Cholestatic syndrome in viral hepatitis A

AIM: To study the cholestatic forms of viral hepatitis A that are described as unusual and very rare, but that are of great significance because of their severe course and high morbidity rate. MATERIAL AND METHODS: We describe herein 17 cases of hepatitis A virus (HAV) infection with pronounced cholestasis treated in the Clinic of Infectious Diseases at St. George University Hospital between 2002 and 2006. They are taken from a contingent of 820 patients we studied in the course of the research: of these 400 were cases of sporadic disease and 420 patients were involved in an epidemic outbreak of the disease. All got this diagnosis based on an anti-HAV/IgM test. Eight parameters were analyzed: age, max TBil, max ALT, ALP, GGT, no urobilinogen in urine, ultrasound monitoring of hepatomegaly, and hospital stay. RESULTS: The 17 patients we discuss here are 2.07% of the total 820 patients with viral hepatitis A (VHA). In 14 the disease had a cholestatic component; 3 cases were a cholestatic form of the disease. The mean hospital stay was 49.1 +/- 11.5 days, the longest--75 days. The hyperbilirubinemia had high levels at the disease climax - the mean concentration was 356.6 microkmol/l, and remained greater than 150 microkmol/l for more than a month. In 10 patients (58.2%) transaminase activity was over 1400 U/l, (mean 2011 U/l). CONCLUSION: Viral hepatitis A ran with cholestatic syndrome in 2.07%; 23.5% of these cases were classified as severe forms of the disease and 76.5%--as moderate. This is evinced by the enhanced transaminase activity, the elevated TBil, pronounced intoxication, the adynamia, vomiting, headache, the vertigo, all of these items in the objective severity score system we used.