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Revista Da Associacao Medica Brasileira... Jul 2019The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at... (Review)
Review
OBJECTIVE
The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at a better understanding and improvement of patient support.
METHODS
We used 3 different researchers to investigate the topic of Fulminant Acute Hepatitis in pediatrics in papers published by Latin American and Caribbean authors in the PubMed and SciELO databases from 2000 to 2016.
RESULTS
We found 2,879 articles in the databases searched. After selecting and excluding articles according to the study protocol, 68 remaining studies were obtained for analysis. A total of 1,265 cases of acute fulminant hepatitis were detected, with a predominance of females (42.9%), followed by males (39.4%), with no description of sex in 17.7% of the cases. The main cause was viral hepatitis, representing 45.1% of the cases. The hepatitis A virus was responsible for 34.7% of the total cases and 76.9% of the infectious causes. Of the total number of patients, 26.9% were described as idiopathic, and 11.5% had no cause.
CONCLUSION
The preventable causes of Fulminant Acute Hepatitis include hepatitis viruses - primarily the hepatitis A virus - and poisoning. Active vaccination, basic sanitation, and public awareness can reduce the number of patients and, consequently, the costs of liver transplantation due to these causes.
Topics: Caribbean Region; Female; Hepatitis; Humans; Latin America; Liver Failure, Acute; Male
PubMed: 31340325
DOI: 10.1590/1806-9282.65.6.914 -
Revista de Gastroenterologia de Mexico... 2020Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response,...
Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resulting in 37 recommendations. Alcohol-related liver disease covers a broad spectrum of pathologies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and its complications. Severe alcoholic hepatitis is defined by a modified Maddrey's discriminant function score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21. There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyperbilirubinemia (> 3 mg/dL), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide the diagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone of treatment. Steroids are indicated for severe disease and have been effective in reducing the 28-day mortality rate. At present, liver transplantation is the only life-saving option for patients that are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colony stimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patient survival.
Topics: Hepatitis, Alcoholic; Humans; Mexico
PubMed: 32532534
DOI: 10.1016/j.rgmx.2020.04.002 -
Ugeskrift For Laeger Jul 2021Hepatitis E virus (HEV) is the most common cause of acute clinical hepatitis in the world and can cause extrahepatic disease including the nervous system. This is a case...
Hepatitis E virus (HEV) is the most common cause of acute clinical hepatitis in the world and can cause extrahepatic disease including the nervous system. This is a case report of two patients illustrating this disorder. One patient was a 69-year-old man with painless affection of both brachial plexuses, and the other patient was a 61-year-old man with painful right brachial plexus affection, headache and cognitive problems. Both had pleocytosis in cerebrospinal fluid and tested positive for HEV immunoglobulin (Ig) G and IgM in blood, and the first also in blood with PCR analysis. No other infectious agents were identified. Symptoms improved over months.
Topics: Acute Disease; Aged; Hepatitis Antibodies; Hepatitis E; Hepatitis E virus; Humans; Immunoglobulin M; Male; Middle Aged; Nervous System Diseases
PubMed: 34356020
DOI: No ID Found -
Viruses Dec 2022Hepatitis A is responsible for 126,000,000 cases of acute viral hepatitis distributed heterogeneously worldwide, with a high disability-adjusted life year (DALY) rate,...
BACKGROUND
Hepatitis A is responsible for 126,000,000 cases of acute viral hepatitis distributed heterogeneously worldwide, with a high disability-adjusted life year (DALY) rate, especially in low-income countries. Data related to Hepatitis A provides information to improve control measures and identify the population at risk. This study aims to analyze temporal trends of Hepatitis A in Brazil and its regions from 2007 to 2018, based on official notification data.
METHODS
Data related to Hepatitis A reported cases from 2007 to 2018 were fitted to a joinpoint model by Brazilian regions, age groups, and gender, allowing the calculation of average annual percentage change (AAPC) and annual percentage change (APC) to estimate trends of Hepatitis A in Brazil.
FINDINGS
From 2007 to 2018, 65,284 Hepatitis A cases notified in Brazil were available for analysis. The Northeast Region reported 18,732 (28.69%) cases, followed by the North Region reporting 18,430 (28.23%), the Southeast Region reporting 14,073 (21.55%), the South Region reporting 7909 (12.11%), and the Central-West Region reporting 6140 (9.4%), respectively. Temporal trend analysis showed that Hepatitis A incidence decreased from 2007 to 2016 in all Brazilian regions for individuals less than 20 years old, but increased in the South and Southeast males between 10 and 39 years after 2016.
CONCLUSIONS
Hepatitis A endemicity is heterogeneous among Brazilian regions. In addition, an unexpected outbreak of HAV among Southeast and South adult males in 2016 resembles the outbreak in Europe, revealing a vulnerable population that should be prioritized by vaccination programs and control measures.
