RESUMO
INTRODUCTION: Chronic active Epstein Barr virus infection (CAEBV) is a rare condition, where the body is unable to counteract Epstein Barr viral replication (EBV), leading the patient to a chronic state with variable symptoms. Early recognition of infrequent or atypical clinical manifestations is relevant due to the particularities of their management and prognosis. OBJECTIVE: to describe a case of CAEBV manifes ted with colitis and hepatitis, summarizing the clinical-pathological and endoscopic characteristics and their evolution. CLINICAL CASE: A 6-year-old girl, previously healthy, presented recurrent episodes of jaundice, hepatosplenomegaly, and fever. EBV hepatitis was diagnosed with a blood viral load of 328,000 copies / mL. Her liver biopsy revealed Epstein-Barr virus-encoded small RNAs (EBER). She evolved with mucosanguineous diarrhea and weight loss; the colonoscopy showed loss of the haustral pattern, multiple aphthous ulcers covered with fibrin, and 7 million copies of EBV / gram of tissue were found in the colon. T-cell lineage infection was identified, therefore Rituximab was started, with a decrease in viral load, complete resolution of diarrhea, and improvement in liver function tests. The definitive treatment was bone marrow transplantation. CONCLUSIONS: CAEBV is a serious disor der, little documented, and should be considered in the face of a prolonged or intermittent course of hepatitis, accompanied by general and gastrointestinal manifestations such as chronic diarrhea, hematochezia, and weight loss, since its outcome without treatment can be fatal.
Assuntos
Infecções por Vírus Epstein-Barr , Hepatite Viral Humana , Criança , Doença Crônica , Colo/patologia , Diarreia/complicações , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Feminino , Hepatite Viral Humana/complicações , Herpesvirus Humano 4 , Humanos , Infecção Persistente , Redução de PesoRESUMO
Chronic infections due to hepatitis B and hepatitis C viruses are responsible for most cases of hepatocellular carcinoma (HCC) worldwide, and this association is likely to remain during the next decade. Moreover, viral hepatitis-related HCC imposes an important burden on public health in terms of disability-adjusted life years. In order to reduce such a burden, some major challenges must be faced. Universal vaccination against hepatitis B virus, especially in the neonatal period, is probably the most relevant primary preventive measure against the development of HCC. Moreover, considering the large adult population already infected with hepatitis B and C viruses, it is also imperative to identify these individuals to ensure their access to treatment. Both hepatitis B and C currently have highly effective therapies, which are able to diminish the risk of development of liver cancer. Finally, it is essential for individuals at high-risk of HCC to be included in surveillance programs, so that tumors are detected at an early stage. Patients with hepatitis B or C and advanced liver fibrosis or cirrhosis benefit from being followed in a surveillance program. As hepatitis B virus is oncogenic and capable of leading to liver cancer even in individuals with early stages of liver fibrosis, other high-risk groups of patients with hepatitis B are also candidates for surveillance. Considerable effort is required concerning these strategies in order to decrease the incidence and the mortality of viral hepatitis-related HCC.
Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Hepatite B , Hepatite Viral Humana , Neoplasias Hepáticas , Adulto , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/prevenção & controle , Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vírus da Hepatite B , Hepatite B Crônica/complicações , Hepatite B Crônica/epidemiologia , Hepatite Viral Humana/complicações , Hepatite Viral Humana/epidemiologia , Humanos , Recém-Nascido , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle , Fatores de RiscoAssuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Hepatite Viral Humana/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/complicações , Contraindicações de Medicamentos , Países em Desenvolvimento , Hepatite Viral Humana/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Cirrose Hepática/etiologia , Metanálise como Assunto , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Peru/epidemiologia , Medição de Risco , Sinvastatina/efeitos adversos , Sinvastatina/uso terapêuticoRESUMO
Renal dysfunction is a common finding in cirrhotic patients and has a great physiologic, and therefore, prognostic relevance. The combination of liver disease and renal dysfunction can occur as a result of systemic conditions that affect both the liver and the kidney, although primary disorders of the liver complicated by renal dysfunction are much more common. As most of the renal dysfunction scenarios in cirrhotic patients correspond to either prerenal azotemia or hepatorenal syndrome (HRS), physicians tend to conceive renal dysfunction in cirrhotic patients as mainly HRS. However, there are many systemic conditions that may cause both a "baseline" chronic kidney damage and a superimposed kidney dysfunction when this systemic condition worsens. The main aim of this article is to review some of the most important non prerenal non-HRS considerations regarding acute on chronic kidney dysfunction in cirrhotic patients, including renal manifestation of related to non-alcoholic steatohepatitis (NASH) viral hepatitis, the effect of cardiorenal syndrome in cirrhotics and corticosteroid-deficiency associated renal dysfunction.
