Acute hepatitis E in Montenegro: epidemiology, clinical and laboratory features

OBJECTIVE

To evaluate the incidence, demographic, clinical and laboratory characteristics of patients with acute viral hepatitis E in Montenegro.

MATERIAL AND METHODS

A total of 400 patients with acute viral hepatitis from January 1st, 2000 to December 31st, 2007 were enrolled in the study. Serological tests for hepatitis A, B, C, D, and E viruses, Epstein-Barr virus, cytomegalovirus, and herpes simplex viruses were performed. Standard laboratory tests for liver function were analyzed. The results are presented as absolute numbers, mean +/- SD, range of values, and percent. A P value < 0.05 was considered significant.

RESULTS

Twenty-four (6%) patients had clinically and/or serologically confirmed acute hepatitis E. The mean age of the patients was 25 +/- 6 years; 62.5% were males. The majority of the patients (66%) belonged to the 20 to 40 yrs age group (P < 0.05). Seven patients were asymptomatic. Foremost symptoms were loss of appetite (100%), fatigue (94%) and vomiting (75%). The most frequent clinical sign was mild to moderate liver enlargement (94%). Jaundice had 12/17 symptomatic patients. Elevation of alanine aminotransferase was found in 19 patients including two patients without symptoms. The enzyme, gamma glutamyltranspeptidase was increased in all patients.

CONCLUSION

Acute hepatitis E in Montenegro emerges as an autochthonous infection with a low incidence. Sub-clinical and anicteric infections may occur. Elevation of gamma glutamyltranspeptidase is an important parameter of the biochemical profile of the disease.

Liver enlargement associated with opportunistic infections in patients with human immunodeficiency virus infection

BACKGROUND AND AIM

Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to determine the frequency of liver enlargement and its association with opportunistic infections in patients with HIV infection.

PATIENTS AND METHODS

A total of 400 HIV-infected patients were investigated. Commercial kits (Ortho EIA; BioRad, ELISA) were used for detection of serum specific antibodies to HIV, hepatitis C virus, surface antigen of hepatitis B virus, and cytomegalovirus. Liver tissues were stained for various microorganisms. The electronic data base SPSS for Windows (version 10.0) was used for statistical analysis. A p <0.05 was considered significant.

RESULTS

Ultrasonographic screening revealed liver enlargement in 63.75% of HIV patients. In 40.7% the right lobe size varied from 140 mm to 160 mm. Of those with hepatomegaly, 60.7% had AIDS. Hepatitis C and B viruses and Mycobacterium tuberculosis were detected in 50%, 29% and 18% of patients, respectively. Histological changes were mostly non-specific. Liver pathology depended on the degree of cellular immune deficiency, particularly in patients with HBV co-infection. In a minority of patients (32.5%), the histology revealed granulomatous hepatitis. Liver function tests were abnormal in 46%.

CONCLUSION

Liver enlargement is common in HIV-infected patients mostly in association with hepatitis C and B viruses and Mycobacterium tuberculosis.