Pub Date : 2020-02-13DOI: 10.5772/intechopen.90431
S. Gargouri, Lamia Fki-Berrajah, I. Ayadi, A. Chtourou, A. Hammami, H. Karray-Hakim
Improvements in hygiene and socio-economic conditions in many parts of the world have led to an epidemiological shift in hepatitis A with a transition from high to low endemicity. Consequently, in these areas, higher proportion of symptomatic disease among adolescents resulting in large-scale community outbreaks has been described. In Tunisia, an increase in the average age at the time of infection has been reported, hence resulting in regular outbreaks, especially household and primary school epidemics. Molecular investigation of such outbreaks, based on the determination of viral genotype and genetic relatedness between hepatitis A virus (HAV) strains, is a useful tool to identify the potential source of HAV contamination but also to assess the virus molecular dynamics over time, such as the introduction of a new genotype or a specific clustering of HAV strains according to the geographical origin. In Sfax city, (Center-East of Tunisia), only HAV strains of genotype IA are circulating. In rural areas, HAV infection is still highly endemic with probably a water-borne transmission pattern. Nevertheless, the considerable genetic heterogeneity observed in urban areas highlights the changing pattern of hepatitis A epidemiology in these settings. Further molecular studies are strongly needed to better understand HAV epidemiology in Tunisia.
{"title":"Epidemiological Aspects of Hepatitis A: Endemicity Patterns and Molecular Epidemiology","authors":"S. Gargouri, Lamia Fki-Berrajah, I. Ayadi, A. Chtourou, A. Hammami, H. Karray-Hakim","doi":"10.5772/intechopen.90431","DOIUrl":"https://doi.org/10.5772/intechopen.90431","url":null,"abstract":"Improvements in hygiene and socio-economic conditions in many parts of the world have led to an epidemiological shift in hepatitis A with a transition from high to low endemicity. Consequently, in these areas, higher proportion of symptomatic disease among adolescents resulting in large-scale community outbreaks has been described. In Tunisia, an increase in the average age at the time of infection has been reported, hence resulting in regular outbreaks, especially household and primary school epidemics. Molecular investigation of such outbreaks, based on the determination of viral genotype and genetic relatedness between hepatitis A virus (HAV) strains, is a useful tool to identify the potential source of HAV contamination but also to assess the virus molecular dynamics over time, such as the introduction of a new genotype or a specific clustering of HAV strains according to the geographical origin. In Sfax city, (Center-East of Tunisia), only HAV strains of genotype IA are circulating. In rural areas, HAV infection is still highly endemic with probably a water-borne transmission pattern. Nevertheless, the considerable genetic heterogeneity observed in urban areas highlights the changing pattern of hepatitis A epidemiology in these settings. Further molecular studies are strongly needed to better understand HAV epidemiology in Tunisia.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131625334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-12DOI: 10.5772/intechopen.90714
S. Więcek
Primary sclerosing cholangitis (PSC) is a chronic liver disease of unknown aetiology affecting extrahepatic and/or intrahepatic bile ducts causing its inflammation and fibrosis with most frequent consequences including biliary cirrhosis and liver failure. The incidence of PSC in children and adolescents is 0.2 per 100,000 children per year, when in adults the reported incidence is higher and equals 0.5 to 1 in 100,000 individuals per year. PSC is more common among men and boys. The diagnosis is usually established in the second decade of life in the paediatric population with the mean age of diagnosis of 13.8 years. Many studies point out a strong correlation between IBD and PSC, especially ulcerative colitis. The prevalence of IBD among children with PSC diagnosis varies from 60 to 99%; however, the incidence of PSC is about 12% in patients with ulcerative colitis and fluctuates about 2–5% in Crohn’s disease diagnosed patients. Clinical symptoms are present in approximately half of cases and they are unspecific in many of them. Elevated liver enzymes and biochemical markers of cholestasis are sometimes the only signs of PSC. Gold standard for PSC diagnosis is magnetic resonance cholangiopancreatography (MRCP) as a non-invasive procedure comparing to endoscopic retrograde cholangiopancreatography (ERCP) which is also used in some cases. The aim of the study was to review the risk factors, clinical symptoms, diagnostic methods and treatment of paediatric patients with primary sclerosing cholangitis.
