Characterization and Investigation of Risk Factors for Late-Relapsing Hepatitis After Yellow Fever
Author:
Rezende Izabela Mauricio de12ORCID, McClure Max A2, Pereira Leonardo S3, Fradico Jordana R B4, Cenachi Adriana R C3, Moura Alexandre S3, Paladino Luísa L de A3, Dutra Maria Rita T3, Alves Pedro A5, Xavier Marcelo A P5, Said Rodrigo F do C6, Ramalho Dario B3, Gama Thaysa D P3, Martins-Filho Olindo A4, Monath Thomas P7, Teixeira-Carvalho Andréa4, Drumond Betânia P1, LaBeaud Angelle D2, Castro Bragato Alexandre Maurício, Araújo Argus Leão, de Almeida Faria Flávio Augusto, Penido Indiara, Menezes Letícia, Rabelo Livia Frota, Pamplona Livia, da Cunha Melo Lívia Fulgêncio, Fonte Boa Lívia Soares Coelho, dos Santos Lívia Zignago Moreira, de Paula Ludmila, Marçal Marcelle Cardoso, Albuquerque Natalia Soares, Macedo Rodrigo, Araújo Tayrine,
Affiliation:
1. Laboratory of Viruses, Microbiology Department, Federal University of Minas Gerais , Belo Horizonte , Brazil 2. Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine , California 3. Eduardo de Menezes Hospital , Belo Horizonte, Minas Gerais , Brazil 4. Integrated Group of Biomarkers Research, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ , Belo Horizonte, Minas Gerais , Brazil 5. Immunology of Viral Diseases, René Rachou Institute, Oswaldo Cruz Foundation/FIOCRUZ 6. Secretaria de Estado de Minas Gerais , Belo Horizonte, Minas Gerais , Brazil 7. Crozet BioPharma LLC , Lexington, Massachusetts , USA
Abstract
Abstract
Background
Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46–60 days after YF symptom onset.
Methods
Here we have characterized the clinical course and risk factors for LHep-YF using data from a representative cohort of patients who survived YF in Brazil, 2017–2018. A total of 221 YF-positive patients were discharged from the infectious disease reference hospital in Minas Gerais and were followed up at 30, 45, and 60 days post–symptom onset.
Results
From 46 to 60 days post–symptom onset, 16% of YF patients (n = 36/221) exhibited a rebound of aminotransferases (aspartate aminotransferase or alanine aminotransferase >500 IU/L), alkaline phosphatase, and total bilirubin levels. Other etiologies of liver inflammation such as infectious hepatitis, autoimmune hepatitis, and metabolic liver disease were ruled out. Jaundice, fatigue, headache, and low platelet levels were associated with LHep-YF. Demographic factors, clinical manifestations, laboratory tests, ultrasound findings, and viral load during the acute phase of YF were not associated with the occurrence of LHep-YF.
Conclusions
These findings provide new data on the clinical course of Late-relapsing hepatitis during the convalescent phase of YF and highlight the need for extended patient follow-up after acute YF.
Funder
National Institutes of Health Secretaria de Estado de Saúde de Minas Gerais Secretaria de Estado de Planejamento de Minas Gerais Instituto René Rachou Fundação Oswaldo Cruz Conselho Nacional de Desenvolvimento Científico e Tecnológico Fundação de Amparo a Pesquisa do Estado de Minas Gerais Coordenação de Aperfeiçoamento de Pessoal de Nı́vel Superior CNPq Research Fellows Hospital Eduardo de Menezes Fundação de Hospitais do Estado de Minas Gerais US Collaborative Biomedical Research Program CNPq MS
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
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