Assuntos
Injúria Renal Aguda/metabolismo , Síndrome Cardiorrenal/metabolismo , Hepatite Viral Humana/metabolismo , Cirrose Hepática/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Insuficiência Renal Crônica/metabolismo , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Corticosteroides/deficiência , Síndrome Cardiorrenal/complicações , Síndrome Cardiorrenal/fisiopatologia , Hepatite Viral Humana/complicações , Hepatite Viral Humana/fisiopatologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologiaRESUMO
INTRODUCTION: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. OBJECTIVE: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. MATERIAL AND METHODS: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. RESULTS: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. CONCLUSIONS: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.
Assuntos
Cirrose Hepática/mortalidade , Idoso , Alcoolismo/complicações , Infecções Bacterianas/complicações , Feminino , Hepatite Viral Humana/complicações , Mortalidade Hospitalar , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Peritonite/complicações , Peritonite/microbiologia , Peru , Estudos Prospectivos , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção TerciáriaRESUMO
Introducción: La cirrosis hepática descompensada por infecciones bacterianas es uno de los principales diagnósticos de admisión a hospitalización, teniendo en cuenta que el riesgo per se en ello es más alto que en pacientes no cirróticos, conllevando a cifras altas de mortalidad. Objetivo: El presente estudio buscó determinar los predictores de infección y mortalidad en pacientes con cirrosis hepática, así como las características epidemiológicas-clínicas de los pacientes con cirrosis. Materiales y métodos: De manera prospectiva se recolectaron los datos de los pacientes cirróticos hospitalizados en el servicio de Gastroenterología y Medicina interna del hospital de alta complejidad Virgen de la Puerta desde el 2015 a Junio del 2018. Resultados: El estudio incluyó 66 pacientes. La frecuencia de infección fue de 37,88%, siendo más frecuente la peritonitis bacteriana espontánea (21,2%) y la mortalidad total fue de 12,12%. Al realizar regresión logística binaria y curva ROC se obtuvieron como predictores de mortalidad, el valor de MELD >13,5 (p=0,003), TP >18,26 (p=0,003) y el estadio Child Pugh C (p=0,02, IC 95% EXP(B) 0,13-0,365). Las variables que predicen ausencia de mortalidad fueron un valor de plaquetas ≥ 74 500 /mm3 (p=0,01) y Sodio ≥133 mEq/l (p=0,019). Los predictores de infección, valor de MELD ≤14,5 (p=0,0004) y el nivel de sodio ≥134,5 mEq/l (AUC 0,696, p=0,028), para predecir ausencia de infección. Conclusiones: El MELD alto es un factor predictor tanto de mortalidad como de infección. El Child Pugh C y los valores de tiempo de Protrombina altos son predictores de mortalidad. El nivel de sodio normal es un predictor de ausencia de mortalidad e infección, así como el valor de plaquetas discretamente disminuido es predictor de ausencia de mortalidad.
Introduction: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. Objective: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. Material and methods: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. Results: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. Conclusions: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirrose Hepática/mortalidade , Peritonite/complicações , Peritonite/microbiologia , Peru , Infecções Bacterianas/complicações , Índice de Gravidade de Doença , Estudos Prospectivos , Fatores de Risco , Curva ROC , Mortalidade Hospitalar , Alcoolismo/complicações , Centros de Atenção Terciária , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatite Viral Humana/complicações , Cirrose Hepática/etiologiaRESUMO
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.