{"title":"Primary Sclerosing Cholangitis (PSC) in Children","authors":"S. Więcek","doi":"10.5772/intechopen.90714","DOIUrl":"https://doi.org/10.5772/intechopen.90714","url":null,"abstract":"Primary sclerosing cholangitis (PSC) is a chronic liver disease of unknown aetiology affecting extrahepatic and/or intrahepatic bile ducts causing its inflammation and fibrosis with most frequent consequences including biliary cirrhosis and liver failure. The incidence of PSC in children and adolescents is 0.2 per 100,000 children per year, when in adults the reported incidence is higher and equals 0.5 to 1 in 100,000 individuals per year. PSC is more common among men and boys. The diagnosis is usually established in the second decade of life in the paediatric population with the mean age of diagnosis of 13.8 years. Many studies point out a strong correlation between IBD and PSC, especially ulcerative colitis. The prevalence of IBD among children with PSC diagnosis varies from 60 to 99%; however, the incidence of PSC is about 12% in patients with ulcerative colitis and fluctuates about 2–5% in Crohn’s disease diagnosed patients. Clinical symptoms are present in approximately half of cases and they are unspecific in many of them. Elevated liver enzymes and biochemical markers of cholestasis are sometimes the only signs of PSC. Gold standard for PSC diagnosis is magnetic resonance cholangiopancreatography (MRCP) as a non-invasive procedure comparing to endoscopic retrograde cholangiopancreatography (ERCP) which is also used in some cases. The aim of the study was to review the risk factors, clinical symptoms, diagnostic methods and treatment of paediatric patients with primary sclerosing cholangitis.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"263 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115212005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-23DOI: 10.5772/intechopen.88851
J. T. Rodrigues, Priscila Menezes Ferri Liu, A. T. Rodrigues
Hepatitis A is a disease known for a long time. It has a universal distribution, although it has a higher prevalence in places with poor sanitary conditions due to its main form of transmission: fecal-oral. The local health conditions also influence the age of acquisition of the disease and, therefore, its clinical presen-tation, because the disease in young children is usually asymptomatic. It is a viral disease whose prevention is possible through improvements in the population’s basic sanitation conditions and vaccination. Since the introduction of vaccines, it has been possible to see a reduction in its incidence, especially in places where universal vaccination of children has been instituted. In recent years immunoglobulin therapy is being replaced by vaccination in pre- and postexposure prophylaxis (PEP), except in specific situations. Its incidence, even in developing countries, has decreased after introduction of hepatitis A vaccine. The vaccine is recommended in two doses for children, starting at the age of 1. Argentina and, more recently, Brazil have adopted the universal vaccination of all children upon completion of 12 months of age in a single-dose regimen. Despite this breakthrough isolated outbreaks in homeless and drug users are still described in developed countries.
{"title":"Hepatitis A: How We Are after the Introduction of Vaccines","authors":"J. T. Rodrigues, Priscila Menezes Ferri Liu, A. T. Rodrigues","doi":"10.5772/intechopen.88851","DOIUrl":"https://doi.org/10.5772/intechopen.88851","url":null,"abstract":"Hepatitis A is a disease known for a long time. It has a universal distribution, although it has a higher prevalence in places with poor sanitary conditions due to its main form of transmission: fecal-oral. The local health conditions also influence the age of acquisition of the disease and, therefore, its clinical presen-tation, because the disease in young children is usually asymptomatic. It is a viral disease whose prevention is possible through improvements in the population’s basic sanitation conditions and vaccination. Since the introduction of vaccines, it has been possible to see a reduction in its incidence, especially in places where universal vaccination of children has been instituted. In recent years immunoglobulin therapy is being replaced by vaccination in pre- and postexposure prophylaxis (PEP), except in specific situations. Its incidence, even in developing countries, has decreased after introduction of hepatitis A vaccine. The vaccine is recommended in two doses for children, starting at the age of 1. Argentina and, more recently, Brazil have adopted the universal vaccination of all children upon completion of 12 months of age in a single-dose regimen. Despite this breakthrough isolated outbreaks in homeless and drug users are still described in developed countries.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123600636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-30DOI: 10.5772/intechopen.90831
M. Martinefski, S. Lucangioli, L. Bianciotti, V. Tripodi
Cholestasis is defined as the impairment in formation or excretion of bile from the liver to the intestine. It may result from defects in intrahepatic production of bile, impairment of hepatic transmembrane transporters, or mechanical obstruction to bile flow. In cholestasis, hepatocytes are exposed to high levels of bile acids, particularly those bearing hydrophobic properties. The increase in bile acids induces oxidative stress, leading to an imbalance in the prooxidant:antioxidant ratio which determines the final cellular redox status. This chapter will focus on the close relationship between bile acids and the most powerful endogenous antioxidant, coenzyme Q10 in cholestasis, and the eventual alternative therapeutic option of CoQ10 supplementation to current traditional therapies.
