RESUMO
This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.
Este relato de caso, junto com a revisão de literatura, descreve um paciente com diagnóstico de hepatite viral aguda, que desenvolveu quadro de dor abdominal intensa e alterações laboratoriais compatíveis com pancreatite aguda. Casos de pancreatite aguda complicando hepatites virais agudas fulminantes e não fulminantes tem sido esporadicamente relatados e vários mecanismos são propostos para explicar esta complicação, no entanto sua causa ainda se mantém desconhecida. Como a hepatite aguda é doença comum, é importante estimular o desenvolvimento de mais estudos na América Latina que visem determinar a incidência local e o perfil dos pacientes que apresentam esta complicação.
Assuntos
Adulto , Feminino , Humanos , Hepatite Viral Humana/complicações , Pancreatite/etiologia , Doença Aguda , Hepatite Viral Humana/classificação , Hepatite Viral Humana/diagnóstico , Pancreatite/diagnósticoRESUMO
Las manifestaciones clínicas de la hepatitis viral tipo B tienen un amplio abanico de presentaciones, dependiendo de muchos factores, algunos desconocidos y otros, perfectamente identificables: subtipo del virus, características genéticas del huésped, estado inmunológico en el momento de la inoculación, carga viral y vía de entrada de dicha inoculación, entre los más importantes. La clínica de la hepatitis viral por virus B tanto aguda como crónica puede ser desde síntomas inespecíficos sin ictericia, a un cuadro severo con ictericia y encefalopatía. La hepatitis B que se manifiesta por primera vez, se clasifica como hepatitis aguda y hepatitis fulminante. La hepatitis B no aguda se clasifica en hepatitis subaguda o prolongada, hepatitis crónica persistente y hepatitis crónica activa.
The clinical manifestations of hepatitis B has a wide spectrum of presentations that depend on many factors, some are unknown and others very well identifiable: virus subtypes, genetic characteristics of the host, immunological status at the time of inoculation, viral burden, and entrance pathway of such inoculation, among others. The clinical case of acute and chronic hepatitis type B, can show either unspecific symptoms without jaundice or a severe case of jaundice and encephalopathy. The hepatitis B that manifests for the first time is classified as acute hepatitis and fulminant.
Assuntos
Humanos , Hepatite B/diagnósticoRESUMO
Se realizó un estudio observacional analítico de tipo prospectivo en instituciones cerradas de Ciudad de La Habana durante un brote epidémico de hepatitis viral aguda en el período comprendido desde marzo de 2005 a enero de 2006. La fuente de datos se obtuvo del sistema de vigilancia de la Unidad Territorial de Higiene y Epidemiología. En los conglomerados epidémicos se estimó el índice de vulnerabilidad como expresión probabilística de riesgo y se comprobó su correspondencia con las áreas de impacto de la morbilidad. Se calcularon los indicadores de riesgo, los cuales reflejaron que la agrupación 1 presentó el mayor acumulado de factores vulnerables, y por tanto, la mayor tasa esperada con 8,05 por cada 1 000 habitantes. Los factores que aportaron más riesgo de contraer hepatitis viral aguda fueron la mala calidad sanitaria del agua (90 %), el insuficiente suministro de esta y las inadecuadas facilidades sanitarias para el lavado de manos, (88 %). Por otro lado, el municipio Arroyo Naranjo presentó un riesgo relativo de 2,75, por lo que fue el área de mayor impacto de riesgos ambientales. Se observó asociación entre los factores vulnerables y la morbilidad por hepatitis viral aguda, ya que las unidades con mayor acumulado de factores fueron las que presentaron mayores tasas. De manera general, no hubo diferencias significativas entre las tasas observadas y esperadas, lo cual refleja la buena capacidad de discriminación del método. Se demostró la importancia de la calidad sanitaria del agua, las facilidades sanitarias para el lavado de manos y el suficiente suministro de agua entre otros, en la prevención de la hepatitis viral aguda, factores estos que más aportaron al riesgo de contraer dicha enfermedad.
An analytical prospective and observational study was conducted in closed institutions of Havana City during an epidemic outbreak of acute viral hepatitis from March 2005 to January 2006. The data source was obtained from the surveillance system of the Hygiene and Epidemiology Territorial Unit. In the epidemic conglomerates, it was estimated the vulnerability rate as a probable expression of risk and it was also verified its correspondence with the morbidity impact. Risk indicators were calculated, which showed that group 1 had the greatest number of vulnerable factor and, hence, the highest expected rate with 8.05 per 1 000 inhabitants. The factor representing more risks for acquiring acute viral hepatitis were the poor quality of water (90 %), an insufficient water supply, and the inadequate health facilities for hand washing (88 %). On the other hand, Arroyo Naranjo municipality had a relative risk of 2.75, beign the area with the greatest impact of environmental risks. It was found a relationship between vulnerable factors and morbidity from acute viral hepatitis, since the units with the greatest accumulation of factors presented the highest rates. In general, there were no significant differences between the observed and the expected rates. It was proved the importance of the quality of water, of the health facilities for hand washing, and of an adequate water supply, among others, to prevent acute viral hepatitis, since these factors are a big risk for acquiring this disease.