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Shahid Y, Butt AS, Jamali I, Ismail FW. Rising incidence of acute hepatitis A among adults and clinical characteristics in a tertiary care center of Pakistan. World J Virol 2025; 14:97482. [PMID: 40134835 PMCID: PMC11612870 DOI: 10.5501/wjv.v14.i1.97482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/29/2024] [Accepted: 10/15/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND For decades, hepatitis A virus (HAV) has been a leading cause of acute hepatitis among children and was less prevalent among adults. However, recently a paradigm shift has been observed in the epidemiology of HAV, as evident by cases of acute hepatitis due to HAV among adults. AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus (HEV) infection. METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi (Sindh, Pakistan) from February 2024 to May 2024. Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed. To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed. Data regarding clinical and laboratory parameters were recorded. The yearly trend of acute hepatitis due to HAV and HEV was analyzed, and comparative analysis was done between HAV and HEV cases among adults. RESULTS A total of 396 patients were found to have acute hepatitis during our study duration. HAV was diagnosed in 234 patients (59%) while 157 patients (39.6%) were found to have acute HEV infection. Additionally, acute hepatitis B virus infection was identified in 3 patients (0.7%), whereas acute hepatitis C virus infection was found in 2 (0.5%) cases of acute hepatitis. Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years. The patients with acute HAV were younger than patients with HEV (28 years ± 8 years vs 30 years ± 8 years; P < 0.01). Higher levels of total bilirubin were seen in HEV infection, while higher levels of alanine transaminase were seen in HAV infection. However, a higher proportion of acute liver failure (ALF), coagulopathy, and mortality were observed in HEV. CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E, highlighting the need for better sanitation, hygiene, and adult hepatitis A vaccination programs.
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Affiliation(s)
- Yumna Shahid
- Division of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Amna Subhan Butt
- Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Iqra Jamali
- Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Faisal Wasim Ismail
- Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
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González Grande R, Santaella Leiva I, López Ortega S, Jiménez Pérez M. Present and future management of viral hepatitis. World J Gastroenterol 2021; 27:8081-8102. [PMID: 35068856 PMCID: PMC8704279 DOI: 10.3748/wjg.v27.i47.8081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis can result in important morbidity and mortality, with its impact on health conditioned by the specific type of hepatitis, the geographical region of presentation and the development and access to new drugs, among other factors. Most acute presentation forms are self-limiting and may even go unnoticed, with just a small percentage of cases leading to acute liver failure that may necessitate transplantation or even cause the death of the patient. However, when they become chronic, as in the case of hepatitis B virus and C virus, unless they are diagnosed and treated adequately they may have severe consequences, like cirrhosis or hepatocarcinoma. Understanding of the mechanisms of transmission, the pathogenesis, the presence of vaccinations and the development over recent years of new highly-efficient, potent drugs have meant that we are now faced with a new scenario in the management of viral hepatitis, particularly hepatitis B virus and hepatitis C virus. The spectacular advances in hepatitis C virus treatment have led the World Health Organization to propose the objective of its eradication by 2030. The key aspect to achieving this goal is to ensure that these treatments reach all the more vulnerable population groups, in whom the different types of viral hepatitis have a high prevalence and constitute a niche that may perpetuate infection and hinder its eradication. Accordingly, micro-elimination programs assume special relevance at the present time.
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Affiliation(s)
- Rocío González Grande
- UGC de Aparato Digestivo. Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
| | - Inmaculada Santaella Leiva
- UGC de Aparato Digestivo. Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
| | - Susana López Ortega
- UGC de Aparato Digestivo. Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
| | - Miguel Jiménez Pérez
- UGC de Aparato Digestivo. Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
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Karacaer Z, Tosun S, Batırel A, Şahin S, Altaş İ, Uysal S, Erol S, Ceran N, Albayrak A, Yıldız İE, Kostakoğlu U, Kaçar F, Kuzhan N, Kadanalı A, Karagöz G, Yenilmez E, Turan DB, Yıldırım AA, Koçak F, Çetinkaya RA, Parlak M, Aydın Ö, Ergen P, Durmuş G, Kaygusuz TÖ, Dağlı Ö, Demir C, Karadağ FY. Changes in acute viral hepatitis epidemiology in the Turkish adult population: A multicenter study. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:177-182. [PMID: 29749324 PMCID: PMC6284710 DOI: 10.5152/tjg.2018.17431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIMS The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. MATERIALS AND METHODS Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. RESULTS The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. CONCLUSION In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.
