Thirteen patients of different age groups were examined. They presented with clinico-biochemical data about acute viral hepatitis serologically decoded as acute viral hepatitis C. In 9 cases an evidence of inoculative manipulations (in 6 venous drug abusers and in 3 cases after surgical interventions) was established. The course of the disease was not very severe. In one patient it was even slight. There was a tendency towards a chronic course in 5 cases. In two patients the catamnestic folllowing-up revealed a histological evidence of chronic viral hepatitis C. Interferon therapy was administered

Manolov, P.

Radkova, D.

English

Varna Medical University Press: Journals

cripta Scientifica Medica, vol. 31 (1999), pp. 139-142 Copyright © Medical University, Varna * ACUTE V I R A L HEPATITIS С P. Manolov, D. Radkova Department of Infectious Diseases and Epidemiology, Medical University of Varna, Varna Thirteen patients of different age groups were examined. They presented with clinico-biochemical data about acute viral hepatitis serologically decoded as acute viral hepatitis C. In 9 cases an evidence of inoculative manipulations (in 6 venous drug abusers and in 3 cases after surgical interventions) was established. The course of the disease was not very severe. In one patient it was even slight. There was a tendency towards a chronic course in 5 cases. In two patients the catamnestic folllowing-up revealed a histological evidence of chronic viral hepatitis C. Inter­feron therapy was administered. Key-words: Acute viral hepatitis C, drug abusers, diagnosis, treatment Hepatitis С viral infection be­comes an important socio-medical prob­lem which affects a considerable contin­gent of people in many countries in the world, i . е., about and more than 2 per cent of the population. It is known that there are diverse clinical forms of the in­fection - from viral carriers to severe forms. The prevalence rate of the primary chronic hepatitis is about 70-80-90 per cent as compared with the acute one. The absent opportunity to examine all the pa­tients with acute viral hepatitis for anti-he­patic С virus (anti-HCV) imposes the search for viral hepatitis С only when the acute viral hepatitis A, B , and D are ex-Address for correspondence: P. Manolov, Dept. of Infectious Diseases and Epidemiology, Medical University, 55 Marin Drinov St, BG-9002 Varna, BULGARIA E-mail: infect@asclep.muvar.acad.bg eluded in the infectious hospitals (1-6). The aim of this study was to ex­amine the clinical and epidemiological char-acteristics of the patients with acute viral hepatitis С (AVH-C) among the patients' contingent hospitalized in the Department of Infectious Diseases and Epidemiology, Medical University of Varna, in 1998. MATERIAL AND METHODS The trial covered a group of 13 patients diagnosed in the Department of Infectious Diseases and Epidemiology, Medical University of Varna, in 1998 as a viral hepatitis С infection. A series of clinico-laboratory methods such as anam­nesis, patient's status, and analysis of the pathological alterations during the hospi­tal stay, one month after it but in some cases N P. Manolov, D. Radkova during a 2-year period were applied. Sev-eral haematological indicators, enzyme activity, serum bilirubin, hepatitis markers such as HBsAg, anti-HBcIgM, anti-HAV IgM, and anti-HCV were studied. RESULTS AND DISCUSSION Patients' distribution according to age, sex, probable mechanism of trans-mission of the infection as well as accord-ing to the severity of the disease were pre-sented on Tables 1 through 3. The beginning of the disease was typical of viral hepatitis Icterus manifesta-tion was preceded by a rather typical preicteric period in almost all the patients. Only a girl coming from the Infectious Di-vision of the District Hospital of the town of Bourgas presented with a chronic course of the disease. Subsequently, she proved to be an intravenous drug abuser. Dyspeptic and asthenovegetative com-plaints were found in 100 per cent of the cases. In a male patient the disease initi-ated with similar complaints and rush caus-ing his admission in ahaematologic clinic with a preliminary diagnosis of Schonlein-Henoch's purpura. It was rejected after the specification of the diagnosis of AVH-C. Table 1 Percentage patients's distribution according to the gender and age Age (years) 15-30 30-60 Over 60 Males 7 0 1 Females 3 1 1 Total 10 1 2 % 75 8,33 