Acute Viral Hepatitis- Beyond A, B and C*


As defined by Neil Theise at the 9th edition of Robbins (1), “Hepatitis” stands for histologic patterns of lesions found in the livers infected by hepatotropic viruses , by other viruses leading to a liver inflammation in the context of systemic infection, or due to autoimmune , drug or toxins involving the liver. Pathological findings encompasses a set of diffuse necro-inflammation of the liver, presenting heterogeneous distribution. In acute hepatitis , necro-inflammation is more intense in the parenchyma, whereas in chronic forms the inflammation is more relevant at the portal tract and at the porto-parenchymal interface (acinar zone 1). The present review is based on our recent comprehensive approach to acute viral hepatitis at Saxena ́s Practical Hepatic Pathology (2). Herein , we will target especially the histological patterns of injury in acute viral hepatitis, describing aspects related to : 1. The so-called “hepatotropic viruses A, B, C, D and E” ; 2. Viruses responsible for the “icteric hemorrhagic fevers” (dengue, hantavirus, yellow fever). A brief mention to viruses causing hepatitis in immunosuppressed patients will also be presented. Although globalization has exposed travelers to previously unexpected agents, potentially disseminating viruses from different regions of the world, remarkable differences in incidence of each type of viral hepatitis still remain . A recent series of 206 cases of acute viral hepatitis from India 3 identified HEV in 95 cases, HAV in 36, HBV in 18 and mixed infections of these viruses in additional 27 cases. HCV was detected in only one patient. The other 29 cases were ascribed to CMV or EBV. In the USA, official reports of acute hepatitis from CDC for the year 2013 include 1,781 cases of HAV, decreasing to 1,239 in 2014. Notifications of acute hepatitis due to HBV were 3,050 in 2013 and 2,791 in 2014. Acute hepatitis due to HCV totalized 2,138 in 2013, rising to 2,194 in 2014. No data regarding HEV is depicted and, elsewhere in the site, CDC comments that, in the USA, HEV is believed to be uncommon . When symptomatic hepatitis E does occur, it is usually the result of travel to a developing country where hepatitis E is endemic. 4


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