Hepatitis A in Adults: Experience from a Moroccan Hospital Center
Abstract:
Background: In children, hepatitis A virus infection is usually symptom-free and provides long-term immunity. However, in changing socio-economic environments, certain adults encounter infection risks, exposing them to symptomatic illness and complications. This study aims to outline the profile of adult hepatitis A patients.
Methods: We conducted a retrospective study from 2017 to 2023, involving all patients aged over 14 years who presented with acute hepatitis and tested positive for anti-HAV antibodies. Demographic, laboratory and clinical data were analyzed.
Results: The analysis involved 109 cases (mean age 21 +/- 6 years, 57.8% males). All patients were symptomatic. Among them, 71.6% presented with a pseudo-flu-like syndrome, 89% with jaundice, 50.5% with fever and 30.2% with gastrointestinal symptoms. Thirty patients were hospitalized (26.6%), among them one subfulminant was recorded. Clinically, hepatomegaly was found in 8 patients (7.3%). One patient had presented with a skin rash. Serum alanine aminotransferases levels were more than 50 times the normal range in 47.7% of cases, with an average bilirubin level of 89 mg/l. Severe acute hepatitis was observed in 26.6% of patients.
Conclusion: Our findings revealed that over 25% of adult patients experienced severe acute hepatitis, with one patient progressing to acute liver failure. These results underline the importance of raising awareness of hygiene practices and prompt a study of the overall seroprevalence of hepatitis in the adult population in order to improve viral hepatitis prevention and control strategies in the country.
KeyWords:
Hepatitis A virus - HAV - Adults – Jaundice - Vaccination
References:
- Agrawal A, Singh S, Kolhapure S, Hoet B, Arankalle V, Mitra M. Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent. Infect Dis Ther. 2019 Dec;8(4):483-497. doi: 10.1007/s40121-019-00270-9. Epub 2019 Nov 2. PMID: 31679118; PMCID: PMC6856242.
- Lai, Michelle, and Sanjiv Chopra. "Hepatitis A virus infection in adults: Epidemiology, clinical manifestations, and diagnosis." U: UpToDate, Baron EL ed. UpToDate [Internet]. Waltham, MA: UpToDate (2019).
- Koroglu M, Jacobsen KH, Demiray T, Ozbek A, Erkorkmaz U, Altindis M. Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa. J Infect Public Health. 2017 Sep-Oct;10(5):513-517. doi: 10.1016/j.jiph.2016.09.020. Epub 2017 Feb 2. PMID: 28162965.
- Bouskraoui M, Bourrous M, Amine M. Prévalence des anticorps de l'hépatite A chez l'enfant dans la région de Marrakech [Prevalence of anti-hepatitis A virus antibodies in chidren in Marrakech]. Arch Pediatr. 2009 Oct;16 Suppl 2:S132-6. French. doi: 10.1016/S0929-693X(09)75317-5. PMID: 19836677.
- WHO, Department of immunization, Vaccines and biological. The global prevalence of hepatitis A virus infection and susceptibility: a systematic review; 2010. Available from: http://www.whqlibdoc.who.int/hq/2010/ WHO_IVB_10.01_eng.pdf
- Nandi B, Hadimani P, Arunachalam R, Ganjoo RK. Spectrum of acute viral hepatitis in Southern India. Medi J Armed Forces India. 2009;65(1):7–9.
- Kamath SR, Sathiyasekaran M, Raja TE, Sudha L. Profile of viral hepatitis A in Chennai. Indian Pediatr. 2009;46(7):642–643.
- Chadha MS, Lole KS, Bora MH, Arankalle VA. Outbreaks of hepatitis A among children in western India. Trans R Soc Trop Med Hyg. 2009;103(9):911–916.
- Malik MJ, Shahid M, Naheed S, Alam AY, Khan EA. Are there reasons for universal immunization for hepatitis A virus infection? Rawal Med J. 2008;34(1):36–39.
- Dahanayaka NJ, Kiyohara T, Agampodi SB, et al. Clinical features and transmission pattern of hepatitis A: an experience from a hepatitis a outbreak caused by two cocirculating genotypes in Sri Lanka. Am J Trop Med Hyg. 2016;95(4):908–914.
- Hussain Z, Das BC, Husain SA, Murthy NS, Kar P. Increasing trend of acute hepatitis A in north India: need for identification of high-risk population for vaccination. J Gastroenterol Hepatol. 2006;21(4):689–693.
- Ma, Michael MD1; Golfeyz, Shmuel MD2; Chen, Christine DO2; Naik, Jahnavi MD2. Relapsing Hepatitis A: An Asymptomatic Recurrence of Elevated Liver Chemistries: 2406. American Journal of Gastroenterology 113():p S1342-S1343, October 2018
- Kassas AL, Telegdy L, Méhesfalvi E, Szilágyi T, Mihály I. Polyphasic and protracted patterns of hepatitis A infection: a retrospective study. Acta Med Hung. 1994;50(1-2):93.
- Stránský J, Honzáková E, Vandasová J, Kyncl J. Relapsující a protrahovaná forma virové hepatitidy A: porovnání dospĕlých s dĕtmi [A relapsing and protracted form of viral hepatitis A: comparison of adults and children]. Vnitr Lek. 1995 Aug;41(8):525-30. Czech. PMID: 7483334.
- Bhatt G, Sandhu VS, Mitchell CK. A rare presentation of hepatitis a infection with extrahepatic manifestations. Case Rep Gastrointest Med. 2014;2014:286914. doi: 10.1155/2014/286914. Epub 2014 Sep 14. PMID: 25295197; PMCID: PMC4177781.
- Cao G, Jing W, Liu J, Liu M. The global trends and regional differences in incidence and mortality of hepatitis A from 1990 to 2019 and implications for its prevention. Hepatol Int. 2021 Oct;15(5):1068-1082. doi: 10.1007/s12072-021-10232-4. Epub 2021 Aug 3. PMID: 34345993; PMCID: PMC8514357.
- Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S, Koneru A, Haber P, Hagan L, Romero JR, Schillie S, Harris AM. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. doi: 10.15585/mmwr.rr6905a1. Erratum in: MMWR Morb Mortal Wkly Rep. 2021 Feb 26;70(8):294. PMID: 32614811; PMCID: PMC8631741.