Hepatitis. Algemeen Medisch Laboratorium Antwerpen. Dr. Johan Beert

Transcription

1 Hepatitis Algemeen Medisch Laboratorium Antwerpen Dr. Johan Beert

2 Acute hepatitis Man, 66 jaar (collega) Bloedafname op 29/1/2018

3 Acute hepatitis Man, 66 jaar Bloedafname op 29/1/2018

4 Acute hepatitis Differential diagnosis Marked elevations in serum aminotransferase levels may be seen with: Alcoholic hepatitis Autoimmune hepatitis Acetaminophen (paracetamol) toxicity Idiosyncratic drug reactions Toxin exposure, including mushroom poisoning Acute viral hepatitis (hepatitis A, B, C, D, E; herpes simplex virus; varicella zoster virus; Epstein-Barr virus; cytomegalovirus [CMV]); other viral infections; or an acute exacerbation of chronic viral hepatitis (hepatitis B) Wilson disease Ischemic hepatitis Budd-Chiari syndrome Sinusoidal obstruction syndrome (veno-occlusive disease) HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and occasionally acute fatty liver of pregnancy Malignant infiltration (most often breast cancer, small cell lung cancer, lymphoma, melanoma, or myeloma) Partial hepatectomy Sepsis Heat stroke Muscle disorders (acquired muscle disorders [eg, polymyositis], seizures, and heavy exercise [eg, long distance running]) UptoDate, accessed 8/1/2018

5 Acute hepatitis Man, 66 jaar Bloedafname op 6/11/2017

6 Analyse(s) bijgevoegd na telefonisch overleg: Serologie voor EBV, CMV, Hep A en B immuunstatus, Hep E Auto-immune oorzaken. 6

7 Auto-immune oorzaak? ANA (HEp-2, 1/80) Positief ANA patroon Nucleolair kernfluorescentiepatroon ANA titer 80 C R P slechts licht verhoogd : 28,9 (< 5,0 mg/l) 7

8 WEEFSELANTISTOFFEN (IgG tegen:) Mitochondriën (1/20) Negatief LKM (1/20) Negatief Lever autoimmuun immunoblot AMA-M2 Negatief M2-3E (BPO) Negatief LKM-1 Negatief Liver Cytosol Antigen 1 Negatief Soluble Liver Antigen/LP Negatief Sp100 Negatief gp210 Negatief PML Negatief 8

9 Virale serologie: Hep A IgG pos Hep B géén detecteerbare antistoffen CMV en EBV doorgemaakt Hep E IgM duidelijk pos en IgG neg vals +? 9

10 AST/ALT (U/ml) Bilirubine (mg/dl) Hepatitis E: IgM +++ Confirmatietest: Hep. E: RNA +++ = Acute hepatitis E ALT AST Bilirubine , , , , , , , ,00 28/01 30/01 1/02 3/02 5/02 7/02 9/02

11 Hepatitis E Meestal na reis naar ontwikkelingslanden maar niet altijd 4 genotypes Genotype 1 en 2 Azie, India, Noord Afrika Waterborne Genotype 2 Mexico en West Afrika Waterborne Genotype 3 Westerse landen, N-Amerika, Azie Zoonotic Genotype 4 Europa en Azie Zoonotic 11

12 Acute hepatitis E globale distributie Marano G et al. Blood transfusion. 2015;13(1):6-17.

13 Acute hepatitis E Waterborne infection HEV genotype 1 and 2 infections are spread by fecally contaminated water in endemic areas. Zoonotic transmission HEV genotypes 3 and 4 usually cause infections due to consumption of contaminated food. Most cases are sporadic and unidentified as an acute viral hepatitis, Swine are most frequently implicated in transmission, followed by consumption of filter feeder shellfish [48-51]. However, many animal species (including rodents in some regions), have been identified as part of the viral reservoir of disease [52]. HEV transmission has been reported from consumption of undercooked deer meat, wild boar meat, pig liver sausage, and internal organs of animals in Japan, Germany, and France [53-56]. There are limited data regarding food preparation to reduce/eliminate HEV transmission. In one study, cooking liver at 191 F for five minutes or boiling liver for five minutes reduced the risk of transmission by inactivating HEV [58]. UptoDate, accessed 8/1/2018

14 Typisch symptomen Hepatitis E Icterus Malaise Anorexie Nausea, braken, buikpijn Koorts Hepatomegalie Soms: diarree, arthralgie, pruritus, urticariele rash 14

15 Verloop Hepatitis E Incubatietijd 15 tot 60 dagen Meestal mild en zelflimiterend normalisatie levertesten na 1 a 6 w. Regelmatig verlengde cholestase Supportieve therapie volstaat meestal Soms chronische vormen (vnl. genotype 3) bij immunodeficit Zelden ernstige vormen waarvoor antivirale R/ (Ribavirine) Voorkomen: hygiëne, voedselkeuze, vaccinatie (China) 15

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