Hepatitis: Mathur P

Mathur P, Arora NK. · Indian Council of Medical Research, New Delhi, India. · Indian J Med Res. · Pubmed #19246792 links to  free full text

Abstract: With improvement in economic and living conditions of the communities, the age of acquiring hepatitis A virus (HAV) infection is shifting from early childhood to adolescence and young adulthood. Such epidemiological shift leads to an increased incidence of symptomatic HAV infection, including heightened risk of liver failure. Data from India indicate that the population is no longer homogeneous for its HAV exposure profile. Occasional outbreaks of HAV and higher proportions of symptomatic cases are reported amongst older children and adults from different regions of the country. However, the heterogeneous exposure to HAV defies widespread use of the vaccine. The challenge is to recognize the susceptible pockets and take pre-emptive steps. In regions with rapid improvement in living standards and environmental hygiene, there is a need for regular surveillance through structured protocols that are able to identify early signs of epidemiological shift. This review discusses relevant issues and concerns to influence decision making for HAV vaccination in such transition societies.

Arora NK, Mathur P, Ahuja A, Oberoi A. · Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. · Indian J Pediatr. · Pubmed #12619956 No free full text.

Abstract: Acute liver failure in children is associated with a high mortality. Most cases in our setup are due to water borne hepatotropic viruses HAV and HEV. The clinician must be aware of the earliest and the subtle signs of acute liver failure to identify cases early enough and institute supportive therapy. Focus of therapy has to be on prevention, early recognition and appropriate management of complications. Despite good intensive care, about 40-60% children with liver failure die. As and when liver transplantation becomes available in India, it would be an attractive option.

Mathur P, Arora NK. · Department of Pediatrics, AIIMS, New Delhi. · Indian J Pediatr. · Pubmed #10798043 No free full text.

Abstract: Currently available evidence indicates that most parts of India still quality to be hyper-endemic regions and hence recommendations for vaccinations developed for low endemicity regions are not applicable. There are however, some pockets which showed evidence of distinct epidemiologic shift. There is need to identify geographic regions like Kerala which have potential for epidemic outbreaks through cyclic sero-epidemiological surveys. With economic development and consequent improvements in the levels of sanitation and quality of water supplies, more such areas will be identified. Efforts to improve sanitation and personal hygiene will remain as the most important and efficient intervention to retard the transmission of HAV. Unless a critical improvement in the living standards of our population is achieved, aim of eradicating HAV infection from the community is not realistic. Presently, the cost of three doses of HAV is exorbitant and the focus of HAV vaccination will have to be restricted to individual protection who are likely to remain unexposed till adulthood and can afford to pay for it. HAV Infection below 5 years is mostly asymptomatic. The most efficient use of resources will therefore be to offer HAV vaccine to high risk individuals beyond this age after screening for antibodies against HAV.

Mathur P, Samantaray JC, Samanta P. · Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India. · Clin Gastroenterol Hepatol. · Pubmed #18619918 No free full text.

Abstract: BACKGROUND & AIMS: Functional derangement of liver in visceral leishmaniasis is reported infrequently in the literature. Because of this, many cases are wrongly diagnosed and treated as hepatitis. We therefore envisaged to assess the actual magnitude of liver function derangement in confirmed cases of visceral leishmaniasis at our hospital. METHODS: All confirmed kala-azar cases presenting over a period of 3 years at our tertiary care hospital were included in the study. A detailed assessment of their liver functions was performed at the time of diagnosis and at various intervals until their discharge. RESULTS: A total of 114 cases of microscopy-confirmed visceral leishmaniasis were included in the study. Of these, 15 (13%) had jaundice at the time of presentation, 58 (51%), 37 (32%), 27 (24%), and 24 (21%) had increased levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin, respectively. Eleven of the 114 cases had a fatal outcome, of whom 9 (82%) had some form of functional hepatic derangement. CONCLUSIONS: Thus, in our study, functional derangement of liver was found to be common in patients with visceral leishmaniasis. In some cases, hepatitis confounded and delayed the diagnosis of kala-azar.