Topics: Adult; Male; Humans; Young Adult; Hepatitis A; Brazil; Disease Outbreaks; Incidence; Europe
PubMed: 36560740
DOI: 10.3390/v14122737 -
International Journal of Molecular... Mar 2022Hepatitis is defined as inflammation of the liver; it can be acute or chronic. In chronic cases, the prolonged inflammation gradually damages the liver, resulting in... (Review)
Review
Hepatitis is defined as inflammation of the liver; it can be acute or chronic. In chronic cases, the prolonged inflammation gradually damages the liver, resulting in liver fibrosis, cirrhosis, and sometimes liver failure or cancer. Hepatitis is often caused by viral infections. The most common causes of viral hepatitis are the five hepatitis viruses-hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). While HAV and HEV rarely (or do not) cause chronic hepatitis, a considerable proportion of acute hepatitis cases caused by HBV (sometimes co-infected with HDV) and HCV infections become chronic. Thus, many medical researchers have focused on the treatment of HBV and HCV. It has been documented that host lipid metabolism, particularly cholesterol metabolism, is required for the hepatitis viral infection and life cycle. Thus, manipulating host cholesterol metabolism-related genes and proteins is a strategy used in fighting the viral infections. Efforts have been made to evaluate the efficacy of cholesterol-lowering drugs, particularly 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, in the treatment of hepatitis viral infections; promising results have been obtained. This review provides information on the relationships between hepatitis viruses and host cholesterol metabolism/homeostasis, as well as the discovery/development of cholesterol-lowering natural phytochemicals that could potentially be applied in the treatment of viral hepatitis.
Topics: Cholesterol; Hepacivirus; Hepatitis A; Hepatitis B virus; Hepatitis C; Hepatitis Delta Virus; Hepatitis E virus; Hepatitis Viruses; Hepatitis, Viral, Human; Humans; Inflammation; Lipid Metabolism; Liver Cirrhosis
PubMed: 35409259
DOI: 10.3390/ijms23073897 -
Frontiers in Cellular and Infection... 2023Hepatitis is an inflammation of the liver whose etiology is very heterogeneous. The most common cause of hepatitis is viral infections from hepatotropic viruses,... (Review)
Review
Hepatitis is an inflammation of the liver whose etiology is very heterogeneous. The most common cause of hepatitis is viral infections from hepatotropic viruses, including hepatitis A, B, C, D and E. However, other factors such as infections from other agents, metabolic disorders, or autoimmune reactions can also contribute to hepatitis, albeit to a lesser extent. On April 5, 2022, the United Kingdom Health Security Agency alerted the World Health Organization (WHO) on the increased incidence of severe acute hepatitis of unknown causes (not A-E) in previously healthy young children, with symptoms of liver failure that in some cases required liver transplantation. By July 2022, 1,296 cases were reported in 37 countries. Acute hepatitis of unknown causes is not an exceptional phenomenon: in fact, it represents more than 30% of cases of acute hepatitis in children, however in the present instance the large proportion of severe cases was surprising and alarming (6% of liver transplants and almost 3% mortality). Multiple hypotheses have been proposed to explain the etiology of such higher proportion of acute hepatitis, including their co-occurrence in the context of COVID-19 pandemic. This is a review of the history of a clinical threat that has put in check a world health care system highly sensitized by the current COVID-19 pandemics, and that it looks like has ended with the arguments that the severe acute pediatric hepatitis is caused by Adeno-associated virus 2 (AAV2) infection associated with a coinfection with a helper virus (human Adenovirus HAdV or human herpesvirus 6) in susceptible children carrying HLA-class II antigen HLA-DRB1*04:01.
Topics: Humans; Child; Child, Preschool; Pandemics; COVID-19; Liver Transplantation; Acute Disease; Hepatitis
PubMed: 37808908
DOI: 10.3389/fcimb.2023.1175996 -
World Journal of Pediatrics : WJP Aug 2022Severe acute hepatitis of unknown etiology in children has recently exhibited a global trend of concentrated occurrence. This review aimed to summarize the current... (Review)
Review
BACKGROUND
Severe acute hepatitis of unknown etiology in children has recently exhibited a global trend of concentrated occurrence. This review aimed to summarize the current available information regarding the outbreak of severe acute hepatitis and introduce our hospital's previous experiences with the diagnosis and treatment of severe acute hepatitis for reference.
DATA SOURCES
Websites including the UK Health Security Agency, European Centre for Disease Prevention and Control, CDC, WHO, and databases including PubMed/Medline, Cochrane Library, Embase and Web of Science were searched for articles on severe acute hepatitis in children.
RESULTS
As of May 26, 2022, a total of 650 cases have been reported in 33 countries; at least 38 (6%) children required liver transplantation, and nine (1%) died. Cases are predominantly aged between 3 and 5 years old, and there are no epidemiological links among them. The common manifestations are jaundice, vomiting and pale stools. Adenovirus tested positive in most cases, and SARS-CoV-2 and other viruses were detected in a few cases, but virus particles were not found in liver tissue. Adenovirus immunohistochemistry showed immunoreactivity in the intrasinusoidal lumen from some liver samples. The hierarchical treatment includes symptomatic and supportive therapy, management of coagulation disorders and hepatic encephalopathy, artificial liver support, and liver transplantation (approximately 6%-10% of cases require liver transplant).
