Uday George, Zachariah (2007) Clinical Spectrum of Acute Hepatitis E infection in patients with Chronic Liver Disease in a Tertiary Level Institution. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Hepatitis E virus (HEV) infection is a major public health problem in several developing countries of the world, especially the Indian sub-continent, South East and Central Asia, where it is endemic. HEV in endemic regions not only causes large epidemics but is also responsible for a significant proportion of acute sporadic hepatitis in both children and adults. In India, HEV infection alone has been shown to account for 50-70% of all episodes of sporadic viral hepatitis.4,5 It has been suggested that HEV is more widespread than previously believed, prompting the World Health Organization to label HEV as an “emerging pathogen”. Acute HEV infection is generally a self limiting illness similar to other forms of acute viral hepatitis, except in pregnant women in whom the illness is particularly severe with a high mortality rate. Accumulating evidence indicates that HEV infection may be associated with severe liver disease in certain other settings also, namely, concomitant HEV and HAV infection in children9, acute liver failure in the sporadic setup and superinfection on preexisting chronic liver disease (CLD). Therefore the disease burden of HEV in the developing world is heavy as it causes substantial morbidity, mortality and economic loss. Acute on chronic liver failure (ACLF) is a poorly defined entity which has been described by Jalan et al as an acute deterioration in liver function over a period of two to four weeks in patients with previously well compensated CLD, caused by precipitating events such as sepsis, upper gastrointestinal bleed, ischaemia or superimposed liver injury due to alcohol, hepatotoxic drugs or hepatitis virus infection.17 The role of viral hepatitis infections in the genesis of ACLF gains significance in countries like India which are hyperendemic for the enterically transmitted hepatotrophic viruses, hepatitis A virus (HAV) and HEV. AIM : 1. To study the clinical profile and outcome of acute hepatitis E virus superinfection in patients with chronic liver disease. 2. To identify factors affecting the outcome and determine their prognostic significance. CONCLUSIONS : Acute HEV superinfection in patients with underlying CLD produces severe decompensation and is associated with a high mortality rate. The MELD score and serum creatinine are the most important and accurate prognostic indicators of patient mortality in this setting. A serum creatinine of 1.3 mg/dl and a MELD score of 24 were 80% sensitive and specific in predicting mortality. The duration of jaundice did not affect the outcome. Infections, including spontaneous bacterial peritonitis did not worsen the outcome. A possible association between Wilson’s disease and HEV superinfection requires further in depth study A liver biopsy is crucial in conclusively establishing a diagnosis of underlying cirrhosis and must be performed when the clinical picture is unclear. Obsessive attention to prevention and early aggressive management of treatable causes of renal failure may aid in improving the current short term mortality rates. In a developing country like India, with limited resources, one is duty bound to emphasize the importance of safe drinking water to all patients, especially those with CLD, in preventing HEV infection.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Spectrum ; Acute Hepatitis E infection ; patients ; Chronic Liver Disease ; Tertiary Level Institution. |
| Subjects: | MEDICAL > Gastroenterology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 14 Jul 2017 03:12 |
| Last Modified: | 14 Jul 2017 03:12 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1620 |
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