MacKinney-Novelo I, Barahona-Garrido J, Castillo-Albarran F, Santiago-Hernández JJ, Méndez-Sánchez N, Uribe M, Chávez-Tapia N

Language: English
References: 18
Page: 652-657
PDF size: 117.27 Kb.

ABSTRACT

Background. Hepatitis A is the most common type of viral hepatitis in Mexico. The change of hepatitis A epidemiology in Mexico from high to intermediate endemicity leads to increasing susceptible adults for severe illness. Objective. To describe the clinical characteristics and hospital outcome of adult patients with acute hepatitis A infection, and determine risk factor for mortality. Material and methods. This is a retrospective observational, multicentre study in Mexico City and in Guatemala City. All inhospital patients were followed until discharge or death. Risk factors for death/acute liver failure were identified. Results. Forty seven patients were analyzed, sixty percent were male, the prodrome phase was from 3 to 30 days. The three most common symptoms were fever, malaise and jaundice, with 87%, 74% and 62% respectively. The incidence of patients who were treated with antibiotics before hospital admission was up to 34%. Unnecessary imaging studies and out of guidelines drugs were used. Presence of encephalopathy, leukocytes› 19,000/mL, blood urea nitrogen › 36 mg/dL, creatinine › 2 mg/dL, albumin ‹ 2.5 mg/dL and total bilirubin › 9.6 mg/dL, are predictors of mortality. Serum creatinine › 2 mg/dL has the best sensibility and specificity for predicting fulminant hepatitis/death. Conclusion. Acute hepatitis A infection in adults is associated some unnecessary diagnostic and therapeutic approach. Could be associated with fulminant hepatitis, and a creatinine value › 2 mg/dL is the best predictor for fulminant hepatitis and death.

REFERENCES

1. Di Giammarino L, Dienstag JL. Hepatitis A-the price of progress. New Engl J Med 2005; 353: 944-6.

2. Panduro A, Escobedo Melendez G, Fierro NA, Ruiz Madrigal B, Zepeda-Carrillo EA, Roman S. Epidemiology of viral hepatitis in Mexico. Sal Pub Mex 2011; 53(Suppl. 1): S37-S45.

3. Garcia-Juarez I, Solorzano Santos F, Alvarez-y-Munoz MT, Vazquez-Rosales JG. Is there a shift in the epidemiology of hepatitis A in Mexican children?. Rev Invest Clin 2008; 60: 292-6.

4. Kumate J, Alvizouri AM, Isibasi A. Serologic survey of hepatitis A antibodies in Mexican children. Bulletin of the Pan American Health Organization 1982; 16: 156-60.

5. Gay NJ, Morgan-Capner P, Wright J, Farrington CP, Miller E. Age-specific antibody prevalence to hepatitis A in England: implications for disease control. Epidemiology and infection 1994; 113: 113-20.

6. Moon HW, Cho JH, Hur M, Yun YM, Choe WH, Kwon SY, Lee CH. Laboratory characteristics of recent hepatitis A in Korea: ongoing epidemiological shift. WJG 2010; 16: 1115-8.

7. Hussain Z, Das BC, Husain SA, Murthy NS, Kar P. Increasing trend of acute hepatitis A in north India: need for identification of high-risk population for vaccination. J Gastroenterology and Hepatology 2006; 21: 689-93.

8. Tanaka J. Hepatitis A shifting epidemiology in Latin America. Vaccine 2000; 18(Suppl. 1): S57-S60.

9. Jeong SH, Lee HS. Hepatitis A: clinical manifestations and management. Intervirology 2010; 53: 15-9.

10. Souza LJ, Braga LC, Rocha Nde S, Tavares RR. Acute acalculous cholecystitis in a teenager with hepatitis a virus infection: a case report. Braz J Infect Dis 2009; 13: 74-6.

11. Amariei R, Willms AR, Bauch CT. The United States and Canada as a coupled epidemiological system: an example from hepatitis A. BMC Infect Dis 2008; 8: 23.

12. Barrientos-Gutierrez T, Brizuela-Alcantara D, Chavez-Tapia NC. Hepatitis A virus infection in high-risk subjects. Ann Hepatol 2011; 10: 578-9.

13. Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat 2000; 7(Suppl. 1): 7-8.

14. Junaidi O, Di Bisceglie AM. Aging liver and hepatitis. Clinics in geriatric medicine 2007; 23: 889-903, viii.

15. Radha Krishna Y, Saraswat VA, Das K, Himanshu G, Yachha SK, Aggarwal R, Choudhuri G. Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis. Liver Int 2009; 29: 392-8.

16. Cho SY, Choi SH, Park JH, Chung JW. Initial laboratory predictors of severe hepatitis and acute kidney injury in patients with acute hepatitis A. Diagn Microbiol Infect Dis 2011; 69: 400-4.

17. Wilkinson SP, Davies MH, Portmann B, Williams R. Renal failure in otherwise uncomplicated acute viral hepatitis. British Medical J 1978; 2: 338-41.

18. Kim SH, Yoon HE, Kim YK, Kim JY, Choi BS, Choi YJ, Kim YO, et al. Acute hepatitis A-associated acute renal failure in adults. Nephron Clinical Practice 2008; 109: c127-c132.