Late-Relapsing Hepatitis after Yellow Fever
Late-Relapsing Hepatitis after Yellow Fever
复制标题
DOI：
10.3390/v12020222
复制
发表时间：
2020-02-01
期刊：
影响因子：
4.7
通讯作者：
Drumond, Betania Paiva
中科院分区：
文献类型：
--
作者：
Rezende, Izabela Mauricio;Pereira, Leonardo Soares;Drumond, Betania Paiva
1例患者在急性黄热病（YF）发作后2个月出现食欲减退、虚弱、水肿和黄疸;加上实验室检查显示肝细胞溶解和丙氨酸和天冬氨酸转氨酶反弹，以及总胆红素和直接胆红素水平。实验室检查排除了自身免疫性肝炎、炎症性或代谢性肝病以及嗜肝性药物引起的新感染。在不同时间检测到抗YFV IgM、IgG和中和抗体，但未发现病毒血症。在YF发病后三个月收集肝活检，并检测YFV抗原和野生型YFV-RNA阳性（364 RNA拷贝/克/肝）。转氨酶和胆红素水平持续升高5个月，症状的抑制持续6个月后，急性YF发作。测定了几种血清趋化因子、细胞因子和生长因子。在疾病的早期阶段观察到类似的免疫应答特征，随后在后期阶段发生更明显的变化，此时转氨酶水平恢复正常。结果表明，病毒在肝脏中的持续存在和持续的肝细胞损伤后三个月的YF发病，并加强了需要延长随访的YF患者。进一步的研究，以调查可能的病毒持久性和免疫反应的作用，导致复发性肝炎后，YF也是必要的。
One patient presented hyporexia, asthenia, adynamia, and jaundice two months after acute yellow fever (YF) onset; plus laboratory tests indicating hepatic cytolysis and a rebound of alanine and aspartate transaminases, and total and direct bilirubin levels. Laboratory tests discarded autoimmune hepatitis, inflammatory or metabolic liver disease, and new infections caused by hepatotropic agents. Anti-YFV IgM, IgG and neutralizing antibodies were detected in different times, but no viremia. A liver biopsy was collected three months after YF onset and tested positive for YFV antigens and wild-type YFV-RNA (364 RNA-copies/gram/liver). Transaminases and bilirubin levels remained elevated for five months, and the arresting of symptoms persisted for six months after the acute YF onset. Several serum chemokines, cytokines, and growth factors were measured. A similar immune response profile was observed in the earlier phases of the disease, followed by more pronounced changes in the later stages, when transaminases levels returned to normal. The results indicated viral persistence in the liver and continual liver cell damage three months after YF onset and reinforced the need for extended follow-ups of YF patients. Further studies to investigate the role of possible viral persistence and the immune response causing relapsing hepatitis following YF are also necessary.