High levels of circulating HMGB1 as a biomarker of acute liver failure in patients with viral hepatitis E

2013 ◽  
Vol 33 (9) ◽  
pp. 1341-1348 ◽  
Author(s):  
Manasi Majumdar ◽  
Radhakanta Ratho ◽  
Yogesh Chawla ◽  
Mini P. Singh
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Hepatitis E

scholarly journals Role of formalin fixed paraffin embedded liver tissues in the diagnosis of viral hepatitis E in patients with undiagnosed acute liver failure

VirusDisease ◽  
2019 ◽  
Vol 30 (2) ◽  
pp. 302-306
Author(s):  
Radha Kanta Ratho ◽  
Vikram Thakur ◽  
Manasi Majumdar ◽  
Mini P. Singh ◽  
Ashim Das ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Hepatitis E ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Formalin Fixed ◽  
Liver Tissues

Acute liver failure and misdiagnosis: Do not forget viral hepatitis E

2019 ◽  
Vol 38 (1) ◽  
pp. 73-75 ◽  
Author(s):  
Thomas Laumon ◽  
Hélène Dietrich ◽  
Laurent Muller ◽  
Claire Roger
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Hepatitis E

A CASE OF ACUTE LIVER FAILURE DUE TO HEPATITIS E

2021 ◽  
pp. 1-2
Author(s):  
Mansi. Makwana ◽  
Jaydev Mod
Keyword(s):  
Hepatitis B ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Medical History ◽  
Hepatitis E ◽  
Fulminant Liver Failure ◽  
Liver Impairment ◽  
Viral Hepatitis B

We report the case of a 20 year old male who came to the hospital because of jaundice and a fever. His symptoms were associated with signicant liver impairment and a necroinammatory pattern due to viral hepatitis B although he had no relevant medical history. His symptoms developed rapidly until death. We present the factors that may have inuenced his progression to fulminant liver failure as described in the literature.

scholarly journals HEV-related Liver Disease in India : Why is the Disease Stormy?

2018 ◽  
Vol 54 (01) ◽  
pp. 054-061
Author(s):  
Premashis Kar
Keyword(s):  
Developing Countries ◽  
Viral Load ◽  
Mortality Rate ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Pregnant Women ◽  
Viral Hepatitis ◽  
High Viral Load ◽  
Hepatitis E ◽  
Women And Girls