CONCLUSIONS
The etiology of this severe acute hepatitis in children is not clear. The clinical features are severe acute hepatitis with significantly elevated liver enzymes. Clinicians need to be alert to children with hepatitis.
Topics: Acute Disease; Child; Child, Preschool; Hepatitis; Humans
PubMed: 35771382
DOI: 10.1007/s12519-022-00581-x -
Cold Spring Harbor Perspectives in... Sep 2019Both hepatitis A virus (HAV) and hepatitis E virus (HEV) cause self-limited infections in humans that are preventable by vaccination. Progress in characterizing adaptive... (Review)
Review
Both hepatitis A virus (HAV) and hepatitis E virus (HEV) cause self-limited infections in humans that are preventable by vaccination. Progress in characterizing adaptive immune responses against these enteric hepatitis viruses, and how they contribute to resolution of infection or liver injury, has therefore remained largely frozen for the past two decades. How HAV and HEV infections are so effectively controlled by B- and T-cell immunity, and why they do not have the same propensity to persist as HBV and HCV infections, cannot yet be adequately explained. The objective of this review is to summarize our understanding of the relationship between patterns of virus replication, adaptive immune responses, and acute liver injury in HAV and HEV infections. Gaps in knowledge, and recent studies that challenge long-held concepts of how antibodies and T cells contribute to control and pathogenesis of HAV and HEV infections, are highlighted.
Topics: Adaptive Immunity; Antibodies, Neutralizing; B-Lymphocytes; Hepatitis A; Hepatitis E; Humans; T-Lymphocytes; Vaccination; Virus Replication
PubMed: 29844218
DOI: 10.1101/cshperspect.a033472 -
British Journal of Hospital Medicine... Mar 2018Autoimmune hepatitis occurs in genetically susceptible individuals as a result of loss of immunological tolerance to hepatic autoantigens that can be precipitated by... (Review)
Review
Autoimmune hepatitis occurs in genetically susceptible individuals as a result of loss of immunological tolerance to hepatic autoantigens that can be precipitated by environmental triggers. The clinical manifestation is usually insidious but can be also acute with liver failure. The diagnosis is made on the basis of antibody positivity, elevated immunoglobulin G levels and interface hepatitis on liver histology. Induction of remission is achieved with high-dose steroids in the majority of cases, and maintenance of remission with azathioprine. Treatment withdrawal is achievable only in a small proportion of patients. Patients with acute liver failure unresponsive to steroids or those with end-stage liver failure or hepatocellular carcinoma may require liver transplantation. Variant forms of overlapping autoimmune hepatitis with either primary biliary cholangitis or sclerosing cholangitis are associated with worse outcomes. New insights into the pathophysiology of the disease may provide novel therapeutic targets and a more individualized approach to treatment of autoimmune hepatitis.
Topics: Hepatitis, Autoimmune; Humans
PubMed: 29528732
DOI: 10.12968/hmed.2018.79.3.151 -
Viruses Jan 2023Viral hepatitis is an infection of human hepatocytes resulting in liver damage. Dual infection of two hepatotropic viruses affects disease outcomes. The hepatitis A... (Review)
Review
Viral hepatitis is an infection of human hepatocytes resulting in liver damage. Dual infection of two hepatotropic viruses affects disease outcomes. The hepatitis A virus (HAV) and hepatitis E virus (HEV) are two enterically transmitted viruses; they are single-stranded RNA viruses and have common modes of transmission. They are transmitted mainly by the fecal-oral route and ingestion of contaminated food, though the HAV has no animal reservoirs. The HAV and HEV cause acute self-limiting disease; however, the HEV, but not HAV, can progress to chronic and extrahepatic infections. The HAV/HEV dual infection was reported among acute hepatitis patients present in developing countries. The impact of the HAV/HEV on the prognosis for acute hepatitis is not completely understood. Studies showed that the HAV/HEV dual infection increased abnormalities in the liver leading to fulminant hepatic failure (FHF) with a higher mortality rate compared to infection with a single virus. On the other hand, other reports showed that the clinical symptoms of the HAV/HEV dual infection were comparable to symptoms associated with the HAV or HEV monoinfection. This review highlights the modes of transmission, the prevalence of the HAV/HEV dual infection in various countries and among several study subjects, the possible outcomes of this dual infection, potential model systems for studying this dual infection, and methods of prevention of this dual infection and its associated complications.
Topics: Humans; Hepatitis E virus; Hepatitis A virus; Hepatitis A; Hepatitis E
PubMed: 36851512
DOI: 10.3390/v15020298