Acute sporadic non‐A, non‐B viral hepatitis of adults in India—Epidemiological and immunological studies

Abstract

On the basis of tests for specific IgM class antibodies in the serum, infections by hepatitis A virus, hepatitis B virus and hepatitis non‐A, non‐B virus accounted for 7%, 37.8% and 54.2% respectively of 286 cases of acute sporadic viral hepatitis in adults from three different regions of India. Epstein‐Barr virus and cytomegalo virus were insignificant (0.5–1%) aetiological agents. Approximately one‐quarter of all non‐A, non‐B (NANB) cases were additionally HBsAg carriers; there were significant differences in regional frequencies. NANB hepatitis commonly affected individuals in the mid‐fourth decade and occurred throughout the year with small peaks in different seasons. No antigen‐antibody reaction could be demonstrated in various immunological tests including radioimmunobinding using acute and convalescent phase sera. Neither were virus‐like particles visualized in acute phase sera on electron and immuno‐electron microscopy. However, rhesus monkeys inoculated with acute phase serum from a case of NANB hepatitis developed distinct hepatocellular changes at 43–55 days after inoculation, which had some features of similarity with experimental NANB hepatitis of other simian species. Sporadic NANB hepatitis is a major health problem throughout India and intensive study is needed on its epidemiology and aetiology.

Hepatitis E virus

“…In a study from Greece anti-HEV antibody was found in a larger proportion of patients with acute viral hepatitis who also had serological markers of HBV and HCV infection [39] and suggests the possible spread of HEV by similar routes. Transmission of HEV to rhesus monkey by pooled acute phase sera [216,217] also suggests possible parenteral transmission of HEV.…”

“…These histopathological changes consist of inflammatory cell infiltration and hepatic necrosis. Specific ultrastructural changes are observed in the liver, including dilation of endoplasmic reticulum, degeneration of mitochondria, loss of glycogen, focal thickening of endoplasmic reticulum membrane and appearance of sponge like aggregates of microtubules [216].…”

Outbreak of acute viral hepatitis due to hepatitis E virus in Hyderabad

“…13 An alternative explanation could be that HEV is maintained in the community as a sporadic infection; thus, HEV is acquired early in life, making infants and children immune to another attack. 1,[14][15][16] However, seroanalysis of the epidemic of hepatitis revealed anti-HEV IgM in a few children. 17 Although HEV and HAV have a common route of transmission, HAV infection was infrequent, being the predominant form in individuals less than 15 years (81.12%).…”

Dynamics of HEV viremia, fecal shedding and its relationship with transaminases and antibody response in patients with sporadic acute hepatitis E

“…In Indian subcontinent, it accounts for 30-60% of sporadic hepatitis [3,4]. One distinct feature of hepatitis E, compared with other forms of viral hepatitis is its higher incidence and severity in pregnant woman [5].…”