ABSTRACTHepatitis E virus (HEV) is an important cause of epidemic and sporadic acute viral hepatitis (AVH) in many developing countries, including India. Hepatitis E, a positive-sense single-stranded RNA virus approximately 7.2 kb in length had been classified provisionally into the Caliciviridae family from 1988 to 1998 but HEV is currently placed in the genus Hepevirus and is the only member of the family Hepeviridae. Pregnant women with jaundice and AVH caused by HEV infection have worse fetal and obstetric outcome and higher maternal mortality compared to other types of viral hepatitis. Studies from various developing countries have shown that the incidence of HEV infection in pregnancy is high and a significant proportion of pregnant women can progress to fulminant hepatitis with a mortality rate varying from 30% to 100%. The incidence of hepatitis B virus (HBV) related acute liver failure is known widely in comparison to hepatitis C virus (HCV) infection in which acute liver failure (ALF) is rare. But the severe course of HEV infection causing ALF during pregnancy is unique to this virus with chronicity occurring in recipients of solid organ transplants.Various factors have been suggested to be associated with the mortality rate of the HEV in pregnant women along with the abortion of the fetus. Steroid hormones play a significant role in the viral replication through their effects on viral regulatory elements. The NF-κB signaling pathway regulating at the transcriptional level through p50 subunits has been suggested to correlate with the severe liver damage, leading to multiple organ failure and the death of both the mother and the fetus. Pregnant women in Asia suffer from folate deficiency reducing the immunocompetence to greater risk of multiple viral infections and higher viral load. The viral load of HEV was found to be significantly higher (P < 0.05) in pregnant patients compared to the non-pregnant and the viral copies of HEV with fulminant hepatic failure (FHF) in pregnant women were comparatively higher when compared to the pregnant women with AVH, which may be related to the severity of the disease in these patients. Besides, reduced expression of progesterone and progesterone induced-blocking factor and the high viral load of HEV have been regarded as a cause of poor pregnancy outcome in hepatitis E infection. Vertical transmission of the HEV infection has been reported. There are published reports of abortion, death of the fetus in utero, premature delivery or death of the baby soon after birth in patients with icteric hepatitis or with ALF caused by HEV. However, studies in Europe and United States have shown the course of viral hepatitis during pregnancy resembling with the non-pregnant women. In contrast, various reports carried out in India, Iran, Africa, and Middle East have reported the incidence of ALF to be higher during pregnancy.Data on the viral load of HEV during pregnancy are limited. The study was designed to determine the viral load of HEV and its association with the disease severity in patients with ALF. A total HEV related 163 patients with ALF which included 105 pregnant, 46 non-pregnant women and girls, 12 men, and 730 patients with AVH which comprised of 220 pregnant women; 282 non-pregnant women and girls, and 228 men were included. Viral load was measured by real-time PCR. Comparison was made between the pregnant and non-pregnant women. HEV RNA was detectable in 265 patients (142 pregnant; 75 non-pregnant and 48 men) and 104 patients with ALF (64 pregnant, 34 non-pregnant and 6 men). The viral load of HEV in pregnant women with ALF and AVH was significantly higher 129,984.0±103,104.17 and 768.92±1,105.40 copies/ml, respectively compared to the non-pregnant women which was 189.2±225 and 12.73±7.8 copies/ml (P < 0.0001). The viral load of HEV was also significantly higher in the pregnant patients with ALF compared to the pregnant women with AVH and also men (P < 0.0001). High viral load of HEV during pregnancy could be one of the factors responsible for the severity of the infection during pregnancy.

scholarly journals Complement System as a Target for Therapies to Control Liver Regeneration/Damage in Acute Liver Failure Induced by Viral Hepatitis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Juliana Gil Melgaço ◽  
Carlos Eduardo Veloso ◽  
Lúcio Filgueiras Pacheco-Moreira ◽  
Claudia Lamarca Vitral ◽  
Marcelo Alves Pinto
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Liver Regeneration ◽  
Viral Hepatitis ◽  
Complement System ◽  
Immune Cell ◽  
Ex Vivo ◽  
Heat Inactivation ◽  
Plasma Samples ◽  
The Complement System

The complement system plays an important role in innate immunity inducing liver diseases as well as signaling immune cell activation in local inflammation regulating immunomodulatory effects such as liver damage and/or liver regeneration. Our aim is to evaluate the role of complement components in acute liver failure (ALF) caused by viral hepatitis, involving virus-induced ALF in human subjects using peripheral blood, samples of liver tissues, and ex vivo assays. Our findings displayed low levels of C3a in plasma samples with high frequency of C3a, C5a, and C5b/9 deposition in liver parenchyma. Meanwhile, laboratory assays using HepG2 (hepatocyte cell line) showed susceptibility to plasma samples from ALF patients impairing in vitro cell proliferation and an increase in apoptotic events submitting plasma samples to heat inactivation. In summary, our data suggest that the complement system may be involved in liver dysfunction in viral-induced acute liver failure cases using ex vivo assays. In extension to our findings, we provide insights into future studies using animal models for viral-induced ALF, as well as other associated soluble components, which need further investigation.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

Does Hepatitis E Viral Load and Genotypes Influence the Final Outcome of Acute Liver Failure During Pregnancy?

2008 ◽  
Vol 103 (10) ◽  
pp. 2495-2501 ◽  
Author(s):  
Premashis Kar ◽  
Nishat Jilani ◽  
Syed A. Husain ◽  
Sayed Tazeen Pasha ◽  
Ranjana Anand ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatitis E ◽  
Final Outcome
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