RESUMO
Hepatitis is common in the Stann Creek District of southern Belize. To determine the etiologies, incidence, and potential risk factors for acute jaundice, we conducted active surveillance for cases. Cases of jaundice diagnosed by a physician within the previous 6 weeks were enrolled. Evaluation included a questionnaire and laboratory tests for hepatitis A, B, C, D, and E, a blood film for malaria, and a serologic test for syphilis. Etiologies of jaundice among 62 evaluable patients included acute hepatitis A, 6 (9.7%), acute hepatitis B, 49 (79.0%), hepatitis non-A-E, 2 (3.2%), and malaria, 5 (8.1%). There were no cases of acute hepatitis E. One patient each with antibody to hepatitis C and D were detected. The annualized incidence of hepatitis A was 0.26 per 1,000. All cases of hepatitis A were in children 4-16 years of age. The annualized incidence of hepatitis B, 2.17 per 1,000, was highest in adults aged 15-44 years (4.4 per 1,000) and was higher in men (36 cases; 3.09 per 1,000) than women (13 cases; 1.19 per 1,000). Four (31%) of the women with hepatitis B were pregnant. The annualized incidence was significantly higher in Mestizo (6.18 per 1000) and Maya (6.79 per 1,000) than Garifuna (0.38 per 1,000) or Creole (0.36 per 1,000). Persons with hepatitis B were significantly more likely to be born outside of Belize (82%), had been in Belize < 5 years (73%), and lived and worked in rural areas (96%) than was the general population. Of those > or = 14 years of age with hepatitis B, only 36% were married. Few persons admitted to transfusions, tattoos, IV drug use, multiple sexual partners, visiting prostitutes, or sexually transmitted diseases. Only 1 of 49 had a reactive test for syphilis. Six patients were hospitalized (including 3 with acute hepatitis B and one with hepatitis A), and none to our knowledge died. Acute hepatitis B is the most common cause of viral hepatitis in the Stann Creek District, but the modes of transmission remain obscure. Infants, women attending prenatal clinics, and new workers are potential targets for immunization with hepatitis B vaccine.
Assuntos
Hepatite/epidemiologia , Icterícia/diagnóstico , Doença Aguda , Adolescente , Adulto , Belize/epidemiologia , Criança , Pré-Escolar , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Hepatite/etiologia , Hepatite/imunologia , Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B , Humanos , Incidência , Icterícia/etiologia , Malária/complicações , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Testes Sorológicos , Inquéritos e QuestionáriosAssuntos
Surtos de Doenças , Hepatite D/patologia , Fígado/patologia , Brasil , Colômbia , Hepatite D/epidemiologia , Humanos , VenezuelaRESUMO
Stimulated by observations in an outbreak of hepatitis delta-virus infection among Yucpa Indians in Venezuela, in which unusual histologic features were found, we studied 100 cases of fatal hepatitis from Colombia, South America, which had been obtained by autopsy or viscerotomy. These cases were considered to be "Santa Marta hepatitis," or "hepatitis of the Sierra Nevada de Santa Marta," which has been observed in this region for more than 40 years. Of the 100 cases, 19 had a variety of histologic lesions or were normal, and hepatitis delta-virus antigen was not demonstrated immunocytochemically in any of them. By contrast, 81 cases had a characteristic histologic picture with intense microvesicular steatosis associated with conspicuous eosinophilic necrosis of the hepatocytes, which apparently were sluggishly removed by cytolysis. Hepatitis delta-virus antigen was detected in 70% of the 81 cases, and the absence of detection of this antigen was often associated with poor tissue preservation and more extensive hepatocyte necrosis. A smaller percentage of patients had hepatitis B virus antigens detectable in