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Songtanin B, Chaisrimaneepan N, Mendóza R, Nugent K. Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections. Viruses 2024; 16:618. [PMID: 38675959 PMCID: PMC11055091 DOI: 10.3390/v16040618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Hepatitis B virus (HBV) infections affect approximately 296 million people around the world, and the prevalence of any past or present HBV infection during the years 2015-2018 was as high as 4.3%. Acute HBV infection often presents with nonspecific symptoms and is usually self-limited, but 5% of patients can have persistent infections leading to chronic HBV infection and the risk of turning into chronic HBV infection is significantly higher in babies with vertical transmission (95%). Patients with chronic HBV infection are usually asymptomatic, but 15 to 40% of chronic HBV carriers develop cirrhosis and/or hepatocellular carcinoma. In addition to liver-related disorders, HBV is also associated with several extrahepatic complications, including glomerulonephritis, cryoglobulinemia, neurologic disorders, psychological manifestations, polyarthritis, and dermatologic disorders. Making the diagnosis of HBV can be challenging since patients with chronic infections can remain symptom-free for decades before developing cirrhosis or hepatocellular carcinoma, and patients with acute HBV infection may have only mild, nonspecific symptoms. Therefore, understanding how this virus causes extrahepatic complications can help clinicians consider this possibility in patients with diverse symptom presentations. The pathophysiology of these extrahepatic disorders likely involves immune-related tissue injury following immune complex formation and inflammatory cascades. In some cases, direct viral infection of extrahepatic tissue may cause a clinical syndrome. Currently, the American Association for the Study of Liver Diseases recommends treatment of chronic HBV infections with interferon therapy and/or nucleos(t)ide analogs, and this treatment has been reported to improve some extrahepatic disorders in some patients with chronic HBV infection. These extrahepatic complications have a significant role in disease outcomes and increase medical costs, morbidity, and mortality. Therefore, understanding the frequency and pathogenesis of these extrahepatic complications provides important information for both specialists and nonspecialists and may help clinicians identify patients at an earlier stage of their infection.
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Affiliation(s)
- Busara Songtanin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA (K.N.)
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Hermanussen L, Lampalzer S, Bockmann JH, Ziegler AE, Piecha F, Dandri M, Pischke S, Haag F, Lohse AW, Lütgehetmann M, Weiler-Normann C, zur Wiesch JS. Non-organ-specific autoantibodies with unspecific patterns are a frequent para-infectious feature of chronic hepatitis D. Front Med (Lausanne) 2023; 10:1169096. [PMID: 37387781 PMCID: PMC10300640 DOI: 10.3389/fmed.2023.1169096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/18/2023] [Indexed: 07/01/2023] Open
Abstract
Infections with hepatotropic viruses are associated with various immune phenomena. Hepatitis D virus (HDV) causes the most severe form of viral hepatitis. However, few recent data are available on non-disease-specific and non-organ-specific antibody (NOSA) titers and immunoglobulin G (IgG) levels in chronic hepatitis D (CHD) patients. Here, we examined the NOSA titers and IgG levels of 40 patients with CHD and different disease courses and compared them to 70 patients with chronic hepatitis B (CHB) infection. 43% of CHD patients had previously undergone treatment with pegylated interferon-α (IFN-α). The antibody display of 46 untreated patients diagnosed with autoimmune hepatitis (AIH) was used as a reference. The frequency of elevated NOSA titers (CHD 69% vs. CHB 43%, p < 0.01), and the median IgG levels (CHD 16.9 g/L vs. CHB 12.7 g/L, p < 0.01) were significantly higher in CHD patients than in patients with CHB, and highest in patients with AIH (96%, 19.5 g/L). Also, the antinuclear antibody pattern was homogeneous in many patients with AIH and unspecific in patients with viral hepatitis. Additionally, f-actin autoantibodies were only detectable in patients with AIH (39% of SMA). In CHD patients, IgG levels correlated with higher HDV viral loads, transaminases, and liver stiffness values. IgG levels and NOSA were similar in CHD patients irrespective of a previous IFN-α treatment. In summary, autoantibodies with an unspecific pattern are frequently detected in CHD patients with unclear clinical relevance.
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Affiliation(s)
- Lennart Hermanussen
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sibylle Lampalzer
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jan-Hendrik Bockmann
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Annerose E. Ziegler
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Felix Piecha
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Maura Dandri
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W. Lohse
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Weiler-Normann
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze zur Wiesch
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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An MW, Yoo JJ, Kim JK, Moon A, Kim SG, Kim YS. Focal Segmental Glomerulosclerosis Followed by Acute Hepatitis A Infection: Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050819. [PMID: 37241051 DOI: 10.3390/medicina59050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Chronic viral hepatitis such as hepatitis B or hepatitis C is frequently related to nephropathies, yet acute hepatitis A virus (HAV) infection is an exception. Materials and Methods: A 43-year-old male presented with jaundice accompanied by nausea and vomiting. The patient was diagnosed with acute HAV infection. Although the liver function improved after conservative treatment, various symptoms such as proteinuria, hypoalbuminemia, generalized edema and pleural effusion persisted. Due to nephrotic syndrome, the patient was referred to the clinic of the nephrology department and a renal biopsy was performed. Results: The result of the renal biopsy was focal segmental glomerulosclerosis (FSGS) based on histology, electron microscopy and immunohistochemistry. Therefore, based on the clinical history and biopsy results, the patient was diagnosed as having FSGS aggravated by acute HAV infection. Proteinuria, hypoalbuminemia and generalized edema were improved after prednisolone treatment. Conclusions: Although less common, acute HAV infection can also present with an extrahepatic manifestation, for example, FSGS. Hence, clinical attention is required if proteinuria or hypoalbuminemia persists in patients with acute HAV infection.
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Affiliation(s)
- Min-Woo An
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
| | - Jeong-Ju Yoo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
| | - Jin Kuk Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
| | - Ahrim Moon
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
| | - Sang Gyune Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
| | - Young Seok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea
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Zangeneh M, Mesgarian M, Khosravani-Nezhad Y. Association of acute hepatitis B and acute myopathy: a case report. J Med Case Rep 2022; 16:143. [PMID: 35395817 PMCID: PMC8994323 DOI: 10.1186/s13256-022-03330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B virus infection is a global public health problem. Although hepatitis B virus primarily affects hepatocytes, it sometimes develops disease manifestations outside the liver, such as myopathy, which is commonly caused by chronic hepatitis B. CASE PRESENTATION This case report describes a 57-year-old Iranian woman admitted to the hospital with jaundice, fever, body itching, abdominal pain, progressive muscle weakness, icteric sclera, right upper quadrant pain, and decreased muscle force. Examination on the first day of admission revealed that the patient was negative for hepatitis D antibody, positive for hepatitis B core (IgM) antibody, positive for hepatitis B surface antigen, and negative for hepatitis B e antibody but positive for hepatitis B e antigen. Moreover, she showed high levels of hepatitis B virus DNA viral load, creatine kinase, lactate dehydrogenase, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, total bilirubin, direct bilirubin, and alkaline phosphatase, and electromyography/nerve conduction velocity showed acute myopathic process. CONCLUSIONS Interestingly, myopathy symptoms improved after improving hepatitis symptoms and decreasing hepatitis B viral load, suggesting a close association between hepatitis B infection and myopathy.
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Affiliation(s)
- Mehrangiz Zangeneh
- Department of Infectious Diseases, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Zargandeh st, Khaghani st, Shariati, Tehran, Iran.,Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Masoomeh Mesgarian
- Islamic Azad University of Medical Sciences, Zargandeh st, Khaghani st, Shariati, Tehran, Iran
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Zahidin MA, Mohd Noor NH, Johan MF, Abdullah AD, Zulkafli Z, Edinur HA. A Review on Secondary Immune Thrombocytopenia in Malaysia. Healthcare (Basel) 2021; 10:healthcare10010038. [PMID: 35052202 PMCID: PMC8774929 DOI: 10.3390/healthcare10010038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/12/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary ITP (sITP) forms were addressed. All published (twenty-three) sITP articles among children and adults in Malaysia, identified on the academic databases were retrieved. The articles were published between 1981 and 2019, at a rate of 0.62 publications per year. The publications were considered low and mainly focused on rare presentation and followed-up of secondary diseases. This review revealed that sITP in Malaysia is commonly associated with autoimmune diseases (Evan’s syndrome, SLE and WAS), malignancy (Kaposi’s sarcoma and breast cancer) and infection (dengue haemorrhagic fever, Helicobacter pylori and hepatitis C virus). The relationship between ITP and autoimmune diseases, malignancy and infections raise the question concerning the mechanism involved in these associations. Further studies should be conducted to bridge the current knowledge gap, and the further information is required to update the existing CPG of management of ITP in Malaysia.
