Hepatitis during measles in young adults: Possible role of antipyretic drugs

Abstract

Fifty-six per cent of 118 young adults observed during a recent measles epidemic had some disturbance on liver function tests. Five per cent developed overt jaundice. Patients treated for fever with paracetamol were found to have significantly higher rates of transaminase impairment compared to those treated with dipyrone. Sixty-five and 58% of patients given paracetamol had elevated ALT and AST levels, respectively. Only 15% of patients given dipyrone had elevated levels of these two enzymes (p less than 0.01 for ALT and p less than 0.02 for AST). The mean levels of transaminases and bilirubin in the paracetamol-treated patients were significantly higher than those found in the dipyrone-treated patients [92 +/- 86 vs. 42 +/- 49 IU (p less than 0.02) for AST and 12 +/- 6.0 vs. 7.0 +/- 2.0 mumoles per liter (p less than 0.01) for bilirubin]. The cumulative dose of paracetamol in those who had impaired liver function was higher than that ingested by patients who did not develop liver damage, although still within the usual therapeutic range [11.6 +/- 5.8 vs. 7.6 +/- 4.2 gm (p = 0.02)]. The possible ways in which measles infection and paracetamol in combination can lead to hepatic damage are discussed.

Metamizole (Dipyrone) and the Liver: A Review of the Literature

“…While 58% of patients treated with acetaminophen had an elevation of ALT and AST concentrations, only 15% of patients treated with metamizole showed an elevation of these enzymes ( P < .01 for ALT and P < .02 for AST). Furthermore, mean concentrations of AST and bilirubin were significantly higher in the patients treated with acetaminophen compared to those treated with metamizole ( P < .02 for AST and P < .01 for bilirubin) . Results of this trial do not seem to support significant hepatotoxicity for metamizole, especially since the drug's dosing was too brief to draw further conclusions.…”

“…Furthermore, mean concentrations of AST and bilirubin were significantly higher in the patients treated with acetaminophen compared to those treated with metamizole (P < .02 for AST and P < .01 for bilirubin). 99 Results of this trial do not seem to support significant hepatotoxicity for metamizole, especially since the drug's dosing was too brief to draw further conclusions. Furthermore, among other potential biases of this evaluation, it must be considered that measles can also cause hepatitis, 100 and the authors interpreted their results in the context of a combined drug-virus effect.…”

“…Results of this trial do not seem to support significant hepatotoxicity for metamizole, especially since the drug's dosing was too brief to draw further conclusions. Furthermore, among other potential biases of this evaluation, it must be considered that measles can also cause hepatitis, and the authors interpreted their results in the context of a combined drug‐virus effect . However, this effect might play a significant role in the future because the incidence of measles infections has been increasing over the past several years, even in Western countries …”

Bacterial- and Viral-Induced Inflammation Increases Sensitivity to Acetaminophen Hepatotoxicity

“…In humans, APAP hepatotoxicity has been associated with several types of viruses, including those that produce mononucleosis and measles (Rosenberg et al, 1977;Ackerman et al, 1989). Among patients with viral hepatitis, those taking APAP had more severe liver damage compared to those who were not taking the drug (Yaghi et al, 2006).…”

Anti-oxidant activity in measles

“…20 Some studies have demonstrated raised bilirubin levels in measles. [21][22][23] In a previous study, we measured CLP, uric acid, albumin, bilirubin, SOD, CAT and GPx levels in children with acute bacterial meningitis and encephalitis. 24 Significant differences were found between the study and control groups for all parameters except uric acid.…”