liver tissue. The characteristic lesion in these 81 cases could be distinguished from other causes of microvesicular steatosis by the extensive eosinophilic necrosis. Other variable accompanying features included intraacinar, mainly macrophagic, scavenger cell inflammation, intense portal inflammation, a parenchymal regeneration, and ductular and arteriolar proliferation. Santa Marta hepatitis as a severe form of hepatitis delta-virus infection differs markedly from fulminant delta-hepatitis in Europe and the United States in which the microsteatosis with marked eosinophilic degeneration is not found. The causes for these differences are unknown but may relate to nutritional factors or environmental toxins.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hepatite D/patologia , Fígado/patologia , Antígenos Virais/isolamento & purificação , Colômbia , Eosinófilos/patologia , Fígado Gorduroso/patologia , Antígenos de Superfície da Hepatite B/análise , Hepatite D/epidemiologia , Vírus Delta da Hepatite/imunologia , Humanos , Indígenas Sul-Americanos , Necrose/patologia , VenezuelaRESUMO
"Santa Marta" hepatitis has been recognized as an unusual type of severe hepatitis occurring in northern Colombia since 1930. Liver specimens from a historic viscerotomy series, used by Gast-Galvis to identify cases and describe epidemiologic features of this disease, were available for review and histopathologic staining for delta-virus. Of 86 liver specimens examined from cases of fulminant Santa Marta hepatitis, 81 showed a distinct histopathologic picture, in various stages of progression, with features of eosinophilic necrosis, microvesicular fat infiltration of the liver parenchyma and morula cells; 69% were positive for delta-antigen by immunoperoxidase staining. This disease occurred predominantly in several small towns within 50 km of Santa Marta, with mortality reaching 1.25 per 1,000 inhabitants per year during the 1940's. Children under age 15 were most commonly affected and males affected twice as frequently as females. Liver specimens obtained from children, or within 15 hr of death, or which showed early histologic stages of disease were most likely to be positive for delta-antigen. This and the accompanying study confirm the existence of a distinct type of fulminant hepatitis in Colombia for over 50 years. The epidemiologic and histopathologic features are comparable to severe hepatitis in Venezuela Indians and in the Amazon basin of Brazil, suggesting that all are caused by delta-superinfection of hepatitis B virus carriers.
Assuntos
Hepatite D/epidemiologia , Adolescente , Adulto , Antígenos Virais/análise , Criança , Pré-Escolar , Colômbia , Feminino , Hepatite D/patologia , Vírus Delta da Hepatite/imunologia , Humanos , Fígado/patologia , MasculinoRESUMO
The prevalences of hepatitis B virus (HBV), hepatitis delta virus and hepatitis A virus infections were studied in two regions of Colombia. In Bogota, 10 of 53 patients with acute hepatitis were HBsAg positive and three of these were hepatitis D antigen positive. Hepatitis A virus was the major cause of acute hepatitis in this group. In 366 healthy controls from Bogota, 1.6% were HBsAg positive and 7.1% had at least one marker of HBV infection. In northern Colombia, individuals from three villages with outbreaks of the fulminant "hepatitis of the Sierra Nevada de Santa Marta" were tested. The prevalences of HBsAg (1.8 to 23%) and HBV infection (35 to 93%) were generally high and varied from village to village; 60% of the HBsAg carriers in one village were positive for antibody to hepatitis D antigen, and two individuals in the outbreak area had circulating hepatitis D antigen. The findings suggest that HBV and the associated hepatitis delta virus are etiologic factors in the "hepatitis of the Sierra Nevada de Santa Marta."