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Affiliation(s)
- Muhamad Aidil Zahidin
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
| | - Noor Haslina Mohd Noor
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.H.M.N.); (Z.Z.)
| | - Muhammad Farid Johan
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
| | - Abu Dzarr Abdullah
- Department of Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Zefarina Zulkafli
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.H.M.N.); (Z.Z.)
| | - Hisham Atan Edinur
- Forensic Science Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
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Clinicopathological characteristics and prognosis of hepatitis B associated membranous nephropathy and idiopathic membranous nephropathy complicated with hepatitis B virus infection. Sci Rep 2021; 11:18407. [PMID: 34526634 PMCID: PMC8443741 DOI: 10.1038/s41598-021-98010-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022] Open
Abstract
The main objective of this study is to analyze the clinical and pathological features and prognosis of patients with Hepatitis B associated membranous nephropathy (HBV-MN) and idiopathic membranous nephropathy (IMN) complicated with hepatitis B virus (HBV) infection. This study will provide more basis for diagnosis and prognosis evaluation. A total of 50 patients with HBV-MN were included in this study. 56 IMN patients complicated with HBV infection diagnosed during the same period formed the control group. Parameters including blood routine, urine routine and plasma levels of albumin (ALB), serum creatinine (SCR), blood urea nitrogen (BUN), urea acid (UA), total cholesterol (T-CHO), triglycerides (TG), complement C3 and C4, glutamic pyruvic transaminase (ALT), glutamic pyruvic transaminase (AST), 24-h urinary protein quantification (24 h-TP), renal phospholipase A2 receptor (PLA2R) and HBV related markers during the hospitalization and outpatient follow-up study period were collected for all the patients. The proportion of male patients was high in both groups. The average age of the HBV-MN group was 37.2 ± 14.187 years old, it was younger compared with the IMN group (P = 0.003). Nephrotic syndrome was the major clinical manifestation among patients. There was no significant difference between the two groups in the levels of anemia, microscopic hematuria, renal dysfunction, liver dysfunction, liver cirrhosis. The level of serum C3 and C4 in the HBV-MN group was lower compared with the IMN group (P = 0.002, P = 0.014). In the HBV-MN group, serum HBV markers were negative in 6 (12%) patients, 4 patients (8%) were positive for PLA2R in serum, and 5 patients (10%) were positive for PLA2R in renal tissue. Stronger IgG1 and C1q and weaker IgG4 staining were found in HBV-MN group renal tissues (P = 0.003, P = 0.025, and P = 0.001, respectively). There were no statistical differences compared with serum and renal PLA2R between HBV-MN and IMN groups (P = 0.098, P = 0.109). During the 1-year follow-up, there was no significant difference in complete remission rate between the two groups (P = 0.7739). Renal biopsy is crucial to diagnose HBV-MN. IgG subtypes in the HBV-MN group were mainly IgG1 deposition, while those in IMN complicated with HBV infection group were mainly IgG4 deposition. When HBV-associated antigen and PLA2R are present in renal tissue, lower level of serum C3 and C4, high intensity of renal C1q and IgG1 is more supportive of HBV-MN. The positive of PLA2R in serum and renal tissue in differentiating HBV from IMN complicated with HBV infection remains to be discussed.
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7
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Rapid and high seroprotection rates achieved with a tri-antigenic Hepatitis B vaccine in healthy young adults: Results from a Phase IV study. Vaccine 2021; 39:1328-1332. [PMID: 33451780 DOI: 10.1016/j.vaccine.2020.12.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sci-B-Vac® is a tri-antigenic recombinant Hepatitis B vaccine (TAV) containing the small (s), medium (pre-S2) and large (pre-S1) hepatitis B surface (HBs) antigens. To comply with vaccine licensure, a new reference standard batch was qualified by characterizing the seroprotection rate (SPR) for anti-HBs titers ≥10 mIU/mL, following vaccination. METHODS Ninety-one healthy adults aged 20-40 years were enrolled in an open label, single-arm phase IV study receiving three IM doses of 10 μg TAV at 0, 1 and 6 months. Immunogenicity was evaluated monthly and at 7, 9 and 12 months. The primary endpoint to qualify the reference standard was an SPR ≥95% by month 7. Secondary endpoints were proportion of high responders (anti-HBs titers ≥100 mIU/mL) and geometric mean concentrations (GMC) of HBs antibodies each month. Participants were followed for safety to month 12. RESULTS The primary endpoint was met 2 months after the second dose at month 3 [SPR 98.8%; 95% CI: 93.7%, 99.7%]. Proportion of high responders at months 3 and 7 were 81.4% and 97.6%, respectively. GMC at months 3 and 7 were 413.6 mIU/mL and 6799.9 mIU/mL, respectively. TAV was safe and well-tolerated. CONCLUSIONS The new reference standard batch of TAV was qualified successfully, demonstrating efficacy, a favorable safety profile and a rapid onset of seroprotection, including after two vaccine doses. Clinical trial registry: NCT04179786.
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8
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Wang CR, Tsai HW. Human hepatitis viruses-associated cutaneous and systemic vasculitis. World J Gastroenterol 2021; 27:19-36. [PMID: 33505148 PMCID: PMC7789062 DOI: 10.3748/wjg.v27.i1.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/19/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
Human hepatitis viruses (HHVs) include hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis delta virus, and hepatitis E virus and can cause liver inflammation in their common human host. Usually, HHV is rapidly cleared by the immune system, following acute HHV invasion. The morbidities associated with hepatitis A virus and hepatitis E virus infection occur shortly after their intrusion, in the acute stage. Nevertheless, the viral infectious process can persist for a long period of time, especially in HBV and HCV infection, leading to chronic hepatitis and further progressing to hepatic cirrhosis and liver cancer. HHV infection brings about complications in other organs, and both acute and chronic hepatitis have been associated with clinical presentations outside the liver. Vascular involvement with cutaneous and systemic vasculitis is a well-known extrahepatic presentation; moreover, there is growing evidence for a possible causal relationship between viral pathogens and vasculitis. Except for hepatitis delta virus, other HHVs have participated in the etiopathogenesis of cutaneous and systemic vasculitis via different mechanisms, including direct viral invasion of vascular endothelial cells, immune complex-mediated vessel wall damage, and autoimmune responses with stimulation of autoreactive B-cells and impaired regulatory T-cells. Cryoglobulinemic vasculitis and polyarteritis nodosa are recognized for their association with chronic HHV infection. Although therapeutic guidelines for HHV-associated vasculitis have not yet been established, antiviral therapy should be initiated in HBV and HCV-related systemic vasculitis in addition to the use of corticosteroids. Plasma exchange and/or combined cyclophosphamide and corticosteroid therapy can be considered in patients with severe life-threatening vasculitis manifestations.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
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9
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Kang C, Huang J, Nie X, Zhao F, Yu Z. A child with painful swollen joints, rash and proteinuria: Answers. Pediatr Nephrol 2020; 35:2093-2095. [PMID: 32297002 DOI: 10.1007/s00467-020-04529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Chengdong Kang
- Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou, 350025, Fujian, People's Republic of China
| | - Juan Huang
- Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, 350025, Fujian, People's Republic of China
| | - Xiaojing Nie
- Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, 350025, Fujian, People's Republic of China
| | - Feng Zhao
- Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou, 350025, Fujian, People's Republic of China.,Department of Pediatrics, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, 350025, Fujian, People's Republic of China
| | - Zihua Yu
- Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou, 350025, Fujian, People's Republic of China. .,Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou, 350025, Fujian, People's Republic of China. .,Department of Pediatrics, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, 350025, Fujian, People's Republic of China.
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Abstract
Given the visibility of cutaneous findings, skin manifestations are often a presenting symptom of underlying systemic disease, including chronic liver disease. Many cutaneous signs and symptoms that correlate with chronic liver disease are common physical examination findings in patients with no history of liver disease. It is nonetheless important to be aware that these cutaneous findings may be an indication of underlying liver disease and often occur in the setting of such hepatic dysfunction. This article covers general cutaneous signs that may correlate with various liver diseases and describes specific cutaneous signs as they relate to more specific liver diseases.
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Affiliation(s)
- Ashaki D Patel
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Kimberly Katz
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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11
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El Amrousy D, Hassan S, El Ashry H. Chronic Hepatitis B Infection in Children and Its Relation to Pulmonary Function Tests: A Case-control Study. Pediatr Infect Dis J 2020; 39:192-196. [PMID: 31764377 DOI: 10.1097/inf.0000000000002543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the pulmonary function test (PFT) abnormalities, if any, in children with newly diagnosed chronic hepatitis B (CHB) infection over 3 years. METHODS This is an observational case-control study. One hundred children and adolescents with newly diagnosed CHB were enrolled as the patient group that was further subdivided into 2 groups (50 patients each): inactive carriers (group I) and patients in immunotolerant phase (group II). Only 90 patients completed the study. Fifty healthy children of matched age, sex and height served as a control group, only 45 of them completed the study. PFTs in the form of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, residual volume, total lung capacity, mid-forced expiratory flow of 25%-75% and diffusing capacity of the lung for carbon monoxide were evaluated in all studied children at the start, yearly and at the end of the study after 3 years. Liver function tests were also evaluated. RESULTS There was a significant progressive decrease in FEV1, FVC, forced expiratory flow, total lung capacity and diffusing capacity of the lung for carbon monoxide in CHB patient groups compared with their pulmonary functions at the start of the study and with the control group (P < 0.05), while FEV1/FVC and residual volume showed nonsignificant change (P > 0.05). CONCLUSIONS Subclinical PFT abnormalities are present in children with CHB more than we expected. So, PFT monitoring is recommended in pediatric patients with CHB.
