Epidemiological characteristics and clinical manifestations of acute non-A-E hepatitis

Abstract

Background/Aim. Acute non-A, non-B, non-C, non-D, non-E hepatitis (non-A-E AH) is an acute disease of the liver of unknown etiology for which one or more new, so far undetected, hepatotropic viruses may be responsible. The frequency of non-A-E AH ranges from 3.8% to 33.9%, and therefore it has a significant place within current infectology and hepatology. The aim of our study was to establish the frequency, clinical and biochemical characteristics, natural course and outcome of non-A-E AH and compare them with control groups affected by acute viral hepatitis A, B and C. Methods. This descriptive-analytic prospective study included 31 patients with non-A-E AH treated at the Institute of Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, from 2003 to 2008. They were followed up during the period not less than 6 months. The controls involved randomly selected patients, treated at the same time with a definite diagnosis of acute viral hepatitis A, B and C. Statistical data analysis used Mann-Whitney Utest, Student's t-test and variance analysis. The value of p < 0.05 was considered statistically significant. Results. The frequency of non-A-E AH was 7.6%. Almost no difference was found between sexes (male/female ratio was 1 : 1.07); it was developed in all age groups, with the highest incidence in the middle age (mean age was 38.32 ? 15.3 years). It appeared equally throughout the whole year. Out of risk factors, inoculation risk was predominant (before all, dental interventions), mostly involving urban population living in comfortable conditions. The duration of incubation varied much ranging from 20 to 180 days (median 60 days). By clinical course, moderate and icteric forms were most common, mostly corresponding to acute hepatitis A and C. On the other hand, by duration of the disease (mean duration was 67.1 ? 27.1) and chronic transformation, non-A-E AH resembled to acute hepatitis B. Progression to chronicity was recorded in 9.68% of the patients. There was no fulminant neither cholestatic form of the disease. Conclusion. Based on the results obtained in this study, it is probable that there are some so far undetected primary hepatotropic viruses in our environment.Uvod/Cilj. Akutni hepatitis ni A, ni B, ni C, ni D, ni E (AH ni A-E) predstavlja akutno zapaljensko oboljenje jetre nepoznate etiologije za koje bi mogao biti odgovoran jedan ili vise novih, do sada neotkrivenih, hepatotropnih virusa. Ucestalost AH ni A-E krece se od 3,8% do 33,9%, te, stoga, predstavlja znacajno mesto u danasnjoj infektologiji i hepatologiji. Cilj rada bio je da se utvrdi ucestalost, klinicke i biohemijske karakteristike, prirodni tok i ishod AH ni A-E i da se uporedi sa kontrolnim grupama obolelih od akutnog virusnog hepatitisa A, B i C. Metode. Deskriptivnoanalitickom studijom prospektivnog karaktera bio je obuhvacen 31 bolesnik sa AH ni A-E koji su leceni od 2003. do 2008. godine. Praceni su u vemenskom periodu od najmanje sest meseci. Kontrolne grupe cinili su bolesnici izabrani metodom slucajnog izbora, leceni u istom vremenskom periodu sa postavljenom dijagnozom akutnog virusnog hepatitisa A, B i C. Za statisticku obradu podataka korisceni su Mann-Whitney U-test, Studentov ttest i analiza varijanse. Vrednost p < 0,05 smatrana je statisticki znacajnom. Rezultati. Ucestalost AH ni A-E iznosila je 7,6%. Gotovo da nije bilo razlike u zastupljenosti ovog hepatitisa medju polovima (odnos musko : zensko bio je 1 : 1,07); javljao se u svim uzrastima, sa najvecom ucestaloscu u srednjem zivotnom dobu (prosecna starost bila je 38,32 ? 15,3 godine). Podjednako se javljao tokom cele godine. Od faktora rizika bilo je dominantno prisus tvo inokulacionih rizika (pre svega stomatoloskih intervencija), pri cemu je vecinom obolevalo gradsko stanovnistvo koje zivi u konfornim zivotnim uslovima. Duzina inkubacije bila je veoma varijabilna i kretala se od 20 do 180 dana (medijana 60 dana). Po klinickom toku, najcesce bile su blaze i iktericne forme bolesti koje najvise odgovaraju akutnom hepatitisu A i C. S druge strane, po duzini trajanja bolesti (prosecno trajanje bolesti iznosilo je 67,1 ? 27,1 dan) i prelasku u hronicitet, AH ni A-E odgovarao je akutnom hepatitisu B. Progresija u hronicitet zabelezena je kod 9,68% obolelih. Nije bilo fulminantnog, ni holestaznog oblika bolesti. Zakljucak. Na osnovu rezultata dobijenih u ovoj studiji, vrlo je verovatno postojanje jos nekih, do sada neotkrivenih, primarno hepatotropnih virusa u nasoj sredini.