Assuntos
Antígenos da Hepatite B , Hepatite Viral Humana/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Colômbia , Surtos de Doenças , Feminino , Hepatite A/epidemiologia , Hepatite A/imunologia , Anticorpos Anti-Hepatite A , Anticorpos Anti-Hepatite/análise , Hepatite B/epidemiologia , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/análise , Antígenos de Superfície da Hepatite B/análise , Antígenos da Hepatite delta , Hepatite Viral Humana/imunologia , Humanos , MasculinoRESUMO
During a 33-month period, 295 patients with acute viral hepatitis were admitted to a state hospital for civil servants and their dependents in São Paulo, Brazil. Seventy-nine per cent (232) were HBsAg negative. To define the contribution of non-A, non-B viral hepatitis to hepatitis morbidity in this population, further serological studies were performed in 147 confirmed HBsAg-negative patients. One hundred and twelve (76%) were serologically classified as hepatitis A based on identification of IgM antibody to hepatitis A virus. Thirty patients (20%) without IgM antibody to hepatitis A virus, HBsAg, or anti-HBc were categorized as the non-A, non-B hepatitis group. The remaining five patients had probable hepatitis B (IgM antibody to hepatitis A virus negative, HBsAg negative, anti-HBs negative but anti-HBc positive). These data suggest that all three etiological forms of viral hepatitis are endemic in São Paulo. Epidemiological, clinical, and laboratory features were compared to the hepatitis A and non-A, non-B hepatitis groups. Patients with non-A, non-B hepatitis were significantly older than patients with hepatitis A (mean age +/- S.D.: 30 +/- 22 years vs. 9 +/- 9 years, p less than 0.001). Contact with hepatitis or jaundice was recognized in 26 (23%) of 112 hepatitis A patients and 3 (10%) of 30 non-A, non-B patients, a difference which was not statistically significant. Parenteral exposures were identified in 13 (43%) of 30 patients with non-A, non-B hepatitis and 23 (21%) of the 112 hepatitis A patients. Blood transfusion in the 2 months preceding onset of illness was reported in 5 (17%) of the 30 non-A, non-B patients and in none of the hepatitis A group (p less than 0.001). Although prodromal symptoms and fever were more common in patients with hepatitis A, neither these nor other clinical features appeared to be distinguishing characteristics. Similarly, mean peak SGPT levels, peak SGPT levels of greater than or equal to 1,000 IU/per liter, and the mean duration of SGPT elevations for each group were not significantly different. Mean peak serum bilirubin levels were slightly higher in the non-A, non-B group than in the hepatitis A group (7.6 +/- 8.0 mg per dl vs. 5.1 +/- 2.7, p less than 0.01) and peak bilirubin levels greater than or equal to 10 mg per dl were found in 27% of the non-A, non-B group and 5% of the hepatitis A group (p less than 0.001). Whether the higher bilirubin levels reflect an agent-related phenomenon or an older population of affected patients is uncertain.
Assuntos
Hepatite A/epidemiologia , Hepatite C/epidemiologia , Hepatite Viral Humana/epidemiologia , Adolescente , Adulto , Idoso , Bilirrubina/sangue , Brasil , Criança , Pré-Escolar , Hepatite A/sangue , Hepatite A/diagnóstico , Hepatite C/sangue , Hepatite C/diagnóstico , Hospitais Estaduais , Humanos , Pessoa de Meia-IdadeRESUMO
Previous studies of hepatitis B antigen (HBsAg) and antibody to it (anti-HBs) showed widely differing exposures between Panamanian Indian tribes. Cuna Indians living on islands appeared infrequently exposed to HBsAg; we found no one antigenemic and low age specific anti-HBs rates. In contrast, mainland dwelling Guaymi and Chocó Indians had a high prevalence of anti-HBs. We have now measured HBsAg by counterelectrophoresis and anti-HBs by radioimmunoassay in two Cuna Indian groups who live in the Darien forest. The prevalence of HBsAg among Darien Cuna was low, 3 positive of 239 tested, but 106 (44%) had anti-HBs. Darien Cuna thus evidenced greater exposure to HBsAg than island Cuna (8% had anti-HBs) and had an anti-HBs prevalence similar to the neighboring Chocó Indians (42%). The Guaymi Indians of western Panama had a lower frequency of anti-HBs (29%) than either Chocó or mainland Cuna but their frequency of chronic antigenemia was significantly greater. These data suggest that while exposure may be a function of village habitat, chronic antigenemia may reflect differences in host responses.
Assuntos
Anticorpos Antivirais/isolamento & purificação , Antígenos da Hepatite B/isolamento & purificação , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Cobaias , Hepatite B/epidemiologia , Vírus da Hepatite B/isolamento & purificação , Humanos , Indígenas Sul-Americanos , Lactente , Masculino , Panamá , Meio SocialRESUMO
Several authors have suggested that the host genome determines the occurrence of chronic HBS Ag (hepatitis B surface antigen). In attempts to evaluate this possibility, total infection rate and the combined frequencies of HBS Ag and antibody to HBS Ag and radioimmunoprecipitation to measure antibody to HBS Ag, we tested sera from 255 Panamanian Guaymi Indians. They represented 48 families and 32 living units. Clusters of chronically antigenemic individuals were found in families. Clusters of infection were not found in families or living units. Differences in family composition (age and sex) did not explain the increased occurrence of HGS Ag. These findings support the hypothesis that some humans have an inherited susceptibility to chronic infection with hepatitis B virus after exposure.