Hepatitis: Tsai HT

Tsai HT, Tsai TH, Lu TM, Yang CC. · School of Nursing, Chung Shan Medical University, Taichung, Taiwan, Republic of China. · Int Rev Immunol. · Pubmed #19065350 No free full text.

Abstract: The interaction between immune responses and hepatitis B virus (HBV) is coordinated between innate and adaptive immunity. Anti-HBs antibodies protect the host by blocking the binding ability of HBV. Anti-HBc antibodies are detected with persistent HBV infection. The presence of anti-HBe antibodies is often associated with recovery from active diseases and is clinically used as a benchmark to assess response to treatment. Our studies have revealed that the anti-HBV immunoglobulins secreted are different in subclass patterns in different HBV infection status populations. These revelations may help to understand HBV escape and persistent infection and to develop strategies for prevention and therapeutic management of HBV infection.

Shaukat A, Tsai HT, Rutherford R, Anania FA. · Division of Digestive Diseases (AS, RR, FAA) and Hematology & Oncology (HTT), Emory University School of Medicine, 615 Michael Street, Whitehead Research Building #201, Atlanta, GA 30322, USA. · Hepatol Res. · Pubmed #16112900 No free full text.

Abstract: INTRODUCTION:: Epstein-Barr virus (EBV) infection frequently involves the liver, presenting as elevations in transaminases. EBV infection associated hepatitis, presenting with hyperbilirubinemia is rare. We describe a case of infectious mononucleosis that presented with cholestatasis, and summarize 23 cases from the literature to categorize this increasingly recognized clinical spectrum of EBV infection induced cholestatic hepatitis. METHODS:: We conducted an extensive literature review of all cases of EBV in pediatric and adult literature with cholestatasis using MEDLINE and EMBASE. We also included information on one case from our institution. RESULTS:: We identified 24 cases. Median age was 20 years (range 1-72 years), with 14 (58%) females. On presentation, fever (72%), jaundice (67%) and splenomegaly (62%) were the most common signs. Laboratory data revealed the median asparate aminotransferase (AST), or alanine aminotransferase (ALT) level was 179IU/L (range 56-2518IU/L), median serum bilirubin level 12.6mg/dL (range 2.2-47.5mg/dL) and median alkaline phosphatase level 749IU/L (range 31-3105IU/L). Diagnosis was confirmed using EBV viral capsid antigen IgM in 20 (83%) patients. HIV testing was done in 7 (29%) of the cases, and was negative. One patient died from the illness, while full recovery was reported in all other cases, with median follow-up of 30 days (range 5-180 days). CONCLUSIONS:: Cholestatasis is associated with EBV infection, and should be part of the differential diagnosis in all age groups, presenting with hyperbilirubinemia.