A significant decrease in hepatitis B virus infection and an increase in hepatitis A virus infection have occurred since the earlier study was performed in 1983. The decrease in hepatitis B virus infection is attributable to the steep decrease in hepatitis B virus infection among children that resulted from the universal hepatitis B virus immunization of infants that was initiated in 1991. The increase in clinical hepatitis A virus infection occurred in older patients and could be attributed to improved sanitation that delayed individuals' initial exposures to the virus.

GNBM still has a high mortality rate and should be managed as a medical emergency. GNBM should be suspected in patients with otitis media, neurosurgical, and head trauma or who underwent spinal anesthesia and have disturbance in their level of consciousness, even if there are no signs of meningeal irritation. Ceftriaxone is still an effective drug and had a low rate of resistance in our study.

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Immunological studies among jaundiced patients revealed significant changes in T-helper and T-suppressor cells among chronic HBV cases from the acute and control groups. The chronic cases revealed a highly significant decrease in interleukin-2R expression but their low interferon-gamma values were statistically nonsignificant from the control group. The acute cases recorded the highest interleukin-2R and interferon-gamma values. Lymphocyte blastogenesis assay in response to different mitogens and antigens produced two groups:responders [acute cases] and nonresponders [chronic cases]. The responders revealed more intact specific and nonspecific cellular immune responses. Neither group differed with regard to their proliferative response to HBsAg, but vigorous response to HBcAg was a significant feature of the responders