RESUMO
BACKGROUND: Hepatitis A is the most common type of viral hepatitis in Mexico. The change of hepatitis A epidemiology in Mexico from high to intermediate endemicity leads to increasing susceptible adults for severe illness. OBJECTIVE: To describe the clinical characteristics and hospital outcome of adult patients with acute hepatitis A infection, and determine risk factor for mortality. MATERIAL AND METHODS: This is a retrospective observational, multicentre study in Mexico City and in Guatemala City. All inhospital patients were followed until discharge or death. Risk factors for death/acute liver failure were identified. RESULTS: Forty seven patients were analyzed, sixty percent were male, the prodrome phase was from 3 to 30 days. The three most common symptoms were fever, malaise and jaundice, with 87%, 74% and 62% respectively. The incidence of patients who were treated with antibiotics before hospital admission was up to 34%. Unnecessary imaging studies and out of guidelines drugs were used. Presence of encephalopathy, leukocytes > 19,000/mL, blood urea nitrogen > 36 mg/dL, creatinine > 2 mg/dL, albumin < 2.5 mg/dL and total bilirubin > 9.6 mg/dL, are predictors of mortality. Serum creatinine > 2 mg/dL has the best sensibility and specificity for predicting fulminant hepatitis/death. CONCLUSION: Acute hepatitis A infection in adults is associated some unnecessary diagnostic and therapeutic approach. Could be associated with fulminant hepatitis, and a creatinine value > 2 mg/dL is the best predictor for fulminant hepatitis and death.
Assuntos
Antivirais/uso terapêutico , Hepatite A/tratamento farmacológico , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Progressão da Doença , Feminino , Guatemala/epidemiologia , Hepatite A/sangue , Hepatite A/diagnóstico , Hepatite A/mortalidade , Humanos , Falência Hepática Aguda/tratamento farmacológico , Falência Hepática Aguda/mortalidade , Falência Hepática Aguda/virologia , Masculino , México/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Desnecessários , Adulto JovemAssuntos
Hepatite A/complicações , Leptospirose/complicações , Adulto , Brasil , Coinfecção , Ensaio de Imunoadsorção Enzimática , Evolução Fatal , Feminino , Hepatite A/diagnóstico , Hepatite A/tratamento farmacológico , Humanos , Leptospirose/diagnóstico , Leptospirose/tratamento farmacológico , MasculinoRESUMO
INTRODUCTION: Hepatitis A virus can evolve to acute liver failure with a fatal outcome if it is not reversed. OBJECTIVE: We describe the clinical course of 12 children who presented with hepatitis A acute liver failure and received treatment with oral N-acetylcysteine (NAC). MATERIALS AND METHODS: Of the seventy-two patients with viral hepatitis A, 12 patients who had acute hepatic failure were included. The variables evaluated were age, sex, duration of clinical features prior to hospitalization, signs and symptoms, laboratory parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), partial thromboplastin time (PTT), internal normalization ratio and ammonia], treatment (oral NAC 100 mg/kg/day, lactulose, neomycin and general measures) and clinical course during hospitalization. RESULTS: Six males and six females were included. School-aged and adolescent children predominated. All presented with jaundice, nausea, vomiting and hepatomegaly. Two had stage 2 neurological signs as per the West-Haven scale. All had altered laboratory parameters. All received NAC, six patients for a week and the remaining six for 9-36 days. Treatment was not ceased until patients showed clinical and laboratory improvement. All data were analyzed using both student's t test and Wilcoxon signed rank with alpha = 0.05, the ALT with P = 0.0003 and 0.005, AST with P = 0.0001 and 0.0005, PT with P = 0.0237 and 0.0005, PTT with P = 0.0515 and 0.0039, ammonia with P = 0.0197 and 0.0015 and direct bilirubin with P = 0.0190 and 0.068. There was good tolerance to medications and a satisfactory clinical course. DISCUSSION: The use of oral NAC appears to be an effective therapeutic alternative for hepatitis A-induced liver failure if it is offered appropriately. It can modify the clinical course to a favorable one and prevent the fatal outcome of hepatic encephalopathy.
