AST); the others had type III hepatitis, characterized clinically and biochemically by profound jaundice, hepatomegaly, hepatic encephalopathy (one case only), hyperbilirubinemia and markedly elevated serum AST. Renal biopsy was not performed in any of our patients. However, a combination of proteinuria and abnormal urinary sediments containing red cell casts and granular casts, as noted in these patients, is considered highly suggestive of glomerulonephritis. Although isolated renal failure and hepatitis with hepatomegaly and deranged liver enzyme values have been reported previously in typhoid fever, their occurrence simultaneously in the same patient in distinctly rare, having been reported only twice in the English language literature.     

Acute pancreatitis in acute viral hepatitis

AIM： To elucidate the frequency and characteristics of pancreatic involvement in the course of acute （nonfulminant） viral hepatitis. METHODS： We prospectively assessed the pancreatic involvement in patients with acute viral hepatitis who presented with severe abdomimanl pain. RESULTS： We studied 124 patients with acute viral hepatitis, of whom 24 presented with severe abdominal pain. Seven patients （5.65%） were diagnosed to have acute pancreatitis. All were young males. Five patients had pancreatitis in the first week and two in the fourth week after the onset of jaundice. The pancreatitis was mild and all had uneventful recovery from both pancreatitis and hepatitis on conservative treatment. The etiology of pancreatitis was hepatitis E virus in 4, hepatitis A virus in 2, and hepatitis B virus in 1 patient. One patient had biliary sludge along with HEV infection. The abdominal pain of remaining seventeen patients was attributed to stretching of Glisson＇s capsule. CONCLUSION： Acute pancreatitis occurs in 5.65% of patients with acute viral hepatitis, it is mild and recovers with conservative management.     

Serum ferritin in acute viral hepatitis

Serum ferritin and biochemical liver tests (serum bilirubin, serum aspartate transaminase, serum gamma-glutamyl transpeptidase (gamma-GT), and serum alkaline phosphatase) were recorded at regular intervals from admission to recovery in six patients with acute viral hepatitis. There was a proportional, significant decrease in ferritin bilirubin, and transaminase were reached simultaneously, whereas gamma-GT and alkaline phosphatase remained elevated for a slightly longer time. The correlations between corresponding measurements of ferritin and biochemical liver tests were as follows: ferritin and alkaline phosphatase, r = 0.72, P less than 0.001; ferritin and bilirubin, r = 0.68, P less than 0.001; ferritin and transaminase, r = 0.53, P less than 0.001; ferritin and gamma-GT. r = 0.50, P less than 0.001. In viral hepatitis serum ferritin offers no diagnostic advantage compared with already established tests for hepatocellular damage.