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Affiliation(s)
- Zehra Karacaer
- Department of Infectious Diseases and Clinical Microbiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Selma Tosun
- Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lütfi Kirdar Education and Research Hospital, İstanbul, Turkey
| | - Suzan Şahin
- Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lütfi Kirdar Education and Research Hospital, İstanbul, Turkey
| | - İrem Altaş
- Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Serhat Uysal
- Department of Infectious Diseases and Clinical Microbiology, Buca Seyfi Demirsoy State Hospital, İzmir, Turkey
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Nurgül Ceran
- Department of Infectious Diseases and Clinical Microbiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Ayşe Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - İlknur Esen Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Rize University School of Medicine, Rize, Turkey
| | - Uğur Kostakoğlu
- Department of Infectious Diseases and Clinical Microbiology, Rize University School of Medicine, Rize, Turkey
| | - Fatma Kaçar
- Department of Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Nuretdin Kuzhan
- Department of Infectious Diseases and Clinical Microbiology, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Ayten Kadanalı
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Gül Karagöz
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ercan Yenilmez
- Department of Infectious Diseases and Clinical Microbiology, Haydarpaşa Sultan Abdulhamid Training and Research Hospital, İstanbul, Turkey
| | - Derya Bayırlı Turan
- Department of Infectious Diseases and Clinical Microbiology, Yeni Yüzyıl University School of Medicine, İstanbul, Turkey
| | - Arzu Altunçekiç Yıldırım
- Department of Infectious Diseases and Clinical Microbiology, Ordu University School of Medicine, Ordu, Turkey
| | - Funda Koçak
- Department of Infectious Diseases and Clinical Microbiology, Başakşehir State Hospital, İstanbul, Turkey
| | - Rıza Aytaç Çetinkaya
- Department of Infectious Diseases and Clinical Microbiology, Haydarpaşa Sultan Abdulhamid Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Parlak
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Özlem Aydın
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Gül Durmuş
- Department of Infectious Diseases and Clinical Microbiology, Bursa Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Türkkan Öztürk Kaygusuz
- Department of Infectious Diseases and Clinical Microbiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Özgur Dağlı
- Department of Infectious Diseases and Clinical Microbiology, Bursa Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Canan Demir
- Department of Infectious Diseases and Clinical Microbiology, Bursa Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Fatma Yılmaz Karadağ
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
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Lin KY, Chen GJ, Lee YL, Huang YC, Cheng A, Sun HY, Chang SY, Liu CE, Hung CC. Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review. World J Gastroenterol 2017; 23:3589-3606. [PMID: 28611512 PMCID: PMC5449416 DOI: 10.3748/wjg.v23.i20.3589] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/31/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatitis A virus (HAV) is one of the most common infectious etiologies of acute hepatitis worldwide. The virus is known to be transmitted fecal-orally, resulting in symptoms ranging from asymptomatic infection to fulminant hepatitis. HAV can also be transmitted through oral-anal sex. Residents from regions of low endemicity for HAV infection often remain susceptible in their adulthood. Therefore, clustered HAV infections or outbreaks of acute hepatitis A among men who have sex with men and injecting drug users have been reported in countries of low endemicity for HAV infection. The duration of HAV viremia and stool shedding of HAV may be longer in human immunodeficiency virus (HIV)-positive individuals compared to HIV-negative individuals with acute hepatitis A. Current guidelines recommend HAV vaccination for individuals with increased risks of exposure to HAV (such as from injecting drug use, oral-anal sex, travel to or residence in endemic areas, frequent clotting factor or blood transfusions) or with increased risks of fulminant disease (such as those with chronic hepatitis). The seroconversion rates following the recommended standard adult dosing schedule (2 doses of HAVRIX 1440 U or VAQTA 50 U administered 6-12 mo apart) are lower among HIV-positive individuals compared to HIV-negative individuals. While the response rates may be augmented by adding a booster dose at week 4 sandwiched between the first dose and the 6-mo dose, the need of booster vaccination remain less clear among HIV-positive individuals who have lost anti-HAV antibodies.
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Yang F, Tang X, Ding L, zhou Y, Yang Q, Gong J, Wang G, Wang Z, Yang L. Curcumin protects ANIT-induced cholestasis through signaling pathway of FXR-regulated bile acid and inflammation. Sci Rep 2016; 6:33052. [PMID: 27624003 PMCID: PMC5021964 DOI: 10.1038/srep33052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022] Open
Abstract
Cholestasis is a clinically significant symptom and widely associated with liver diseases, however, there are very few effective therapies for cholestasis. Danning tablet (DNT, a Chinese patent medicine preparation) has been clinically used to treat human liver and gallbladder diseases for more than 20 years in China. However, which ingredients of DNT contributed to this beneficial effect and their mechanistic underpinnings have been largely unknown. In the present study, we discovered that DNT not only demonstrated greater benefits for cholecystitis patients after cholecystectomy surgery in clinic but also showed protective effect against alpha-naphthylisothiocyanate (ANIT)-induced cholestasis model in rodent. Curcumin, one major compound derived from DNT, exerted the protective effect against cholestasis through farnesoid X receptor (FXR), which has been focused as potential therapeutic targets for treating cholestasis. The underlying mechanism of curcumin against cholestasis was restoring bile acid homeostasis and antagonizing inflammatory responses in a FXR-dependent manner and in turn contributed to overall cholestasis attenuation. Collectively, curcumin can be served as a potential treatment option for liver injury with cholestasis.
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Affiliation(s)
- Fan Yang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xiaowen Tang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Lili Ding
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yue zhou
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Qiaoling Yang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Junting Gong
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Guangyun Wang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Zhengtao Wang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Li Yang
- The MOE Key Laboratory for Standardization of Chinese Medicines and the Shanghai Key Laboratory of Compound Chinese Medicines Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Center for Chinese Medical Therapy and Systems Biology, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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