RESUMEN
Finding one major hepatotropic virus may not be enough to identify the aetiology of liver disease when risk factors are present, particularly in patients with past or present infection with other viral agents, or chronic liver disease. The pathogenic process in these cases is often complex. In the five cases we report, acute hepatitis (initiated by halothane, cytomegalovirus or Epstein-Barr virus) preceded the reactivation of hepatitis B infection, and these events occurred in patients with chronic hepatitis C infection. Each case demonstrates how several viruses can be implicated in the development of hepatitis, either as single agents or via cross-activation of T cells. The nosography of hepatitis, therefore, and the optimum therapeutic choices, can puzzle the clinical team.
Asunto(s)
Hepatitis Viral Humana/clasificación , Hepatitis Viral Humana/diagnóstico , Adulto , Femenino , Hepatitis Viral Humana/virología , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/aislamiento & purificaciónRESUMEN
A retrospective study was carried out in 56 patients to establish the association of cytomegalovirus (CMV) with active or inactive hepatitis B virus (HBV) infection as a possible risk factor in the development of severe liver disease. Patients with positive CMV serology and active or inactive HBV infection had elevated alanine aminotransferase activity and had a relatively high incidence of more severe lesions (chronic hepatitis and active cirrhosis). In the absence of CMV, only one case of cirrhosis was identified compared with seven cases of hepatic fibrosis. By analogy with hepatitis C virus, CMV may bring about activation of the host inflammatory response against hepatocytes following HBV infection, resulting in the development of severe hepatitic disease.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Hepatitis B/complicaciones , Hígado/patología , Alanina Transaminasa/metabolismo , Infecciones por Citomegalovirus/patología , Hepatitis B/patología , Hepatitis Crónica/complicaciones , Hepatitis Crónica/patología , Humanos , Cirrosis Hepática/etiología , Cirrosis Hepática/patología , Estudios Retrospectivos , Factores de Riesgo , Pruebas SerológicasRESUMEN
Fifty-one patients with signs of past HBV infection were investigated for the HCV virus antibody. All patients were at least HBsAb, HBcAb positive. Two groups were selected: patients with increased serum AST activity (32/51) and patients with normal serum AST activity (19/51). Prevalence of HCV infection was higher (81.2%) in the group with high serum aminotransferases as compared to that found in the second group (31.6%) (p less than 0.002). Furthermore, histological findings showed higher prevalence of HCV infection in patients with cirrhosis as compared to patients with hepatic fibrosis. Results show that lack of clinical remission in patients with past HBV infection could be due to the presence of HCV, thus representing an unrecognized cause of "cryptogenetic" liver diseases.