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Affiliation(s)
- Doaa El Amrousy
- From the Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samir Hassan
- From the Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba El Ashry
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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12
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Wei MT, Henry L, Nguyen MH. Nonliver Comorbidities in Patients With Chronic Hepatitis B. Clin Liver Dis (Hoboken) 2019; 14:126-130. [PMID: 31632664 PMCID: PMC6784802 DOI: 10.1002/cld.829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mike T. Wei
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | - Linda Henry
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | - Mindie H. Nguyen
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
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13
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Risk factors of synchronous multifocal necrotizing fasciitis: a case control study in comparison with monofocal necrotizing fasciitis in Taiwan. BMC Infect Dis 2019; 19:513. [PMID: 31185920 PMCID: PMC6558844 DOI: 10.1186/s12879-019-4103-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 05/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background Monofocal necrotizing fasciitis (MONF) involves a single site in a rapidly progressing infection and necrosis of the fascia and surrounding soft tissue. Synchronous multifocal necrotizing fasciitis (SMNF), the simultaneous development of NF in multiple noncontiguous sites, is rarely reported. This study aimed to compare the clinical characteristics and outcomes between patients with SMNF and MONF, and to determine the risk factors of SMNF. Methods Our retrospective case-control study compared the clinical characteristics and outcomes, between January 2006 and January 2013, of patients with SMNF and of patients with MONF of the extremities. Results We enrolled 144 patients with NF of the extremities: 19 with SMNF and 125 with MONF. The duration of symptoms before admission was significantly shorter for the former than for the latter (1.7 days vs. 3.3 days, p = 0.001); the prevalence of shock at the initial visit significantly higher (73.7% vs. 36%, p = 0.002); and the total-case postoperative mortality rate significantly higher (68.4% vs. 14.4%, p < 0.001). In further analysis of the total-case mortality, 9 in 13 SMNF deaths (69.2%) within 7 days after fasciotomy were in the majority while 13 with 28-day mortality (72.2%) was the majority of MONF deaths (p < 0.001). SMNF was significantly more likely to involve bacteremia (89.5% vs. 36%, p < 0.001). Independent risk factors for SMNF were liver cirrhosis (LC) (odds ratio [OR] 6.0, p = 0.001) and end-stage renal disease (ESRD) (OR 7.1, p = 0.035). Gram-negative bacteria were most common in SMNF, and Gram-positive bacteria in MONF (83.3% vs. 53.3%, p = 0.005). Vibrio species were the most common single microbial cause (35.4%) of all NF patients and were the overwhelming cause (73.7%) of SMNF. Staphylococcus aureus and group A β-hemolytic streptococcus (45.6%) were the other predominant causes of MONF while both (10.5%) rarely caused multifocal NF. Conclusions SMNF was more fulminant than was MONF. SMNF was attributable primarily to marine Gram-negative bacteria. Physicians should be aware of SMNF because of its extremely high mortality rate.
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14
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Chen YY, Fang WH, Wang CC, Kao TW, Chang YW, Yang HF, Wu CJ, Sun YS, Chen WL. Crosssectional Assessment of Bone Mass Density in Adults with Hepatitis B Virus and Hepatitis C Virus Infection. Sci Rep 2019; 9:5069. [PMID: 30911051 PMCID: PMC6433944 DOI: 10.1038/s41598-019-41674-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis is one of the major complications in chronic hepatitis B virus (HBV) and hepatitis C (HCV) infection. However, few studies had examined the relationship between hepatic viral infection with bone loss. Our aim was to investigate the association between hepatic viral infection with bone mineral density (BMD) in a cross-sectional study. Participants who attended the health examinations at the Tri-Service General Hospital (TSGH), Taiwan, were enrolled in the study. Diagnosis of viral hepatitis was confirmed by the serum viral markers of hepatitis B surface antigen (HBsAg) and anti-HCV, and BMD measurement was performed by the bone densitometry. Subjects were divided into four groups by the presence of viral markers. The association between hepatic viral infection and BMD was examined by a multivariate linear regression model. HBV infection was inversely associated with BMD after full adjusting with β values of -0.17 (95% CI: -0.29, -0.05) (p < 0.05). The relationship remained significant in males (β = -0.16, 95% CI = -0.31, -0.01) (p < 0.05). In subjects with body mass index less than 30 HBV infection was associated with reduced BMD (β = -0.16, 95% CI = -0.29, -0.02) (p < 0.05). However, HCV infection was only associated with an increase in BMD in patients with BMI less than 30 (β = 0.17, 95% CI = 0.21, 0.32) (p < 0.05). Chronic HBV infection was significantly associated with reduced BMD in males. The impact of viral hepatitis on bone health deserves further investigation for the potential pathophysiological mechanisms.
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Affiliation(s)
- Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wen-Hui Fang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Clinical Medical, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yaw-Wen Chang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Fang Yang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Jung Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China
| | - Yu-Shan Sun
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China. .,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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15
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Kim SE, Jang ES, Ki M, Gwak GY, Kim KA, Kim GA, Kim DY, Kim DJ, Kim MW, Kim YS, Kim YS, Kim IH, Kim CW, Kim HD, Kim HJ, Park NH, Baik SK, Suh JI, Song BC, Song IH, Yeon JE, Lee BS, Lee YJ, Jung YK, Chung WJ, Cho SB, Cho EY, Cho HC, Cheon GJ, Chae HB, Choi D, Choi SK, Choi HY, Tak WY, Heo J, Jeong SH. Chronic Hepatitis B Infection Is Significantly Associated with Chronic Kidney Disease: a Population-based, Matched Case-control Study. J Korean Med Sci 2018; 33:e264. [PMID: 30310365 PMCID: PMC6179986 DOI: 10.3346/jkms.2018.33.e264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 or proteinuria as at least grade 2+ of urine protein. RESULTS HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m2 (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m2 along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m2. CONCLUSION Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m2 and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
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Affiliation(s)
- Sung-Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Gi-Ae Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Man Woo Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University, College of Medicine, Incheon, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju, Korea
| | - Chang Wook Kim
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Korea
| | - Ho Dong Kim
- Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Hyung Joon Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Neung Hwa Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeong Ill Suh
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Il Han Song
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jong Eun Yeon
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Youn Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Woo Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Bum Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Eun-Young Cho
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Hyun Chin Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hee Bok Chae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - DaeHee Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung-Kyu Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hwa Young Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Young Tak
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Han J, Wang S, Kwong TNY, Liu J. Dermatomyositis as an extrahepatic manifestation of hepatitis B virus-related hepatocellular carcinoma: A case report and literature review. Medicine (Baltimore) 2018; 97:e11586. [PMID: 30113453 PMCID: PMC6113031 DOI: 10.1097/md.0000000000011586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Dermatomyositis is an idiopathic inflammatory myopathy with specific cutaneous manifestations, which is closely associated with malignancy. However, the exact mechanism remains elusive. Even less is known about dermatomyositis with hepatocellular carcinoma (HCC). PATIENT CONCERNS We reported a case of dermatomyositis with hepatitis B virus (HBV) infection. He incidentally found his lower limbs little weakness accompanied with his wrist erythema. He was found HBsAg positive for forty years with slightly positive of α-fetal protein (AFP). DIAGNOSES A dermapathology from his hand-wrist lesions demonstrated a scattered inflammatory infiltrate around the capillaries of the dermis. Abdominal enhanced computer tomography (CT) revealed infiltrative HCC affecting the whole liver, accompanied by liver metastasis and liver cirrhosis. Liver tumor needle biopsy pathology showed HCC with moderate differentiation. The left supraclavicular lymph node needle biopsy pathology confirmed metastasic HCC. INTERVENTIONS Prednisolone was gradually withdrawn with the introduction of Entecavir 0.5 mg daily. Radiofrequency ablation therapy for liver tumor was performed once in order to decrease the tumor load. OUTCOMES His muscle power improved to grade 4+/5 in the lower limb one month after anti-HBV treatment. However, this patient died finally from liver failure due to the development of liver tumor. LESSONS In the coming clinic work, we must pay more attention to the extrahepatic disorder induced by HBV. On treating experience, glucocorticoid administration is often contraindicated for HBV infected patients because of its potential promotion of HBV replication. Thus, it is necessary to administrate high-effective anti-HBV drug prior to glucocorticoid treatment in order to prevent liver failure.
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Affiliation(s)
- Juqiang Han
- Institute of Hepatology, PLA Army General Hospital, Beijing, PR China
| | - Shuai Wang
- Institute of Hepatology, PLA Army General Hospital, Beijing, PR China
| | - Thomas Ngai Yeung Kwong
- Department of Medicine and Therapeutic, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Jian Liu
- Department of Rheumatology, Aerospace Center Hospital, Beijing, PR China
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17
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Kalantari H, Karimzadeh H, Kalantari S, Talebi M, Yaran M, Golpayegani J. Correlation between Vitamin D3 level and extrahepatic manifestation in chronic hepatitis type-C virus patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:22. [PMID: 29692819 PMCID: PMC5894268 DOI: 10.4103/jrms.jrms_366_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/26/2017] [Accepted: 12/18/2017] [Indexed: 11/04/2022]
Abstract
Background Chronic hepatitis type-C virus (HCV) infection is one of the most common worldwide viral disorders, which leads to various clinical complications as well as extrahepatic manifestations. Furthermore, Vitamin D3 has also been reported to have relationship with the mentioned complications. The aim is to evaluate the correlation between Vitamin D3 level and extrahepatic manifestation in chronic HCV patients. Materials and Methods This cross-sectional study has been carried out on 90 patients with chronic hepatitis C. The level of Vitamin D3 was assessed in plasma of 90 patients with chronic HCV. Genotyping was done and clinical and sign and symptoms of recruited patients were gathered. Extrahepatic manifestations were evaluated and the correlation of blood, hepatic, and immunological factors and the level of Vitamin D3 were assessed. Results Most of our patients were male (92% vs. 8%). Twenty-nine percent had the insufficient amount of Vitamin D3 (21-30 ng/ml), and the remains had the Vitamin D3 level between 13-20 ng/ml. Furthermore, our assessment demonstrated that deficiency of Vitamin D3 was associated with the extrahepatic manifestations such as purpura (odds radio [OR] [95% confidence interval (CI) 95%] = 8.80 [1.74-44.47], P = 0.004), vasculitis (OR [95% CI] = 11.70 [3.01-45.41], P < 0.001), arthralgia (OR [95% CI] = 20.26 [4.21-97.47], P < 0.001), myalgia (OR [95% CI] = 4.00 [1.01-17.27], P = 0.048), and glomerulonephritis (P = 0.021). Conclusion According to our results, the extrahepatic manifestation in the patients with sufficient levels of Vitamin D3 would be less possible. In fact, it could be stated that deficiency in the Vitamin D3 can have a significant relationship with these manifestations.
