A cross sectional study of autoantibodies in children with hepatitis A infection

A cross sectional study of autoantibodies in children with hepatitis A infection

Background: Hepatitis A is one of the most frequently reported vaccine-preventable diseases worldwide and remains endemic in many areas of the world. The study aims to investigate the prevalence of autoantibodies in patients with acute viral hepatitis A. Method: A total of 52 patients diagnosed with hepatitis A (HA) were enrolled in this study. The diagnosis of acute hepatitis A (AHA) was based on negative hepatitis B surface antigen and hepatitis C virus RNA, and positive immunoglobulin (Ig) M HA antibody. Biochemical parameters and the presence of autoantibodies were recorded. Results: Prolonged protrombin time, international normalized ratio corrected with vitamin K and prolonged activated partial thromboplastin time were seen in 11, 11 and in 12 patients respectively. Total bilirubin levels were higher than 2 mg/dL in 21 patients and only five of these patients had direct bilirubin higher than 50% of the total bilirubin and serum bilirubin levels were higher than 10 mg/dL during at least 4 weeks. These 5 patients were evaluated as cholestatic hepatitis. Antinuclear antibodies were detected in four and anti-liver cytosolic antigen type 1 in one patient. Conclusion: The early diagnose of any autoimmune disease in patients with HA was found important since it may help take necessary precautions. In addition, we conclude that further studies in larger populations will contribute to understanding of the relationship between the autoimmune disease and HA.