Assuntos
Proteínas do Sistema Complemento/metabolismo , Hepatite Viral Humana/terapia , Falência Hepática Aguda/terapia , Regeneração Hepática/fisiologia , Fígado/imunologia , Adolescente , Adulto , Apoptose , Linhagem Celular , Proliferação de Células , Criança , Pré-Escolar , Proteínas do Sistema Complemento/uso terapêutico , Feminino , Hepatite Viral Humana/complicações , Humanos , Imunidade Inata , Imunomodulação , Lactente , Fígado/patologia , Fígado/virologia , Falência Hepática Aguda/etiologia , Masculino , Terapia de Alvo Molecular , Adulto JovemRESUMO
GB virus C (GBV-C) is a lymphotropic virus with a low level or non-existent replication in the liver. The interaction between HIV-1 and GBV-C apparently reduces the progression of HIV-1 infection to AIDS and improves the quality of life of HIV-1 infected individuals. A cross-sectional study was established to determine the possible effect of HIV-1/GBV-C coinfection on HIV-1 viral load and CD4+ T lymphocyte counts. Samples from 313 HIV-1 infected persons from the Virus Laboratory of the Federal University of Pará as well as demographic and clinical information were obtained from medical records. This study used a nested PCR method to determine GBV-C viremia. The prevalence of HIV-1/GBV-C coinfection was 17%. There were no significant differences in the distribution according to age, sex or ethnicity between the groups. The differences in HIV-1 viral load and CD4+ T lymphocyte count between the HIV-1 and HIV-1/GBV-C groups were highly significant, indicating that coinfection results in lower viral loads and higher CD4+ T lymphocyte counts compared to HIV-1 mono-infection. The results indicate a protective effect among coinfected individuals.
Assuntos
Coinfecção/virologia , Infecções por Flaviviridae/complicações , Vírus GB C , Infecções por HIV/complicações , HIV-1 , Hepatite Viral Humana/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Infecções por Flaviviridae/virologia , Infecções por HIV/virologia , Hepatite Viral Humana/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Although rare, ALF caused by disseminated HSV infection is associated with high mortality in the neonatal population. This condition is often diagnosed relatively late due to the absence of specific signs. We present a case involving a neonate with ALF submitted to living donor liver transplantation without a prior diagnosis. The patient had no skin or mucosal lesions, and IgM serology was negative for HSV-1 and HSV-2. Immunohistochemical staining of the liver explant was positive for herpes virus infection, and the patient subsequently received antiviral drug treatment, with a good outcome. Due to organ shortages and the rarity of the aforementioned condition, LT has seldom been reported for the treatment of ALF caused by herpes virus infection; however, LT may be the only option for neonates with fulminant hepatitis. The use of living donors in an urgent scenario is well established in Eastern countries and safely applicable for pediatric patients with ALF.
Assuntos
Hepatite Viral Humana/cirurgia , Herpes Simples/cirurgia , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Feminino , Hepatite Viral Humana/complicações , Herpes Simples/complicações , Humanos , Recém-Nascido , Falência Hepática Aguda/virologiaRESUMO
BACKGROUND: Liver transplantation is indicated at the end stage of chronic liver failure, and severity of disease will determine the precocity of this happening. At this stage, the presence of chronic dyspnea is one of several manifestations of progression of the disease, which leads the patient to inactivity. A rehabilitation program can positively influence the evolution of liver transplant recipients. The objective of this study was to establish an association between the perception of dyspnea and the severity of liver disease in patients at a single center of a Brazilian liver pre-transplantation clinic. METHODS: Measurements were performed at a liver pre-transplantation clinic. The severity of liver disease was assessed with the use of the Model for End-Stage Liver Disease (MELD) score, and dyspnea was assessed with the use of a modified Medical Research Council scale of dyspnea (mMRC). RESULTS: Men had a higher prevalence of viral hepatitis. Dyspnea was reported only during intense exercise. Duration of disease and MELD score showed medians of 49 months and 20, respectively. CONCLUSIONS: We found no correlation between mMRC and the MELD score. In addition, no correlation was found between duration of disease and MELD score or mMRC.