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Affiliation(s)
- Hamid Kalantari
- Department of Gastroenterology, Liver and Gastrointestinal Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadi Karimzadeh
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Kalantari
- Department of Endocrinology, Gilan University of Medical Sciences, Rasht, Iran
| | - Majid Talebi
- Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Yaran
- Department of Infectious Diseases, Isfahan Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Golpayegani
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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Tedesco D, Grakoui A. Environmental peer pressure: CD4 + T cell help in tolerance and transplantation. Liver Transpl 2018; 24:89-97. [PMID: 28926189 PMCID: PMC5739992 DOI: 10.1002/lt.24873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/30/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
Abstract
The liver participates in a multitude of metabolic functions that are critical for sustaining human life. Despite constant encounters with antigenic-rich intestinal blood, oxidative stress, and metabolic intermediates, there is no appreciable immune response. Interestingly, patients undergoing orthotopic liver transplantation benefit from a high rate of graft acceptance in comparison to other solid organ transplant recipients. In fact, cotransplantation of a donor liver in tandem with a rejection-prone graft increases the likelihood of graft acceptance. A variety of players may account for this phenomenon including the interaction of intrahepatic antigen-presenting cells with CD4+ T cells and the preferential induction of forkhead box P3 (Foxp3) expression on CD4+ T cells following injurious stimuli. Ineffective insult management can cause chronic liver disease, which manifests systemically as the following: antibody-mediated disorders, ineffective antiviral and antibacterial immunity, and gastrointestinal disorders. These sequelae sharing the requirement of CD4+ T cell help to coordinate aberrant immune responses. In this review, we will focus on CD4+ T cell help due to the shared requirements in hepatic tolerance and coordination of extrahepatic immune responses. Overall, intrahepatic deviations from steady state can have deleterious systemic immune outcomes and highlight the liver's remarkable capacity to maintain a balance between tolerance and inflammatory response while simultaneously being inundated with a panoply of antigenic stimuli. Liver Transplantation 24 89-97 2018 AASLD.
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Affiliation(s)
- Dana Tedesco
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University
| | - Arash Grakoui
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University,Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA,Corresponding Author: Arash Grakoui, Division of Infectious diseases, Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, Telephone: (404) 727-9368;
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19
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Soomro MH, Shi R, She R, Yang Y, Wang T, Wu Q, Li H, Hao W. Molecular and structural changes related to hepatitis E virus antigen and its expression in testis inducing apoptosis in Mongolian gerbil model. J Viral Hepat 2017; 24:696-707. [PMID: 28182318 DOI: 10.1111/jvh.12690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/19/2017] [Indexed: 02/06/2023]
Abstract
Hepatitis E virus (HEV) infection has been associated with a wide range of extrahepatic manifestations, so this study was designed to examine the effect and role of HEV on structural and molecular changes in the testicular tissues of Mongolian gerbils experimentally infected with swine HEV. HEV RNA was first detected in testis at 14 days post-inoculation and reached a peak between 28 and 42 days later with viral load between 3.12 and 6.23 logs/g by PCR assays. Changes including vacuolation, sloughing of germ cells, formation of multinuclear giant cells, degeneration, necrosis of tubules and damaged blood-testis barrier were observed through transmission electron microscopy. HEV ORF2 antigen was detected in the sperm cell cytoplasm along with decrease in relative protein of zonula occludens-1 through immunohistochemistry. HEV ORF3 antigen and ZO-1 protein were detectable by Western blotting. Lower (P<.05) serum testosterone and higher (P<.05) blood urea nitrogen level was observed in inoculated Mongolian gerbils. Likewise, increased (P<.05) germ cell apoptosis rate was detected with significant increased expression of Fas-L and Fas in HEV-inoculated groups at each time points. Up-regulation (P<.05 or P<.01) in mRNA level of Fas-L, Fas, Bax, Bcl-2 and caspase-3 was observed in HEV RNA-positive testes. Our study demonstrated that after experimental inoculation, HEV can be detected in testis tissues and viral proteins produce structural and molecular changes that in turn disrupt the blood-testis barrier and induce germ cell apoptosis.
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Affiliation(s)
- M H Soomro
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China.,Department of Parasitology, Faculty of Veterinary Sciences, Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Sakrand, Pakistan
| | - R Shi
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - R She
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - Y Yang
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - T Wang
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - Q Wu
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - H Li
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
| | - W Hao
- Laboratory of Animal Pathology and Public Health, College of Veterinary Medicine, China Agriculture University, Beijing, China
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20
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RELATIONSHIP BETWEEN UVEITIS, DIFFERENT TYPES OF VIRAL HEPATITIS, AND LIVER CIRRHOSIS: A 12-Year Nationwide Population-Based Cohort Study. Retina 2017; 36:2391-2398. [PMID: 27870801 PMCID: PMC5181127 DOI: 10.1097/iae.0000000000001103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE This study investigates whether patients with viral hepatitis and cirrhosis are at risk of uveitis in the years following hepatitis. METHODS We used data from Taiwan National Health Insurance system. The cases were patients newly diagnosed with viral hepatitis from 2000 to 2011. The end point of interest was a diagnosis of uveitis. A chi-square test was used for the difference of demographic characteristics between viral hepatitis and comparison. The risk of uveitis in hepatitis was stratified using Cox proportional hazard regression. RESULTS We selected 17,389 patients with viral hepatitis and 34,778 matched comparison. The risk of uveitis in hepatitis cohort was 1.30-fold (95% confidence interval = 1.01-1.69). Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk (hazard ratio = 2.88; 95% confidence interval = 1.07-7.78), and followed by only hepatitis C virus infection (hazard ratio = 1.75; 95% confidence interval = 1.10-2.79). Patients with cirrhosis had a higher risk in the multivariable model but did not attach statistic difference. CONCLUSION Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk of uveitis. In patients with hepatitis C virus and/or hepatitis B virus infection, the symptoms of uveitis should be alerted. Although these epidemiologic studies yielded informative results, the underlying mechanisms and the host's genetic factors remain to be investigated.
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21
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Tedesco D, Thapa M, Gumber S, Elrod EJ, Rahman K, Ibegbu CC, Magliocca JF, Adams AB, Anania F, Grakoui A. CD4 + Foxp3 + T cells promote aberrant immunoglobulin G production and maintain CD8 + T-cell suppression during chronic liver disease. Hepatology 2017; 65:661-677. [PMID: 27774611 PMCID: PMC5258825 DOI: 10.1002/hep.28894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/20/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022]
Abstract
Persistent hepatotropic viral infections are a common etiologic agent of chronic liver disease. Unresolved infection can be attributed to nonfunctional intrahepatic CD8+ T-cell responses. In light of dampened CD8+ T-cell responses, liver disease often manifests systemically as immunoglobulin (Ig)-related syndromes due to aberrant B-cell functions. These two opposing yet coexisting phenomena implicate the potential of altered CD4+ T-cell help. Elevated CD4+ forkhead box P3-positive (Foxp3+) T cells were evident in both human liver disease and a mouse model of chemically induced liver injury despite marked activation and spontaneous IgG production by intrahepatic B cells. While this population suppressed CD8+ T-cell responses, aberrant B-cell activities were maintained due to expression of CD40 ligand on a subset of CD4+ Foxp3+ T cells. In vivo blockade of CD40 ligand attenuated B-cell abnormalities in a mouse model of liver injury. A phenotypically similar population of CD4+ Foxp3+, CD40 ligand-positive T cells was found in diseased livers explanted from patients with chronic hepatitis C infection. This population was absent in nondiseased liver tissues and peripheral blood. CONCLUSION Liver disease elicits alterations in the intrahepatic CD4+ T-cell compartment that suppress T-cell immunity while concomitantly promoting aberrant IgG mediated manifestations. (Hepatology 2017;65:661-677).
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Affiliation(s)
- Dana Tedesco
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Manoj Thapa
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Sanjeev Gumber
- Division of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Elizabeth J. Elrod
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Khalidur Rahman
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Chris C. Ibegbu
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | | | - Andrew B. Adams
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Frank Anania
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Arash Grakoui
- Emory Vaccine Center, Division of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA
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22
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Aktas GE, Sarikaya A, Kandemir O. Hepatitis C Virus-related Arthritis: Bone Scintigraphic Appearances. Indian J Nucl Med 2017; 32:30-32. [PMID: 28242981 PMCID: PMC5317066 DOI: 10.4103/0972-3919.198468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A symptomatic joint involvement and arthralgia are frequent in patients with chronic hepatitis C virus (HCV) infection. However, HCV infection-related arthritis (HCVrA) affects up to 4-11% of the subjects suffering from disease. We reported a patient with HCVrA presented with the commonly accepted diagnostic clinical signs and laboratory parameters. The painful joints distinctly demonstrated increased uptake of Tc-99 m methylene diphosphonate in scintigraphy and normal findings in radiography.
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Affiliation(s)
- Gul Ege Aktas
- Department of Nuclear Medicine, Medical Faculty, Trakya University, 22030 Edirne, Turkey
| | - Ali Sarikaya
- Department of Nuclear Medicine, Medical Faculty, Trakya University, 22030 Edirne, Turkey
| | - Ozan Kandemir
- Department of Nuclear Medicine, Sivas Numune Hospital, 58060 Sivas, Turkey
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23
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Lee CY, Li YY, Huang TW, Huang TY, Hsu WH, Tsai YH, Huang JC, Huang KC. Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center. Infection 2016; 44:757-763. [PMID: 27778190 PMCID: PMC5121196 DOI: 10.1007/s15010-016-0932-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Abstract
Purpose No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Methods Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Conclusions Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.