Assuntos
Acetilcisteína/uso terapêutico , Antivirais/uso terapêutico , Hepatite A/complicações , Hepatite A/tratamento farmacológico , Falência Hepática Aguda/tratamento farmacológico , Falência Hepática Aguda/etiologia , Acetilcisteína/administração & dosagem , Administração Oral , Adolescente , Alanina Transaminase/sangue , Antibacterianos/uso terapêutico , Antivirais/administração & dosagem , Aspartato Aminotransferases/sangue , Criança , Quimioterapia Combinada , Feminino , Fármacos Gastrointestinais/uso terapêutico , Hepatite A/sangue , Humanos , Lactulose/uso terapêutico , Falência Hepática Aguda/sangue , Masculino , México , Neomicina/uso terapêutico , Tempo de Protrombina , Estudos Retrospectivos , Resultado do TratamentoRESUMO
As hepatites virais, principalmente as causadas pelos vírus A, B e C, são muito prevalentes no mundo inteiro. As formas crônicas das hepatites B e C são as mais comuns no nosso meio e acarretam importantes conseqüências, tanto sociais quanto econômicas . Sendo assim, é importante que o clínico, independente de sua área, saiba diagnosticar e encaminhar pacientes infectados. Este artigo tem como objetivo revisar os algoritmos diagnósticos das hepatites e expor os tratamentos atualmente preconizados para as formas crônicas destas afecções (hepatites B e C).
Assuntos
Humanos , Masculino , Feminino , Hepatite A/diagnóstico , Hepatite A/tratamento farmacológico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite Crônica/diagnóstico , Hepatite Crônica/tratamento farmacológicoAssuntos
Humanos , Hepatite C/epidemiologia , Hepatite A/epidemiologia , Hepatite B/epidemiologia , Hepatite D/etiologia , Hepatite D/transmissão , Hepatite D/epidemiologia , Chile/epidemiologia , Hepatite E/etiologia , Hepatite E/epidemiologia , Hepatite C/etiologia , Hepatite C/tratamento farmacológico , Hepatite C/transmissão , Hepatite A/etiologia , Hepatite A/tratamento farmacológico , Hepatite A/transmissão , Hepatite B/etiologia , Hepatite B/tratamento farmacológico , Hepatite B/transmissão , Vírus de Hepatite/patogenicidadeRESUMO
En este trabajo reportamos el caso clínico de una adolescente femenina de 11 años de edad, quién manifestó insuficiencia hepática y encefalopatía en etapa II, por virus A. Fue tratada de manera intensiva, agregándose N-acetilcistína como citoprotector, la evolución fue la mejoría con recuperación total sin secuelas, diez días después. Se comentan las bases para la posibilidad del uso de acetilcisteína en paciente con insuficiencia hepática aguda no inducida por paracetamol
Assuntos
Humanos , Feminino , Adolescente , Hepatite A/complicações , Hepatite A/tratamento farmacológico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapiaRESUMO
Con el objeto de ratificar la utilidad de ribavirina en el tratamiento de hepatitis A en pacientes pediátricos, se realizó un estudio clínico doble ciego comparativo con placebo. El diagnóstico fue confirmado en forma serológica, descartándo-se otras causas de inflamación hepática. Sesenta niños fueron divididos en dos grupos al azar, uno de los cuales recibió ribarivina por vía oral a razón de 20 mg/kg/día durante 14 días. Después de analizar los resultados se concluye que este fármaco acorta de manera significativa el periodo de inflamación hepática, hecho que fue valorado por medio de transaminasas y bilirrubinas, lo que ofrece al paciente la posibilidad de incorporarse con mayor rapidez a sus actividades cotidianas
Assuntos
Criança , Humanos , Masculino , Feminino , Hepatite A/tratamento farmacológico , Ribavirina/uso terapêutico , Química , Ensaios Clínicos como Assunto , Método Duplo-CegoRESUMO
Patients with positive serum HBAg reactions were treated with Viramid (1-beta-D-ribofuranozyl-1, 2, 4-triazol-3-carboxamide) a new anti-viral drug. Of the patients involved in this study, 5 had chronic hepatitis or prolonged hepatitis and 12 were healthy HBAg carriers. Results obtained suggest that the drug had some action on serum HBAg titres with a decrease or negativation of HBAg serum titres in peripheric blood, the evaluation of which was immediately seen by employing the counterimmune electrophoresis technique.