Mathur P, Samantaray JC, Samanta P. · Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. · Indian J Med Microbiol. · Pubmed #18087100 links to  free full text

Abstract: Haemophagocytic syndrome (HPS) secondary to infections occurs due to excessive, non-malignant proliferation of histiocytes, with resultant haemophagocytosis. The syndrome is essentially treatable, provided timely etiological diagnosis is achieved. In this report, we present a rare case of a child who hailed from Uttaranchal and presented with severe hepatitis. Bone marrow examination revealed an unexpected diagnosis of HPS secondary to visceral leishmaniasis. Despite initiating appropriate antileishmanial treatment, the child had a fatal outcome.

Gupta S, Mathur P, Singh S. · Department of Clinical Microbiology, All India Institute of Medical Sciences, New Delhi-l10 029, India. · Trop Gastroenterol. · Pubmed #17089623 No free full text.

This publication has no abstract.

Gulati S, Mathur P, Saini D, Mannan R, Kalra V. · Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. · Indian J Pediatr. · Pubmed #15226566 No free full text.

Abstract: Erythema annulare centrifugum (EAC) is a rare disease entity characterized by dense perivascular lymphocytic infiltrates in dermis. It has been associated with a few conditions, though its etiology is largely unknown. To our knowledge there has been no reported association with autoimmune hepatitis described earlier. This child also was positive for hepatitis C virus antibodies, though HCV RNA was negative. We should keep in mind the false positivity of hepatitis C antibodies before deciding on its therapy.

Mathur P, Arora NK. · Division of Paediatric Gastroenterology, Hepatology & Nutrition, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi 110 029. · Indian J Pediatr. · Pubmed #11411381 No free full text.

This publication has no abstract.

Mathur P, Arora NK, Panda SK, Kapoor SK, Jailkhani BL, Irshad M. · Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Community Medicine and Laboratory Medicine, All India Institute of Medical Sciences, New Delhi - 110 029, India. · Indian Pediatr. · Pubmed #11359972 No free full text.

Abstract: OBJECTIVE: To estimate the prevalence of anti-HEV IgG and IgM antibodies to ORF3 peptide of Hepatitis E virus genome in an age stratified urban and rural population of children. DESIGN: Cross sectional survey. SETTING: Pediatric out-patient clinics in a tertiary hospital and a rural dispensary. METHODS: Study subjects between 6 months and 10 years with minor, non-hepatic illnesses were recruited for the study from March to December 1996. Baseline demographic details, drinking water source, sewage disposal methods, reasons for attending the hospital, histories of parenteral exposure in the past 12 months and acute hepatitis in the subjects and the family in the previous six months were obtained. Serum anti-HEV IgG antibodies were screened in all subjects, and in those who were positive, anti-HEV IgM antibodies were assayed as an indicator of recent infection. Serum aminotransferase (ALT) was estimated in those who were anti-HEV IgM antibody positive. RESULT: Out of 2160 subjects recruited, 2070 samples could be screened for anti-HEV IgG antibodies. In the urban population (n = 1065) anti-HEV IgG antibodies were detected in 306 subjects (28.7%; 95% CI 26.0-31.6) and of these 131 (42.8%; 95%CI 37.2-48.6) were anti-HEV IgM antibody positive. Amongst 1005 rural children, anti-HEV IgG antibodies were present in 239 (23.8%; 95% CI 21.1-26.4) and IgM antibodies in 113 (47.3%; 95% CI 40.9-53.7) children. The antibodies were present since the first year of age till 10 years of age and, increased with advancing age. Serum transaminases were raised in 7.5% (9/120) and 5.5% (5/88) of subjects with anti-HEV IgM antibodies in urban and rural centers respectively. Overall the seroprevalence of IgG antibodies against HEV were significantly more in urban as compared to that in rural subjects (p = 0.011). However, proportion of children with anti-HEV IgG carrying IgM antibodies was similar in the two study groups (p = 0.298). A model for estimating expected prevalence of anti-HEV IgG antibodies was developed. The observed antibody prevalence in both urban and rural subjects at each age interval after 48 months was less as compared to the expected levels and this gap increased with advancing age categories. It appeared that there was a decay of HEV antibodies with time. CONCLUSIONS: Children are susceptible to HEV infection since early infancy. The probability of exposure to HEV during childhood was higher in urban than rural population. Seropositivity to HEV antibodies increased by over 2 times beyond 4 years of age as compared to younger age. Anti-HEV IgG antibodies appear to wean off with increasing age.