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Hepatitis C virus-related arthritis.

Although asymptomatic joint involvement and arthralgias are frequent in patients with hepatitis C virus chronic infection (HCV), a true arthritis affects only up to 4% of the subjects. HCV-related arthritis (HCVrA) is usually distinguished in two clinical subsets: a more frequent symmetrical polyarthritis (SP), similar to rheumatoid arthritis but much less serious, and an intermittent mono-oligoarthritis (IMO) that involves medium and large sized joints, mainly the ankle. This latter subset is strictly related to the presence of HCV-induced mixed cryoglobulinemia and its cutaneous manifestatio…

[Occult hepatitis B virus infection].

Occult hepatitis B virus (HBV) infection is a peculiar form of chronic viral infection identified since the early 80's and can be defined as the presence of HBV DNA in the serum and/or in the liver tissue of patients negative for the HBV surface antigen (HBsAg) using usual serological tests. The data about the prevalence of occult HBV infection are contrasting and the reported prevalences in various categories of individuals are highly diverse. The molecular basis of the occult HBV infection is the covalently closed-circular DNA (cccDNA) that persists in the cell nuclei and that serves as a te…

[Hepatitis E: an emerging disease?].

Although hepatitis E is one of the most important cause of acute clinical hepatitis in young adults throughout the developing world, hepatitis E is rare in western countries (25 to 60 annually by country). In these countries, clinical hepatitis is more common in older people (over 50 years). The possible transmission zoonotically (principally) from swine reservoir opens unexpected insights as an emerging disease. Direct foodborne and occupational exposure to pigs have been identified as routes of transmission. Other routes of transmission should be defined. Human sequences of hepatitis E virus…

Острая вирусная инфекция гепатита С.

Около 25% людей, инфицированных вирусом гепатита С (ГХВ), могут самопроизвольно очистить себя от этой инфекции, в то время как большинство из них становятся хронически инфицированными с последующим риском для отдельного пациента, связанным с прогрессивным воспалительным заболеванием печени, циррозом, гепатоклеточной карциномой и смертью от печени (рис. 1). Многое известно об эпидемиологии, патогенезе, диагностике и лечении хронической инфекции ВИЧ. Для сравнения, знания об острой инфекции ВЦВ являются разрозненными. В этой статье мы обратим внимание на проблемы, связанные с острым ВИЧ-инфекцие

Совпадение в аннотации оригинала
Around 25% of people infected with hepatitis C virus (HCV) are able to clear the infection spontaneously, while the majority become chronically infected, with a subsequent risk for the individual patient of progressive inflammatory liver disease, cirrhosis, hepatocellular carcinoma and liver-related death (Figure 1). Much is known about the epidemiology, pat…

Hepatitis C virus and lymphoma.

Hepatitis C virus (HCV) is well known for its aetiological role in chronic non-A, non-B viral hepatitis, liver cirrhosis and hepatocellular carcinoma; in addition, the virus has also been implicated in a number of extra-hepatic "autoimmune" disease manifestations. A causative association between HCV and non-Hodgkin lymphoma (NHL) was postulated relatively recently and has been the subject of intense investigation, as well as some debate. On the strength of epidemiological data, emerging biological investigations and clinical observations, HCV appears to be involved in the pathogenesis of at le…

Current therapy for autoimmune hepatitis.

The treatment of autoimmune hepatitis is evolving as the pathogenic pathways that underlie the disease are defined, new immunosuppressive agents are tested, and site-specific molecular interventions become feasible. Prednisone alone or at a reduced dose combined with azathioprine is the conventional treatment. Patients with HLA genotype DRB1*0301 have a poorer treatment response and a more frequent need for liver transplantation than those with HLA genotype DRB1*0401. Therapy to the point when liver test results and histological findings are normal reduces, but does not eliminate, the occurren…

Autoimmune hepatitis. Part B: diagnosis.

Diagnostic criteria have been codified by the International Autoimmune Hepatitis Group, and a scoring system can quantify the strength of the diagnosis and over-ride the impact of absent or inconsistent features. The absence of a definable etiologic agent and precise diagnostic test, implies that the diagnosis may be missed or misapplied. Centrilobular (zone 3) necrosis may be an early form of autoimmune hepatitis and this pattern can transform to the classical pattern of interface hepatitis. An acute severe or fulminant presentation is possible, and different ethnic groups may have different …

Autoimmune hepatitis. Part A: pathogenesis.

Autoimmune hepatitis is a consequence of a triggering antigen and genetic factors that favor the presentation of autoantigens, polymorphisms that affect immunocyte activation and durability, cytokine alterations that promote proliferation of liver-infiltrating cytotoxic T cells, and perturbations in the number and function of immune-regulatory cell populations, including T regulatory cells and natural killer T cells. The triggering epitope is probably a short sequence peptide that is common in multiple infectious or toxic agents. Homologies between this epitope and self-antigens (molecular mim…

Clindamycin-induced acute cholestatic hepatitis.

