Hepatitis A: Clinical Manifestations and Management

Jeong, Sook Hyang; Lee, Hyo Suk

doi:10.1159/000252779

Cited by 193 publications

(188 citation statements)

References 49 publications

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“…38 There have been concerns about immune activation of different patient cohorts with immune-mediated disorders such as AA patients, patients with autoimmune hematological disorders and patients with rheumatic disorders. The support for these concerns is very limited and is only based on case reports, [39][40][41] while larger controlled studies in rheumatology patients have not shown an increased risk. 42,43 On the other hand, the response to vaccination in patients with very severe AA is likely to be poor.…”

Section: Vaccinationmentioning

confidence: 99%

Supportive care in severe and very severe aplastic anemia

Höchsmann

Moicean

Risitano

et al. 2012

Bone Marrow Transplant

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for the EBMT Working Party on Aplastic AnemiaOptimal management of aplastic anemia (AA) is not confined to immediate diagnosis, early decision making and timely initiation of major treatment strategies (immunosuppression or SCT) but also involves supportive treatment as a crucial part of patient care. Patients are threatened by complications of cytopenia. Here, we summarize current recommendations for prevention and early treatment of fungal, bacterial and viral infections, transfusion strategy and iron chelation and assess the evidence basis. In fact, many recommendations for patients with AA are not based on randomized studies in AA itself, but they are deduced from other conditions with similar severity of cytopenia. Prevention and treatment of complications like hemorrhage, bacterial and fungal infections and of secondary events like alloimmunization to blood products and iron overload have a significant impact on the prognosis of AA patients and need to be carefully observed in daily practice. More controlled studies on supportive care should be performed in this rare disease.Bone Marrow Transplantation (2013) 48, 168-173; doi:10.1038/bmt.2012.220; published online 3 December 2012Keywords: aplastic anemia; supportive treatment; infection; transfusion; hematopoietic growth factors INTRODUCTION Survival of patients with aplastic anemia (AA) after both immunosuppression and allogeneic BMT improved substantially over the past 30 years. 1 For patients who received immunosuppression, this improvement was not restricted to patients who responded to the specific treatment. 2 Remarkably, the prognosis of non-responders to initial immunosuppression also improved substantially over time. 2 This is most likely due to the impact of supportive treatment on the overall survival of patients. The individual risk of a patient is mainly determined by the neutrophil, and monocyte counts. 2-8 During the past two decades, infection-related mortality and invasive fungal infections decreased. 2 However, infections are still the major threat for patients with severe or very severe AA. In the most recently published large clinical trials in AA, the most prevalent complications and the major causes of death still were bacterial and fungal infections. [3][4][5] In the following sections, we will summarize recommendations on the major aspects of supportive treatment in AA, that is, prophylaxis and early treatment of infections, transfusion strategy and treatment of iron overload.

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Section: Vaccinationmentioning

confidence: 99%

Supportive care in severe and very severe aplastic anemia

Höchsmann

Moicean

Risitano

et al. 2012

Bone Marrow Transplant

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“…The clinical course of acute hepatitis A is usually benign, and it is known that symptomatic treatment is sufficient for recovery 2. However, in rare cases, acute hepatitis A can be associated with serious complications which require prolonged hospitalization, and may result in death or liver transplantation 3. Cholestatic hepatitis is one of atypical clinical manifestations of acute viral hepatitis.…”

Section: Introductionmentioning

confidence: 99%

“…Cholestatic hepatitis is one of atypical clinical manifestations of acute viral hepatitis. Although it occurs only at a rate of 0.4~0.8%, protracted symptoms of anorexia, weight loss, pruritus, and jaundice are commonly associated 3. These clinical situations prolong the length of hospital stay, which causes increased medical expenses and social costs.…”

Section: Introductionmentioning

confidence: 99%

Clinical courses after administration of oral corticosteroids in patients with severely cholestatic acute hepatitis A; three cases

et al. 2010

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Acute hepatitis A is currently outbreaking in Korea. Although prognosis of acute hepatitis A is generally favorable, a minority of patients are accompanied by fatal complications. Severe cholestasis is one of the important causes of prolonged hospitalization in patients with acute hepatitis A. In such cases, higher chances of additional complications and increased medical costs are inevitable. We report three cases of severely cholestatic hepatitis A, who showed favorable responses to oral corticosteroids. Thirty milligram of prednisolone was initiated and tapered according to the responses. Rapid improvement was observed in all cases without side effects. We suggest that corticosteroid administration can be useful in hepatitis A patients with severe cholestasis who do not show improvement by conservative managements. Clinical trial will be needed to evaluate effectiveness of corticosteroids in these patients.

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“…Both hepatitis A virus (HAV) and hepatitis E virus (HEV) are well known as enteric transmission hepatitis viruses [1][2][3][4][5][6]. Acute hepatitis due to HAV (AH-A) and HEV (AH-E) infections usually occurs in young people, both sporadically and epidemically, in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Hepatic histological comparison between Acute Self-limiting Hepatitis A and Hepatitis E

Suzuki¹,

Tatemichi²,

Yoshida³

et al. 2017

Arch Hepat Res

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Background: Histological fi ndings of the liver in acute liver injury are basically affected by degree of liver damage. However, the differences in liver histology between acute self-limiting hepatitis A (AH-A) and hepatitis E (AH-E) have not yet been clarifi ed. This study aimed to clarify the differences in histological fi ndings of the liver between AH-A and AH-E.Methods: Fourteen patients with AH-A and 11 patients with AH-E matched with the period between the onset of AH and the performance of liver biopsy and with the degree of liver function impairment were studied. The activity grade and fi brosis stage were evaluated using the METAVIR scoring system and the semiquantitative scores using 9 items from histological fi ndings: interface hepatitis, portal lymphocytes, portal neutrophils, lobular necrosis, lobular infl ammation, steatosis, ballooning, Mallory bodies, and cholestasis. Results:The patients with AH-E were signifi cantly older and had a higher proportion of males than the patients with AH-A. Although liver function test values and prothrombin time on admission signifi cantly differed between AH-A and AH-E, these values on the day of liver biopsy were not signifi cantly different between AH-A and AH-E. Among the histological scores studied, lobular necrosis score was signifi cantly higher in AH-A than in AH-E. Alcohol abuse did not affect the histological differences between AH-A and AH-E. Among the AH-E patients, activity grade, lobular necrosis, and lobular infl ammation scores were signifi cantly high in patients showing positive drug-induced lymphocyte stimulation tests. Conclusions:The lobular necrosis score among the histological fi ndings of the liver was signifi cantly higher in AH-A than in AH-E. Aging and immunoreaction against drugs might contribute to the histological changes in AH-E.

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Hepatitis A: Clinical Manifestations and Management

Cited by 193 publications

References 49 publications

Supportive care in severe and very severe aplastic anemia

Supportive care in severe and very severe aplastic anemia

Clinical courses after administration of oral corticosteroids in patients with severely cholestatic acute hepatitis A; three cases

Hepatic histological comparison between Acute Self-limiting Hepatitis A and Hepatitis E

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