{"title":"Cholestasis: The Close Relationship between Bile Acids and Coenzyme Q10","authors":"M. Martinefski, S. Lucangioli, L. Bianciotti, V. Tripodi","doi":"10.5772/intechopen.90831","DOIUrl":"https://doi.org/10.5772/intechopen.90831","url":null,"abstract":"Cholestasis is defined as the impairment in formation or excretion of bile from the liver to the intestine. It may result from defects in intrahepatic production of bile, impairment of hepatic transmembrane transporters, or mechanical obstruction to bile flow. In cholestasis, hepatocytes are exposed to high levels of bile acids, particularly those bearing hydrophobic properties. The increase in bile acids induces oxidative stress, leading to an imbalance in the prooxidant:antioxidant ratio which determines the final cellular redox status. This chapter will focus on the close relationship between bile acids and the most powerful endogenous antioxidant, coenzyme Q10 in cholestasis, and the eventual alternative therapeutic option of CoQ10 supplementation to current traditional therapies.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125569327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-28DOI: 10.5772/intechopen.90238
S. Padhi, Rajlaxmi Sarangi, S. Patra, S. Samal
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome which results in uncontrolled systemic proliferation of benign macrophages in all reticuloendothelial organs producing worsening peripheral blood cytopenia(s); hypercytokinemia leading to hepatic injury producing hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia; and if not diagnosed and treated early may lead to disseminated intravascular coagulation (DIC), multiorgan dysfunction, and death in nearly all individuals. It is postulated that hepatic injury/dysfunction starts early in the course of the disease which may mimic nonspecific hepatitis like prodrome to fulminant hepatic failure; possibly requiring liver transplant. While HLH as an entity is being increasingly recognized nowadays across wide specialties (both pediatric and adults); hepatic involvement in this setting has been poorly characterized. This chapter is aimed to highlight on the diagnosis and classification of HLH with a special emphasis on the pathophysiology of hepatic dysfunction, histomorphology of liver; and the current concept and controversies on the role of liver transplantation in this clinical setting.
{"title":"Hepatic Involvement in Hemophagocytic Lymphohistiocytosis","authors":"S. Padhi, Rajlaxmi Sarangi, S. Patra, S. Samal","doi":"10.5772/intechopen.90238","DOIUrl":"https://doi.org/10.5772/intechopen.90238","url":null,"abstract":"Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome which results in uncontrolled systemic proliferation of benign macrophages in all reticuloendothelial organs producing worsening peripheral blood cytopenia(s); hypercytokinemia leading to hepatic injury producing hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia; and if not diagnosed and treated early may lead to disseminated intravascular coagulation (DIC), multiorgan dysfunction, and death in nearly all individuals. It is postulated that hepatic injury/dysfunction starts early in the course of the disease which may mimic nonspecific hepatitis like prodrome to fulminant hepatic failure; possibly requiring liver transplant. While HLH as an entity is being increasingly recognized nowadays across wide specialties (both pediatric and adults); hepatic involvement in this setting has been poorly characterized. This chapter is aimed to highlight on the diagnosis and classification of HLH with a special emphasis on the pathophysiology of hepatic dysfunction, histomorphology of liver; and the current concept and controversies on the role of liver transplantation in this clinical setting.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128665661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-22DOI: 10.5772/intechopen.89248
A. Chakravarti, T. Bharara
Hepatitis A virus is a common infectious etiology of acute hepatitis worldwide. It was not until World War II (1973) when hepatitis A virus was first identified by an American virologist, Stephen Mark Feinstone. The virus is most commonly transmitted through contaminated food, water, or sexual contact (oral-anal sex). The discovery of hepatitis A virus vaccine is considered a milestone in the history of acute viral hepatitis. Hepatitis A occurs worldwide and frequent outbreaks have been reported over the years. Major geographic differences have existed in endemicity of the disease depending primarily upon hygiene and sanitation practices. Some countries have experienced shifting of endemicity due to improvement of environmental hygiene, swelled International travel and national recommendations for hepatitis A vaccination. The age of acquiring hepatitis A virus is also shifting toward adolescents and adults. This has led to a more symptomatic disease, since hepatitis A infection among children is usually asymptomatic; this is known as the paradox of Hepatitis A epidemiology.