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Affiliation(s)
- Ching-Yu Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan
| | - Jou-Chen Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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24
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Abstract
There are several extrahepatic cutaneous manifestations associated with hepatitis B and hepatitis C virus infection. Serum sickness and polyarteritis nodosa are predominantly associated with hepatitis B infection, whereas mixed cryoglobulinemia associated vasculitis and porphyria cutanea tarda are more frequently seen in hepatitis C infection. The clinico-pathogenic associations of these skin conditions are not completely defined but appear to involve activation of the host immune system including the complement system. Management of the aforementioned cutaneous manifestations of viral hepatitis is often similar to that done in cases without viral hepatitis, with control of immune activation being a key strategy. In cases associated with hepatitis B and C, control of viral replication with specific antiviral therapy is also important and associated with improvement in most of the associated clinical manifestations.
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Abstract
Viral hepatitis is a significant disease afflicting hundreds of millions of people. Hepatitis-causing viruses initiate significant morbidity and mortality by establishing both acute and chronic infections, and several of these viruses are specifically associated with the development of hepatocellular carcinoma (HCC). Consequently, intense research efforts are focused on increasing our understanding of virus biology and on improving antiviral therapy. Even though viral hepatitis can be caused by several viruses from a range of virus families, the discovery of components of the hepatitis B virus (HBV) became a catalyst for the development of diagnostic assays that differentiate between these viruses as well as strategies for novel methods of vaccine development. Improvements in both the treatment and prevention of viral hepatitis are advancing rapidly. However, HBV, along with the associated infection by the hepatitis D virus, is still among the most common pathogens afflicting humans.
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MESH Headings
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/virology
- Genome, Viral
- Hepatitis B virus/genetics
- Hepatitis Delta Virus/genetics
- Hepatitis, Chronic/virology
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/history
- Hepatitis, Viral, Human/therapy
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
- Liver Neoplasms/epidemiology
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Affiliation(s)
- Emmanuel Thomas
- Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Masato Yoneda
- Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Eugene R Schiff
- Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida 33136
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26
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Nishida N, Kudo M. Clinical features of vascular disorders associated with chronic hepatitis virus infection. Dig Dis 2014; 32:786-90. [PMID: 25376297 DOI: 10.1159/000368023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatitis virus infections can be accompanied by extrahepatic manifestations that may be caused by the host's immune reaction to the viral infection. Vascular involvement is one of these manifestations and is occasionally associated with life-threatening conditions due to systemic organ failure. The unique profile of hepatitis-related vascular involvement is associated with infection by different types of hepatitis viruses. For example, polyarteritis nodosa is more frequently reported in patients with chronic hepatitis B than those with chronic hepatitis C. Similarly, membranous nephropathy is a notable manifestation among hepatitis B virus-positive patients. In contrast, patients infected with hepatitis C virus are at risk for cryoglobulinemia and membranoproliferative glomerulonephritis. Antiviral therapy is necessary to control these kinds of vasculitis related to hepatitis virus infections; however, immunosuppressive agents may be required to treat severe cases. New antiviral drugs for viral hepatitis could improve the prognosis of vascular and renal involvement.
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Affiliation(s)
- Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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27
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Lebano R, Rosato V, Masarone M, Romano M, Persico M. The effect of antiviral therapy on hepatitis C virus-related thrombocytopenia: a case report. BMC Res Notes 2014; 7:59. [PMID: 24457056 PMCID: PMC3915622 DOI: 10.1186/1756-0500-7-59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 01/20/2014] [Indexed: 12/22/2022] Open
Abstract
Background Autoimmune thrombocytopenic purpura is an immunological disorder characterized by increased platelet destruction due to presence of anti-platelet autoantibodies. Hepatitis C virus infection, which is one of the most common chronic viral infections worldwide, may cause secondary chronic immune thrombocytopenic purpura. Case presentation We report a case of a 51-year-old Caucasian female with hepatitis C virus infection who developed a severe, reversible, immune thrombocytopenia. Platelet count was as low as 56.000/mm3, hepatitis C virus serology was positive, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and gamma-glutamyltransferase serum levels were elevated. Disorders potentially associated with autoimmune thrombocytopenic purpura were ruled out. A corticosteroid treatment was started and led to an increase in platelet count. The patient was then treated with pegylated-interferon alpha 2a and ribavirin. After four weeks of treatment hepatitis C virus - ribonucleic acid became undetectable and steroid treatment was discontinued. Six months of antiviral therapy achieved a sustained biochemical and virological response together with persistence of normal platelet count. Conclusion In our case report hepatitis C virus seemed to play a pathogenic role in autoimmune thrombocytopenic purpura. Moreover, the successful response (negative hepatitis C virus - ribonucleic acid) to tapered steroids and antiviral therapy was useful to revert thrombocytopenia.
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Affiliation(s)
| | | | | | | | - Marcello Persico
- Department of Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy.
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28
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Lei X, Gao X, Yang J, Sun Y, Sai Y, You W, Yuan H. The genotype C could play a key role in hepatitis B virus associated nephritis among the northwest Chinese children. Eur J Intern Med 2013; 24:835-8. [PMID: 23988262 DOI: 10.1016/j.ejim.2013.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/04/2013] [Accepted: 07/16/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatitis B virus-associated glomerulonephritis (HBV-GN) is a kind of immune complex-induced glomerulonephritis. The present study was designed to determine whether Hepatitis B virus (HBV) genotype is associated with glomerulonephritis in north-west Chinese children. METHODS A total of 296 HBV-infected patients were enrolled in this study. The serum of patients was subjected to DNA extraction and the HBV genotypes were determined by PCR. RESULTS The results showed that genotype C (49%) was predominant within the subjects, compared to HBV/B (38.5%), B/C recombinant (7.4%) and none B/C (5.1%). The serum tests showed that the changes of Complement 3 (C3) and alanine amino transferase (ALT) levels in the genotype C patients were significantly greater than those in the genotype B patients. The frequency of genotype C in HBV-GN patients was higher than that in non HBV-GN patients (χ2 value=30.239, P<0.001). But, it was not associated with renal dysfunction. Furthermore, The genotype C was associated with high HBV-DNA load (82.9% vs 17.1%, P<0.001), which is seen more frequently in the HBV-GN children (86.3% vs 13.3%, P=0.004). CONCLUSIONS The genotype C may play a role in HBV-GN children, via favoring HBV replication.
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Affiliation(s)
- Xiaoyan Lei
- Pediatric Department, Gansu Provincial Hospital, Lanzhou City, 730000, China.
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29
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Abstract
Eltrombopag is a 2nd generation thrombopoietin-receptor agonist. It binds with the thrombopoietin-receptors found on the surfaces of the megakaryocytes & increases platelet production. Many recent studies have suggested a potential role for this novel agent in the treatment of thrombocytopenia associated with hepatitis-C infection. Studies have shown that adjunct treatment with Eltrombopag can help avoid dose reductions/withdrawals of pegylated interferon secondary to thrombocytopenia. It may also have a role in priming up platelet levels to help initiate antiviral therapy. Similarly, chronic liver disease patients with thrombocytopenia who need to undergo an invasive procedure may be potential candidates for short two-week courses of eltrombopag in the periprocedural period to help reduce the risk of bleeding. Besides the price (deemed very expensive and probably not cost-effective), there are some legitimate concerns about the safety profile of this novel agent (most importantly, portal vein thrombosis, bone marrow fibrosis and hepatotoxicity). In this article, the potential role of eltrombopag in the context of hepatitis C virus (HCV)-related thrombocytopenia is reviewed. To write this article, a MEDLINE search was conducted (1990 to November 2012) using the search terms “eltrombopag,” “HCV,” and “thrombocytopenia.”
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30
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Alavian SM, Mahboobi N, Mahboobi N, Karayiannis P. Oral conditions associated with hepatitis C virus infection. Saudi J Gastroenterol 2013; 19:245-51. [PMID: 24195977 PMCID: PMC3958971 DOI: 10.4103/1319-3767.121032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection in more than 170 million chronically infected patients with no developed preventive vaccine is a globally important issue. In addition to expected hepatic manifestations, a number of extrahepatic manifestations, such as mixed cryoglobulinemia, glomerulonephritis, polyarteritis nodosa, rashes, renal disease, neuropathy, and lymphoma, have been reported following HCV infection, which are believed to be influenced by the virus or the host immune response. HCV combination therapy with pegylated interferon and ribavirin might be associated with side effects as well. The association of HCV with special oral conditions has also been reported recurrently; the mechanism of most of which remains unclear. This article reviews the association of HCV infection with some of the oral conditions such as oral health, Sjogren's syndrome, lichen planus and oral cancer.