16,67 Table 2 Patients' distribution according to the probable mechanism of transmission of the infection Mechanism of transmission n % Surgical intervention 3 23,08 Venous drug users 7 53,84 Unknown 3 23,08 Table 3 Patients' distribution accortrding to the severity of the disease Clinical form n Males % n Females % % Total % Slight 1 1,25 1 20 2 15,38 Moderate 7 87,50 4 80 11 84,62 Severe 0 0 0 0 0 0 140 Viral hepatitis С An acute course of the disease as found out in most cases. A protracted ourse was observed in 4 patients who were discharged from hospital with tran­saminase activity within 100-200 UI . One male patient presented with a subacute course of the disease. In another male patient aged 79 years after surgical inter-ention the disease acquired a chronic ourse. He was catamnestically followed-p. Because of his advanced age and of е accompanying diseases after the op-ration on the occasion of rectal cancer a erapy with interferon was not administ­ered. The latter was given along with ribavirin to another male patient aged 30 years, with a prolonged course of the dis­ease and a slight constant degree of transaminasemia. The transaminase activ­ity normalized after one month of treat­ment. At presence, the interferon therapy ontinued for a second year and should >e stopped. A slight degree of bilirubinaemia at the average of 130,60 mmol/1 was mea­sured at admission to hospital in all the patient while at discharge from hospital it was 23,44 mmol/1. Thymol test was nor­mal at admission in 65,23 % of the pa­tients while at discharge an abnormal evelation was found in one patient only. The average SGPT value at admission was of 629,76 UI , it remained below 1000 U I in all the cases while at discharge the mean SGPT value reduced down to 92,23 UI . In 9 patients (69, 23 % ) there was a re­sidual hepatomegaly not bigger than 2 cm at discharge from hospital. The average hospital stay was about 19,69 days. A regular catamnestic follow-up observation was possible in 6 patients only because the rest drug abusers did not visit the Department of Infectious Diseases and Epidemiology one month after discharge. A persistant transaminasemia was proved in a patient with a protracted course of the disease. Seven months after the onset of the disease the activity of SGPT nor­malized. In two other patients the transami­nase activity normalized within one year. Our study showed that the viral hepatitis С infection was most common in drug abusers and after surgical interven­tions. These patients were rarely hospital­ized in infectious hospitals along with the stream of patients with acute viral hepati­tis. That was why the group of drug abus­ers dominated in this contingent present­ing with an acute character of the disease. Therefore, one is obliged to carry out comprehensive catamnestic observa­tions with these drug abusers and with all the viral hepatitis patients where several types of hepatitis have been established and an interferon therapy has been admin­istered in comparison with the other viral hepatitis types after the acute stage has passed. 141 P. Manolov, D. Radkova REFERENCES 1. Al ter , M. J . , L . A . Moyer. J. AIDS Hum. Retroviral, 18, 1998, Suppl. l,S6-S10.-2. Caceres, N . , M. Cerda, et a l . Rev. Med. Chile, 125, 1977, No 11, 1357-1360.- 3. Goldberg, D . , S. Kameron, J .McMenamin. Commun. Dis. Publ. Health, 1, 1998, No 2, 95-97.- 4. Hagan, H . Substan. Use Misuse, 33, 1998, No 5, 1197-1212.-5. Johnson, M. E . , D. G . Fisher , A . Fenaughty, S. A. Theno.Amer. J. Gastroenterol., 93, 1988, No 5, 785-789.- 6. Kemp, R . , J . Mi l le r , S. Lungley, M. Baker . New Zeal. Med. J., I l l , 1998, No 1060, 50-53. Остър вирусен хепатит С П. Манолов, Д. Радкова Катедра по инфекциозни болести и епидемиология, Медицински университет-Варна Резюме: Проследени са 13 болни от различни възрастови групи, с клинико-биохимични данни за остър вирусен хепатит, разшифровани серологично като ОВХ-С. При девет от болните са установени данни за инокулативни манипулации (при 6 - с венозна наркомания, а 3 - с оперативни интервенции). Заболяването е протекло средно тежко, а при един от случаите - леко. С тенденция към хронично протичане са били пет случая. От катамнестичното проследяване при двама от преболедувалите са установени хистологични данни за хроничен вирусен хепатит С и е проведено лечение с интерферон. 142 

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