We report a case of acute hepatotoxicity in a 42-year-old woman after administration of clindamycin for a dental infection. After 6 d of tre … e (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that clindamycin was the probable cause of the acute hepatitis. In susceptible individuals, clindamycin use may lead to acute mixed-type liver toxicity. Complete recove …

Oral aloe vera-induced hepatitis.

OBJECTIVE: To report a case of possible oral aloe vera-induced hepatitis. CASE SUMMARY: A 73-year-old female was admitted to the hospital for acute hepatitis. Extensive laboratory testing did not reveal the cause of the patient's disease. She was asked multiple times whether she was taking any home medications, which she initially denied. It was only after an extensive medication history done by a clinical pharmacist that the patient admitted to using oral aloe vera capsules for constipation. Upon discontinuation of the oral aloe vera, liver markers of hepatotoxicity returned to normal levels…

Emerging drugs for hepatitis B.

Chronic hepatitis B remains a treatment challenge despite the availability of new nucleoside analogs. This is due to the persistence of viral infection during therapy, which exposes the patient to the risk of developing antiviral drug resistance. Therefore, new polymerase inhibitors are needed to manage resistance to existing drugs and new trials of combination therapy are required to delay drug resistance. In the future, antiviral agents targeting other steps of the viral life cycle will be needed to achieve antiviral synergy and prevent antiviral drug resistance. Immune modulators are also e…

Autoimmune hepatitis in Iranian children.

OBJECTIVE: To evaluate the clinical and para-clinical presentation, including autoantibody pattern and response to treatment in Iranian children with autoimmune hepatitis (AIH). METHODS: Data of 60 children presenting with AIH (56 girls) were analyzed retrospectively for clinical, serological and histological profile. RESULTS: Clinical findings included jaundice (67%),hepatomegaly (50%) and ascites (30%). Forty children (38 girls) had type I AIH and 14 (12 girls) had type II AIH. Liver histology was comparable in the two groups and cirrhosis on initial biopsy was equally frequent in Types I …

[Autoimmune hepatitis and CREST syndrome].

We report the case of an autoimmune hepatitis in a 59-year old woman who was referred for a progressive jaundice. The patient had an history of CREST syndrome. The particularity of this case report is the rare association between these two autoimmune diseases.

Butachlor-induced acute toxic hepatitis.

Butachlor is a highly effective herbicidal substance widely used by farmers. We report a 60-year-old man with exfoliative dermatitis, jaundice, increase in liver enzymes and eosinophilia one day after accidental dermal exposure to butachlor toxin. The diagnostic workup showed no other cause and liver histology was consistent with substance-induced toxic hepatitis. Within two weeks of conservative therapy, his liver function tests returned to normal.

Diagnostic criteria for autoimmune hepatitis.

Diagnosis of Autoimmune Hepatitis (AIH) often represents a clinical challenge. The clinical spectrum of disease is quite heterogeneous. AIH can affect patients of all age groups, both sexes, and any race and region. The course may range from subclinical and very mild to acute attacks of hepatitis up to fulminant hepatic failure. Other patients present very late with the picture of cryptogenic cirrhosis. Laboratory features may also differ. Autoantibodies vary, and some patients do not display any autoantibodies at the time of clinical presentation. SLA/LP-autoantibodies are the only antibodies…

Acute polyarthritis revealing hepatitis E.

We report a case of acute hepatitis E occurring in a 51-year-old French woman, revealed by an abrupt onset of polyarthritis involving the ankles and knees followed by the wrists and fingers. Polyarthritis lasted up to 3 months without recurrence. Our case was characterised by a 9-month prolonged viraemia with persistence of specific IgM in the serum. The hepatitis E virus belonged to genotype 3 and may have been contracted in France or during travel to hyperendemic areas. Our case shows that acute polyarthritis could be another systemic manifestation of hepatitis E virus infection.

Hepatitis B virus genetic diversity.

Hepatitis B virus (HBV) is a human DNA virus, which replicates through an RNA intermediate because of the reverse-transcriptase (RT) activity of its DNA polymerase. As a result, the mutation rate for HBV is higher than the rate observed for most DNA viruses. HBVs are classified into genotypes based on genomic sequencing, and antigenic subtypes based on the antigenic properties of its major surface glycoprotein, the HBV surface antigen (HBsAg). Subgenotypes have been identified within most of the HBV genotypes. The HBV groups defined by the different genotype-HBsAg subtype associations found ov…

Autoimmune hepatitis triggered by statins.

Although the cause of autoimmune hepatitis (AIH) is unknown, drugs are believed to be potential triggers in some patients. In isolated case reports, statins have been considered such triggers. Here we describe 3 patients in whom it is probable that statins initiated the development of AIH. Two men (aged 47 and 51) and one woman (aged 57) developed AIH after the initiation of statin therapy. They developed positive titers of antinuclear antibodies, antismooth muscle antibodies (1/40 to 1/160), and hypergammaglobulinemia. Features of all 3 patients met the criteria for AIH according to the Inter…