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Affiliation(s)
- Seyed-Moayed Alavian
- Department of Gastroenterology and Hepatology, Baqiyatallah University of Medical Sciences, Research Center for Gastroenterology and Liver Disease, Tehran, Iran,Address for correspondence: Prof. Seyed-Moayed Alavian, Professor of Gastroenterology and Hepatology, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Ground Floor of Baqiyatallah Hospital, Mollasadra Avenue, Vanak Square, Tehran, Iran. E-mail:
| | - Nastaran Mahboobi
- Department of Neurology, Marien Hospital Euskirchen, Lehrkrankenhaus der Uni-Bonn, Germany
| | - Nima Mahboobi
- Department of Oral and Maxillofacial Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Karayiannis
- Department of Medicine, Imperial College, Variety Wing Floor D, St Mary's Campus, Norfolk Place, London, England
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31
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Abstract
Approximately 400 million worldwide are chronically infected with the hepatitis B virus (HBV). During the course of illness, approximately 20% of patients develop disease manifestations outside the liver. Neuropathy develops in approximately 5% of patients with chronic HBV infection and rarely during acute HBV infection. The pathogenesis of the various HBV-associated neuropathy syndromes possibly involves deposition of immune complexes in nerves or blood vessel walls. Direct viral infection of nerves has not been demonstrated. Management entailed supportive care with antiviral and immunomodulatory treatment as clinically indicated. Rare cases of muscle disease, mostly inflammatory myopathy, have been associated with HBV infection. Presumably, HBV-associated antigens trigger immune mechanisms directed against components of muscle tissue. There is no evidence of replicative virus infection of muscle fibers. Management entailed immunomodulatory treatment, occasionally with anti-HBV therapy. Physicians should be aware that HBV infection has the potential to trigger presumed immune-mediated neuromuscular syndromes.
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32
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Idilman R, Bozkus Y, Seval G, Mizrak D, Cinar K, Ustun Y, Bektas M, Arat M, Akbulut H, Doganay B, Ozden A. Lymphoproliferative disorders in individuals with chronic hepatitis B and C in the Turkish population. J Med Virol 2012; 83:974-80. [PMID: 21503909 DOI: 10.1002/jmv.21747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aims of this cohort study were to evaluate the association of malignant lymphoproliferative disorders in patients with chronic viral hepatitis and to compare the results with those in individuals with non-alcoholic fatty liver disease. A total of 3,873 patients with chronic liver disease who were seen consecutively in the Liver Disease Outpatient Clinic between January 2001 and July 2007 were assessed retrospectively. The frequency of malignant lymphoproliferative disorders including non-Hodgkin's lymphoma, Hodgkin's lymphoma, and chronic lymphocytic leukemia in these patients was investigated. Of the total, 1,999 patients had chronic hepatitis B infection (male/female: 1,226/773, mean age: 45.1 ± 13.2 years), 978 had chronic hepatitis C infection (male/female: 437/541, mean age: 53.8 ± 13.7 years), and the remaining 896 had non-alcoholic fatty liver disease (male/female: 450/446, mean age: 50.8 ± 11.2 years). A malignant lymphoproliferative disorder was identified in 13 patients (male/female: 9/4, mean age: 52.8 ± 16.8 years) with chronic viral hepatitis, while no case of malignant lymphoproliferative disorder was identified in individuals with non-alcoholic fatty liver disease (P = 0.048). Among the patients with malignant lymphoproliferative disorders, seven had chronic hepatitis B infection and six had chronic hepatitis C infection; 11 had non-Hodgkin's lymphoma and two had chronic lymphocytic leukemia. All non-Hodgkin's lymphoma cases were B-cell lymphoma. Based on the data obtained in this investigation, the association with malignant lymphoproliferative disorders in chronic viral hepatitis seems to be high as compared to that occurring in individuals with non-alcoholic fatty liver disease.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey.
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Abstract
Human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV), and herpes simplex virus (HSV) have been incurable to date because effective antiviral therapies target only replicating viruses and do not eradicate latently integrated or nonreplicating episomal viral genomes. Endonucleases that can target and cleave critical regions within latent viral genomes are currently in development. These enzymes are being engineered with high specificity such that off-target binding of cellular DNA will be absent or minimal. Imprecise nonhomologous-end-joining (NHEJ) DNA repair following repeated cleavage at the same critical site may permanently disrupt translation of essential viral proteins. We discuss the benefits and drawbacks of three types of DNA cleavage enzymes (zinc finger endonucleases, transcription activator-like [TAL] effector nucleases [TALENs], and homing endonucleases [also called meganucleases]), the development of delivery vectors for these enzymes, and potential obstacles for successful treatment of chronic viral infections. We then review issues regarding persistence of HIV-1, HBV, and HSV that are relevant to eradication with genome-altering approaches.
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Riccio A, Tarantino G. Hepatitis C virus-related arthritis and rheumatoid arthritis: could they be different aspects of the same disease? Int J Immunopathol Pharmacol 2012; 25:293-6. [PMID: 22507344 DOI: 10.1177/039463201202500134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role played by HCV in the genesis of many autoimmune disorders has been reported in several studies. In particular, the onset of arthritis has been described in about 2-3 percent of HCV infection cases. At present, this HCV-related arthritis is classified as a reactive arthritis, but a real distinction of this form from classical rheumatoid arthritis is often difficult. In this presentation, the Authors distinguish two arthritic forms observed in HCV-related arthritis patients: one, characterized by asymmetrical oligoarticular-involvement, and another, with poly-articular symmetrical involvement. The Authors suggest that the latter can be considered as a form of rheumatoid arthritis, because of the similarity of the main clinical aspects and laboratory findings (rheumatoid factor, anti-cyclic citrullinated peptide antibodies) to those of classical rheumatoid arthritis, which make the two forms indistinguishable. Therefore, HCV could be considered the etiologic agent of a limited number of cases of rheumatoid arthritis.
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Lu H, Zhu H, Zhou J. S gene mutations of HBV in children with HBV-associated glomerulonephritis. Virol J 2012; 9:59. [PMID: 22390814 PMCID: PMC3311139 DOI: 10.1186/1743-422x-9-59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 03/05/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hepatitis B virus-associated glomerulonephritis (HBV-GN) is a kind of immune complex-induced glomerulonephritis. The present study was designed to determine whether mutation of Hepatitis B virus (HBV) S gene is associated with glomerulonephritis in Chinese children. METHODS Total 53 subjects, including 30 HBV-GN, 5 nephrosis with HBV carriers (control group 1), and 18 HBV carriers (control group 2) were included in this study. Polymerase chain reaction (PCR) was used to detect the HBV-GN S gene mutation. RESULTS (1) The serotype of HBV was adw in the majority (52/53) of subjects, and was adr in only 1 subject in the control group 2; (2) the genotype of HBV was the type B in 51 subjects, the type E in 1 HBV-GN child, and the type C in 1 HBV carrier; (3) Seventeen point mutations in the S gene of HBV were identified in 21 of 30 (70%) HBV-GN patients. Among them, 16 of 21 (76.2%) mutations may cause amino acid substitutions of the HBV proteins, which occur predominantly (11/16 mutations) at threonine, serine or tyrosine phosphorylation sites of mitogen-activated protein kinase (MAPK) or protein tyrosine kinase (PTK). (4) In addition, single nucleotide mutations without amino acid substitutions (same sense mutation) were found in 2 subjects in each control group and 5 subjects in HBV-GN group. CONCLUSIONS HBV S gene mutations and the subsequent amino acid substitutions in HBV proteins were found in most children with HBV-GN, suggesting that these mutations may play an important role in the pathogenesis of HBV-GN.
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Affiliation(s)
- Hongzhu Lu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
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36
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Riccio A, Postiglione L, Sabatini P, Linvelli M, Soriente I, Sangiolo M, Amato P, Tarantino G. Similar Serum Levels of IL-6 and its Soluble Receptors in Patients with HCV-Related Arthritis and Rheumatoid Arthritis: A Pilot Study. Int J Immunopathol Pharmacol 2012; 25:281-5. [DOI: 10.1177/039463201202500132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The high serum levels of Interleukin-6 (IL-6) and its soluble receptors (sIL-6r and sgp 130), described in the course of Rheumatoid Arthritis (RA), have been linked to the enhanced activity of this cytokine in this disorder. In this study, the serum concentrations of IL-6 and its soluble receptors were determined in a group of patients with HCV-related arthritis (HCVrA), a condition resembling RA in several aspects, and then compared to those found in a sample of subjects affected by RA. Twenty-one patients with HCVrA, 24 patients with RA and 20 healthy subjects (control group) were examined. Different ELISA methods were used for determination of serum concentrations of IL-6, sIL-6r and sgp 130. Increased IL-6 serum levels were found in 15 (71%) of the patients with HCVrA and in 16 (62%) of those with RA. Eight (38%) of the patients with HCVrA and 11 (46%) of those with RA denoted high levels of sIL-6r, while sgp 130 levels were elevated in 21 (76%) of the patients with HCVrA and in 16 (69%) of those with RA. A significant difference between the median values of sIL-6r and sgp 130 levels in the two groups of patients versus controls was found. A mild correlation of these parameters with RF levels was detected in the RA group. Furthermore, in HCVrA patients the serum levels of IL-6, sIL-6r and sgpl30 appeared unrelated to HCV viraemia and to levels of transaminases. The enhanced serum levels of IL-6 in HCVra patients indicate an increased synthesis and hyperactivity of this cytokine in HCVrA, and the substantial similarity of the behaviour of IL-6 and its serum receptors in the two groups of patients suggests common mechanisms with RA, in which the function of IL-6 is central.