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  • Gust ID. Epidemiological patterns of hepatitis A in different parts of the world. Vaccine 1992;10;S56–S58.
  • Shapiro CN. Hepatitis A virus In: Long SL, Pickering LK, Prober CG, editors. Principles and practice of pediatric infectious diseases. 2nd edition. London: Churchill Livingstone Inc.; 2003.
  • Munoz Bertran E, Rosa Salazar V, Hostalet Robles F, et al. Autoimmune hepatitisis caused by acute hepatitisis due to hepatitisis A virus. Gastroenterol Hepatol 2002; 25: 501-504.
  • Moon HW, Noh JK, Hur M, et al. High prevalence of autoantibodies in hepatitis A infection: the impact on laboratory profiles J Clin Pathol 2009; 62: 786-788.
  • Hsieh MY, Dai CY, Lee LP, et al. Antinuclear antibody is associated with a more advanced fibrosis and lower RNA levels of hepatitisis C virus in patients with chronic hepatitisis C. J Clin Pathol 2008; 61:333-7.
  • Yee LJ, Kelleher P, Goldin RD, et al. Antinuclear antibodies (ANA) in chronic hepatitisis C virus infection: correlates of positivity and clinical relevance. J Viral Hepat 2004;11: 459-64.
  • Muratori P, Muratori L, Guidi M, et al. Clinical impact of non-organ-specific autoantibodies on the response to combined antiviral treatment in patients with hepatitisis C. Clin Infect Dis 2005; 40: 501-7.
  • Peng YC, Hsieh SC, Yang DY, et al. Expression and clinical significance of antinuclear antibody in hepatitisis C virus infection. J Clin Gastroenterol 2001; 33: 402-6.
  • Cassani F, Cataleta M, Valentini P, et al. Serum autoantibodies in chronic hepatitisis C: comparison with autoimmune hepatitisis and impact on the disease profile. Hepatology 1997; 26: 561-6.
  • Clifford BD, Donahue D, Smith L, et al. High prevalence of serological markers of autoimmunity in patients with chronic hepatitisis C. Hepatology 1995; 21: 613-9.
  • Lenzi M, Bellentani S, Saccoccio G, et al. Prevalence of non-organ-specific autoantibodies and chronic liver disease in the general population: a nested case-control study of the Dionysos cohort. Gut 1999; 45: 435-41.
  • Rigopoulou EI, Mytilinaiou M, Romanidou O, et al. Autoimmune hepatitisis-specific antibodies against soluble liver antigen and liver cytosol type 1 in patients with chronic viral hepatitisis. J Autoimmune Dis 2007; 4:2.
  • Mikata R, Yokosuka O, Imazeki F, et al. Prolonged acute hepatitisis A mimicking autoimmune hepatitisis. World J Gastroenterol 2005;11: 3791-3.
  • Rahaman SM, Chira P, Koff RS. Idiopathic autoimmune chronic hepatitisis triggered by hepatitisis A. Am J Gastroenterol 1994; 89:106-8.
  • Tabak F, Ozdemir F, Tabak O, et al. Autoimmune hepatitisis induced by the prolonged hepatitisis A virus infection. Ann Hepatol 2008; 7: 177-9.
  • Tagle Arrospide M, Leon Barua R. Viral hepatitis A as a triggering agent of autoimmune hepatitisis report of a case and review of literature. Rev Gastroenterol Peru 2003; 23: 134-7.
  • Vento S, Garofano T, Di Perri G, et al. Identification of hepatitisis A virus as a trigger for autoimmune chronic hepatitisis type 1 in susceptible individuals. Lancet 1991; 337: 1183-7.
  • Hiroto T, Hiroto T, Hiroki U, et al. Autoimmune hepatitis triggered by acute hepatitis A. World J Gastroenterol ; 11(38): 6069-6071
  • Schiff ER. Atypical clinical manifestation of hepatitisis A. Vaccine 1992; 10: 18-20
  • Lacerda MA, Ludwig J, Dickson ER, et al. Antimitochondrial antibody-negative primary biliary cirrohosis. Am. J. Gastroenterol 1995; 90: 247-249.
  • Li CP, Tong MJ, Hwang SJ, et al. Autoimmune cholangitis with features of autoimmune hepatitis: successful treatment with immunosuppressive agents and ursodeoxycholic acid. J Gastroenterol Hepatol 2000;15(1):95-98.
  • Petrogiannopoulos C, Papamichael K, Karachalios G, Karachaliou I, Kostakos N, Barbati K, Zacharof A. Autoimmune cholangitis presented as fever of unknown origin. Chemotherapy 2006;52(6):282-284.
  • Rahaman SM, Chira P, Koff RS. Idiopathic Autoimmune Chronic Hepatitisis Triggered by Hepatitis A. Am J Gastroenterol 1994; 89: 106-108
  • Huppertz HI, Treichel U, Gassel AM, et al. Autoimmune hepatitisis following hepatitisis A virus infection. J Hepatol 1995; 23: 204-208.
  • Oshikata S, Miyanaga O, Kikuchi I, et al. A case of autoimmune hepatitisis presumably induced by acute hepatitisis type A. Acta Hepatol Japonica 1996; 37: 738-743
  • Hilzenrat N, Zilberman D, Klein T, et al. Autoimmune Hepatitisis in a Genetically Susceptible Patient. Dig Dis Sci ; 44: 1950-1952
  • Tamura T, Suzuki S, Yamato A, et al. A case report of AIH diagnosed by the opportunity of hepatitis A infection. Nippon Shokakibyo Gakkai Zasshi 2000; 97: 1043-1047.
  • Manns MP, Griffin KJ, Sullivan KF, et al. LKM-1 autoantibodies recognize a short linear sequence in P450IID6, a cytochrome P-450 monooxygenase. J Clin Invest 1991; 88: 1370-1378.
  • Marceau G, Lapierre P, Beland K, et al. LKM1 autoantibodies in chronic hepatitis C infection: a case of molecular mimicry? Hepatology 2005; 42: 675-682
  • Manns MP. Cytoplasmic autoantigens in autoimmune hepatitis: molecular analysis and clinical relevance. Semin Liver Dis 1994;11:205-14.
  • Mackay IR, Taft LI, Melb MD, et al. Lupoid hepatitis. Lancet 1956;2:1323-6.
  • Martini E, Abuaf N, Cavalli F, et al. Antibody to liver cytosol (anti-LC1) in patients with autoimmune chronic active hepatitis type 2. Hepatology 1988;8:1662–6.
  • Muratori L, Cataleta M, Muratori P, et al. Liver/kidney microsomal antibody type 1 and liver cytosol antibody type concentrations in type 2 autoimmune hepatitis. Gut 1998;42:721–6.
  • Manns M, Gerken G, Kyriatsoulis A, et al. Characterisation of a new subgroup of autoimmune chronic active hepatitis by autoantibodies against a soluble liver antigen. Lancet 1987;1:292-4.