{"title":"Epidemiology of Hepatitis A: Past and Current Trends","authors":"A. Chakravarti, T. Bharara","doi":"10.5772/intechopen.89248","DOIUrl":"https://doi.org/10.5772/intechopen.89248","url":null,"abstract":"Hepatitis A virus is a common infectious etiology of acute hepatitis worldwide. It was not until World War II (1973) when hepatitis A virus was first identified by an American virologist, Stephen Mark Feinstone. The virus is most commonly transmitted through contaminated food, water, or sexual contact (oral-anal sex). The discovery of hepatitis A virus vaccine is considered a milestone in the history of acute viral hepatitis. Hepatitis A occurs worldwide and frequent outbreaks have been reported over the years. Major geographic differences have existed in endemicity of the disease depending primarily upon hygiene and sanitation practices. Some countries have experienced shifting of endemicity due to improvement of environmental hygiene, swelled International travel and national recommendations for hepatitis A vaccination. The age of acquiring hepatitis A virus is also shifting toward adolescents and adults. This has led to a more symptomatic disease, since hepatitis A infection among children is usually asymptomatic; this is known as the paradox of Hepatitis A epidemiology.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117332349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-17DOI: 10.5772/intechopen.89172
R. Coelho, G. Macedo
Hepatitis A virus (HAV) is transmitted mostly through exposure to contaminated food or water, or through exposure to infected persons. This infection can occur sporadically or in an epidemic form, confers lifelong immunity and it is preventable by a safe and effective vaccine. Therefore, prevention strategies are crucial and could eradicate the infection if they were successfully employed. In this chapter, authors summarize mode of transmission and preventive measures for HAV among the following population groups: travellers, health care workers, men who have sex with men, individuals who use illicit drugs, sewage workers, food handlers, military personnel, prisoners, blood transfusions recipients, haemophiliacs and patients with HIV and chronic liver disease. Moreover, authors describe which of these groups are eligible for HAV vaccination according to available data.
{"title":"Hepatitis A: At-Risk Populations","authors":"R. Coelho, G. Macedo","doi":"10.5772/intechopen.89172","DOIUrl":"https://doi.org/10.5772/intechopen.89172","url":null,"abstract":"Hepatitis A virus (HAV) is transmitted mostly through exposure to contaminated food or water, or through exposure to infected persons. This infection can occur sporadically or in an epidemic form, confers lifelong immunity and it is preventable by a safe and effective vaccine. Therefore, prevention strategies are crucial and could eradicate the infection if they were successfully employed. In this chapter, authors summarize mode of transmission and preventive measures for HAV among the following population groups: travellers, health care workers, men who have sex with men, individuals who use illicit drugs, sewage workers, food handlers, military personnel, prisoners, blood transfusions recipients, haemophiliacs and patients with HIV and chronic liver disease. Moreover, authors describe which of these groups are eligible for HAV vaccination according to available data.","PeriodicalId":202429,"journal":{"name":"Hepatitis A and Other Associated Hepatobiliary Diseases","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130853358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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