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Affiliation(s)
- A. Riccio
- Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
| | - L. Postiglione
- Department of Cellular and Molecular Biology and Pathology “L. Califano”
| | - P. Sabatini
- U.O.C. Clinical Pathology D.E.A. II Umberto I, A.S.L. SA 1, Nocera Inferiore, Salerno, Italy
| | - M. Linvelli
- Department of Cellular and Molecular Biology and Pathology “L. Califano”
| | - I. Soriente
- U.O.C. Clinical Pathology D.E.A. II Umberto I, A.S.L. SA 1, Nocera Inferiore, Salerno, Italy
| | - M.G. Sangiolo
- Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
| | - P. Amato
- Department of Medicine, A.S.L. SA 1, Nocera Inferiore, Salerno, Italy
| | - G. Tarantino
- Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
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Halawani M, Bakir TM. Determination of hepatitis C virus genotypes in pruritus patients in saudi arabia. Genet Test Mol Biomarkers 2011; 16:46-9. [PMID: 21967468 DOI: 10.1089/gtmb.2011.0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The main objective of this study was to estimate the prevalence of Hepatitis C virus (HCV) genotypes in 56 pruritus patients and 50 healthy blood donors on the basis of clinical and laboratory investigations. Both demographic and clinical data were collected from each subject after obtaining informed consent and approval from an ethics committee. Ten milliliters of venous blood was collected from fasting patients (8-10 h) and serum was used for aspartate transaminase and alanine transaminase tests, anti-HCV antibody testing, HCV-RNA polymerase chain reaction screening, and genotyping analysis. HCV was found to be significantly predominant over HBV infection among the pruritus patients (p<0.001). Twelve pruritus patients (21.42%) were positive for anti-HCV antibodies and nine of them were confirmed positive for HCV RNA presence. Of the two major genotypes revealed, genotype 4 was found to be significantly predominant over the mixed genotype, that is, 4a/c+3a (p<0.001). Subtyping results showed that a significant majority of the type 4 were of the HCV subtype 4a (five patients), followed by 4c (two patients) and 4b genotypes (one patient) and mixed genotype 4a/c+3a (one patient). Results of this prospective study indicated the significant association between pruritus and HCV infection. HCV genotype 4 is the most predominant genotype among the pruritus patients and warrants larger studies in different ethnicities to find the molecular association between HCV genetic variants and pruritus.
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Affiliation(s)
- Mona Halawani
- Department of Dermatology, College of Medicine and King Khalid University Hospital, King Saud University , Riyadh, Kingdom of Saudi Arabia
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38
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Virus de l’hépatite B, manifestations extrahépatiques immunologiques et risque de réactivation virale. Rev Med Interne 2011; 32:622-7. [DOI: 10.1016/j.revmed.2010.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/24/2010] [Accepted: 08/17/2010] [Indexed: 01/15/2023]
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Elhawary EI, Mahmoud GF, El-Daly MA, Mekky FA, Esmat GG, Abdel-Hamid M. Association of HCV with diabetes mellitus: an Egyptian case-control study. Virol J 2011; 8:367. [PMID: 21791087 PMCID: PMC3199807 DOI: 10.1186/1743-422x-8-367] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/26/2011] [Indexed: 12/17/2022] Open
Abstract
Background The highest Hepatitis C Virus (HCV) prevalence in the world occurs in Egypt. Several studies from different parts of the world have found that 13% to 33% of patients with chronic HCV have associated diabetes, mostly type II Diabetes Mellitus (DM). In Egypt the prevalence of DM is 25.4% among HCV patients. Therefore, it is important to identify the magnitude of the problem of diabetes in order to optimize the treatment of chronic hepatitis C. Methods The objective of this case-control study was to evaluate the prevalence of DM and other extrahepatic (EH) manifestations among patients with different HCV morbidity stages including asymptomatic, chronic hepatic and cirrhotic patients. In this study, 289 HCV patients older than 18 were selected as cases. Also, 289 healthy controls were included. Laboratory investigations including Liver Function tests (LFT) and blood glucose level were done. Also serological assays including cryoglobulin profile, rheumatoid factor, antinuclear antibody, HCV-PCR were performed. Results Out of 289 HCV cases, 40 (13.84%) were diabetic. Out of 289 healthy controls, 12 (4.15%) were diabetic. It was found that the diabetic HCV group mean age was [48.1 (± 9.2)]. Males and urbanians represented 72.5% and 85% respectively. Lower level of education was manifested in 52.5% and 87.5% were married. In the nondiabetic HCV group mean age was [40.7 (± 10.4)]. Males and urbanians represented 71.5% and 655% respectively. secondary and higher level of education was attained in 55.4% and 76.7% were married. Comparing between the diabetic HCV group and the non diabetic HCV group, age, residence and alcohol drinking were the only significant factors affecting the incidence of diabetes between the two groups. There was no significant difference regarding sonar findings although cirrhosis was more prevalent among diabetic HCV cases and the fibrosis score was higher in diabetic HCV patients than among the non diabetic HCV cases. Conclusion The diabetic patients in the HCV group were older, more likely to have a history of alcohol drinking than the non diabetic HCV cases. Age and alcohol drinking are factors that could potentially contribute to the development of type 2 diabetes. Logistic regression analyses showed that age and residence in urban regions were the predictive variables that could be associated with the presence of diabetes. Alcohol consumption was not a significant predictive factor.
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Affiliation(s)
- Eman I Elhawary
- Microbiology Department, Faculty of Pharmacy, Minia University, Minia, Egypt.
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Abstract
Chronic liver disease is associated with several cutaneous manifestations. Although many of these changes are nonspecific, some are associated with distinct liver diseases and correlate with the severity of hepatic pathology. Often the first clue to a liver disease is manifested through skin. Although cirrhosis is associated with spider nevi and palmar erythema, disorders can result in noncirrhotic cutaneous manifestations. It is important for physicians to be familiar with the spectrum of these manifestations, to recognize, help detect, and treat the underlying hepatic disease. This article reviews the medical literature and discusses the spectrum of dermatologic manifestations of liver disorders and their pathogenesis, significance, and treatment.
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Abstract
A 52-year-old man with chronic hepatitis C presented with painless, bilateral, simultaneous nonarteritic anterior ischemic optic neuropathy (NAION) and peripheral neuropathy. Symptoms began 19 weeks after starting peginterferon alpha-2a. The peripheral neuropathy and vision of the right eye improved, but the vision of the left eye worsened after stopping interferon. We identified 23 additional cases of NAION during interferon alpha therapy. At least 12 of these patients suffered bilateral NAION. Patients lost vision 1-40 weeks after initiating therapy. Of 21 eyes that had documented initial and follow-up acuities, 8 improved, 1 worsened, and the rest remained stable. One patient had a painful peripheral neuropathy. Treatment with interferon alpha may result in NAION. Discontinuation of therapy deserves consideration after weighing individual risks and benefits.
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Abstract
An estimated 2 million people are living with chronic hepatitis B virus (CHBV) in the United States and are at risk for long-term consequences such as cirrhosis, liver decompensation, and hepatocellular carcinoma. Less than 10 years ago, there was no treatment of CHBV infection, but now, new drugs have recently been approved and there is considerable new knowledge about the treatment of CHBV infection. Recently, consensus guidelines for the management of hepatitis B virus infection have been released by the National Institutes of Health and the American Medical Association, addressing the selection of patients and drugs for treatments. Determining what constitutes best practices to manage patients with CHBV is challenging and requires nurses and nurse practitioners to acquire and maintain up-to-date knowledge to understand recently approved drugs and disease management. Nurses and nurse practitioners should know how to identify patients who need treatment and how to educate, counsel, and monitor treatment adherence and side effects; these skills are crucially important. The goal of this article is to provide nurses with the most current consensus guidelines for the management of CHBV infection and their application in nursing practice to optimize treatment to enhance patient outcomes.
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Affiliation(s)
- Haeok Lee
- College of Nursing & Health Sciences, University of Massachusetts-Boston, Boston, MA 02125, USA.
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Kang JH, Lin HC. Comorbidities in patients with primary Sjogren's syndrome: a registry-based case-control study. J Rheumatol 2010; 37:1188-94. [PMID: 20360180 DOI: 10.3899/jrheum.090942] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although multiple diseases associated with primary Sjögren's syndrome (pSS) have been reported, reliable data regarding the prevalence of specific medical comorbidities among patients with pSS remain sparse. We investigated the prevalence and risk for a broad spectrum of medical conditions among patients with pSS in Taiwan. METHODS A total of 1974 patients with pSS were eligible for inclusion in the study group. We randomly selected 9870 enrollees matched with the study subjects, using the Taiwan National Health Insurance Research Dataset for 2006 and 2007, inclusive. Conditional logistic regression analyses conditioned on sex, age, monthly income, and level of urbanization of the patient's community were used to calculate the odds ratios (OR) of various comorbid conditions. RESULTS Pearson chi-square tests revealed that patients with pSS had significantly higher prevalence of hyperlipidemia, cardiac arrhythmias, headaches, migraines, fibromyalgia (FM), asthma, pulmonary circulation disorders, hypothyroidism, liver disease, peptic ulcers, hepatitis B, deficiency anemias, depression, and psychoses. Conditional regression analyses showed that, compared to patients without the condition, patients with pSS were more likely to have hyperlipidemia (OR 1.42), cardiac arrhythmias (OR 1.32), headaches (OR 1.47), migraines (OR 1.86), FM (OR 1.71), asthma (OR 1.54), pulmonary circulation disorders (OR 1.42), hypothyroidism (OR 2.37), liver disease (OR 1.89), peptic ulcers (OR 1.88), hepatitis B (OR 2.34), deficiency anemias (OR 1.33), depression (OR 2.57), and psychoses (OR 2.15). CONCLUSION The prevalence of several comorbidities was increased among the patients with pSS. Our study provides epidemiological data for comorbidities among pSS patients in an ethnic Chinese population.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation and Neuroscience Research Center, Taipei, Taiwan
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Stasi R, Willis F, Shannon MS, Gordon-Smith EC. Infectious causes of chronic immune thrombocytopenia. Hematol Oncol Clin North Am 2010; 23:1275-97. [PMID: 19932434 DOI: 10.1016/j.hoc.2009.08.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Persistent thrombocytopenia may be the consequence of chronic infections with hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori, and should be considered in the differential diagnosis of primary immune thrombocytopenia (ITP). Studies have shown that on diagnosis of infections, treatment of the primary disease often results in substantial improvement or complete recovery of the thrombocytopenia. In patients with thrombocytopenia due to HCV-related chronic liver disease, the use of eltrombopag, a thrombopoietin receptor agonist, normalizes platelet levels, thereby permitting the initiation of antiviral therapy. Antiviral therapy with highly active antiretroviral therapy for HIV has aided in platelet recovery, with a corresponding decrease in circulating viral load. Thrombocytopenia in the absence of other disease symptoms requires screening for H. pylori, especially in countries such as Japan, where there is a high prevalence of the disease and the chances of a platelet response to eradication therapy are high.
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Affiliation(s)
- Roberto Stasi
- Department of Haematology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Danish FA, Koul SS, Subhani FR, Rabbani AE, Yasmin S. Considerations in the management of hepatitis C virus-related thrombocytopenia with eltrombopag. Saudi J Gastroenterol 2010; 16:51-6. [PMID: 20065578 PMCID: PMC3023106 DOI: 10.4103/1319-3767.58772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia is a common clinical problem in HCV-infected cases. Multiple studies have consistently shown a rise in platelet count following a successful HCV treatment thus proving a cause-effect relationship between the two. Although, many therapeutic strategies have been tried in the past to treat HCV-related thrombocytopenia (e.g. interferon dose reductions, oral steroids, intravenous immunoglobulins, splenectomy etc), the success rates have been variable and not always reproducible. After the cessation of clinical trials of PEG-rHuMGDF due to immunogenecity issues, the introduction of non-immunogenic second-generation thrombopoietin-mimetics (eltrombopag and Romiplostim) has opened up a novel way to treat HCV-related thrombocytopenia. Although the data is still sparse, eltrombopag therapy has shown to successfully achieve the primary endpoint platelet counts of >/=50,000/muL in phase II& III, randomized, double-blind, placebo-controlled trials. Likewise, though it is premature to claim safety of this drug especially in high-risk patient groups, reported side effects in the published literature were of insufficient severity to require discontinuation of the drug. Based on the current and emerging evidence, a review of the pharmacologic basis, pharmacokinetics, therapeutic efficacy, safety profile and future considerations of eltrombopag in the context of HCV-related thrombocytopenia is given in this article. A MEDLINE search was conducted (1990 to August 2009) using the search terms eltrombopag, HCV, thrombocytopenia.
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Affiliation(s)
- Fazal A. Danish
- Princess of Wales Hospital, Coity Road, Bridgend, United Kingdom,Address for correspondence: Dr. Fazal A. Danish, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK.
| | - Salman S. Koul
- Department of Medicine (Unit-I), Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Fazal R. Subhani
- Department of Pediatrics, Holy Family Hospital, Rawalpindi, Pakistan
| | | | - Saeeda Yasmin
- Department of Surgery (Unit-II), Rawalpindi General Hospital, Rawalpindi, Pakistan
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Halawani M, Balbisi A, Alotaibi H, Alsaif F, Bakir TM. The prevalence of HCV antibodies in skin disease patients in Saudi Arabia. Saudi Pharm J 2009; 18:35-9. [PMID: 23960718 DOI: 10.1016/j.jsps.2009.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 10/17/2009] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIM Hepatitis C virus (HCV) infection is a worldwide health issue with about 3% of the world's population having HCV. In Saudi Arabia, prevalence ranges from 1.0% to 5.87%. Cutaneous diseases can indicate the presence of HCV infection. OBJECTIVES The research project aims to identify prospectively the prevalence of HCV infection in 200 patients with various types of skin disorders and 50 healthy blood donors, and to quantify this association through clinical and laboratory investigations. METHODS Two hundred patients with cutaneous manifestations who presented at the Dermatology outpatient clinics of King Khalid University Hospital (KKUH) and King Abdulaziz University Hospital (KAUH), Riyadh, and 50 healthy blood donors were prospectively studied. Patients were examined by a team of dermatologists and clinical data were collected through a standard questionnaire. Ten milliliters of venous blood were collected from fully consented, 8-10 h fasting patients and serum was analyzed for AST, ALT, double infection with HBsAg, anti-HCV antibodies, and screened for HCV-RNA-PCR. RESULTS Patients from the study (n = 200) consisted of 25 (12.5%) males and 175 (87.5%) females, with a mean age of 42.9 ± 15.06 years. Clinical examinations revealed that (35%) had urticaria, followed by pruritus (28%), lichen planus (25.5%), prurigo (10%), and palpable purpura (1.5%). The main serum levels of ALT and AST were within the normal reference ranges. Twenty-four patients (12%) tested positive for anti-HCV antibodies, with 15 (62.5%) being positive for the presence of HCV-RNA by PCR and 9 (37.5%) resulting negative for the viral RNA. Of the 24 anti-HCV positive patients, pruritus 12 (50%), urticaria 5 (20.8%), lichen planus 5(20.8%), and palpable purpura 2(8.3%). Five (2.5%) patients were positive for HBsAg, with 3 (60%) having pruritus and 2 (40%) presenting with urticaria. Of the 50 healthy blood donors, only one (2%) tested positive for the presence of anti-HCV antibodies, and all the donors tested negative for HBsAg. CONCLUSION Results clearly indicate the prevalence of anti-HCV antibodies in 24 out of 200 patients (12%) with skin manifestations seen at the dermatology outpatient clinics and documented with HCV-RNA-PCR positivity of 15/24 (62.5%). A p-value of <0.05 was considered significant, therefore, it is suggested that patients presenting with urticaria, pruritus and LP be investigated to exclude the possibility of HCV infection.
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Affiliation(s)
- Mona Halawani
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia
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Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol 2009; 24:649-54. [DOI: 10.1111/j.1468-3083.2009.03476.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
This article focuses on autoimmune manifestations related to the hepatitis B virus (HBV). Although the HBV vaccination has resulted in the decline of the virus, approximately 400 million individuals are infected worldwide. Up to twenty percent of the afflicted may develop extrahepatic manifestations ranging from the severe polyarteritis nodosa to the many, varied, and less severe clinical and biologic forms. Currently, control of the viral infection is mainly based on the use of antiviral drugs (with the current availability of potent agents). Discussion of two hypotheses of the pathophysiology of the virus is followed by descriptions of the general, renal, rheumatologic, neurologic, skin, ophthalmologic, and hematologic manifestations.
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Affiliation(s)
- Patrice Cacoub
- Service de Médecine Interne, AP, HP Pitié-Salpêtrière Hospital Group, 75651 Paris Cedex 13, France.
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Stasi R. Therapeutic strategies for hepatitis- and other infection-related immune thrombocytopenias. Semin Hematol 2009; 46:S15-25. [PMID: 19245929 DOI: 10.1053/j.seminhematol.2008.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Secondary thrombocytopenia may result from autoimmune diseases, lymphoproliferative disorders, infections, myelodysplastic syndromes, common variable immunodeficiency, agammaglobulinemia, hypogammaglobulinemia, immunoglobulin A deficiency, and drugs. The presence of thrombocytopenia may result from chronic infections with hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori and should be considered in the differential diagnosis of immune thrombocytopenic purpura (ITP). Studies have shown that upon diagnosis of infections, treatment of the primary disease allows for stabilization of platelet counts. Antiviral therapy with highly active antiretroviral therapy (HAART) for HIV has aided in platelet recovery with a corresponding decrease in circulating viral load. In some cases, the use of a thrombopoietin (TPO) agonist, eltrombopag, normalizes platelet levels in patients with these infections. Thrombocytopenia in the absence of other disease symptoms requires screening for H pylori, especially in regions where there is a high prevalence of the disease, such as in Japan, and in cases where platelets have normalized following eradication therapy. In other regions where these infections are not prevalent, such testing is controversial.
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Affiliation(s)
- Roberto Stasi
- Department of Medical Sciences, Ospedale Regina Apostolorum, Albano Laziale, Italy.
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Abstract
Primary immune thrombocytopenic purpura (ITP) remains a diagnosis of exclusion both from nonimmune causes of thrombocytopenia and immune thrombocytopenia that develops in the context of other disorders (secondary immune thrombocytopenia). The pathobiology, natural history, and response to therapy of the diverse causes of secondary ITP differ from each other and from primary ITP, so accurate diagnosis is essential. Immune thrombocytopenia can be secondary to medications or to a concurrent disease, such as an autoimmune condition (eg, systemic lupus erythematosus [SLE], antiphospholipid antibody syndrome [APS], immune thyroid disease, or Evans syndrome), a lymphoproliferative disease (eg, chronic lymphocytic leukemia or large granular T-lymphocyte lymphocytic leukemia), or chronic infection, eg, with Helicobacter pylori, human immunodeficiency virus (HIV), or hepatitis C virus (HCV). Response to infection may generate antibodies that cross-react with platelet antigens (HIV, H pylori) or immune complexes that bind to platelet Fcγ receptors (HCV), and platelet production may be impaired by infection of megakaryocyte (MK) bone marrow–dependent progenitor cells (HCV and HIV), decreased production of thrombopoietin (TPO), and splenic sequestration of platelets secondary to portal hypertension (HCV). Sudden and severe onset of thrombocytopenia has been observed in children after vaccination for measles, mumps, and rubella or natural viral infections, including Epstein-Barr virus, cytomegalovirus, and varicella zoster virus. This thrombocytopenia may be caused by cross-reacting antibodies and closely mimics acute ITP of childhood. Proper diagnosis and treatment of the underlying disorder, where necessary, play an important role in patient management.
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Affiliation(s)
- Douglas B Cines
- University of Pennsylvania School of Medicine, Department of Pathology and Laboratory Medicine, Philadelphia, PA 19104, USA.
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