Ocorrência de hepatites não-anão-B em unidade de hemodiálise

Takahashi, Clarina; Yoshida, Clara F. T.; Gaspar, Ana Maria C.; Baptista, Marcia L.; Hoette, Marcos; Ruzany, Frederico

doi:10.1590/S0037-86821988000300003

Resumos

A monitorização mensal de alanina aminotransferase (ALT) sérica de pacientes em hemodiálise e os testes sorológicos para exclusões de infecções por vírus da hepatite A (HAV), vírus da hepatite B (HBV), citomegalovirus (CMV) e vírus Epstein-Barr (EBV), permitiu-nos identificar 11 casos de hepatites não-A, não-B em 111 indivíduos avaliados durante o período de 12 meses e acompanhados por 2 anos. Foram observados 3 padrões de atividade de ALT: elevação em pico monofásico em 2, bifásico ou polifásico em 6 e em platô em 3 pacientes. Individíduos com padrão monofásico exibiram os níveis mais elevados de ALT. Cinco pacientes apresentaram normalização bioquímica persistente 4,8 meses em média após o início da elevação aguda e seis evoluíram com ascensão crônica de ALT durante o período de estudo. A hepatite não-A, não-B foi, predominantemente, assintomática e anictérica, sempre antecedida por transfusões sangüíneas e com maior incidência nos seis primeiros meses de terapia dialítica dos pacientes.

Hepatite não-A, não-B; Hemodiálise; Transfusão sagüinea

Through monthly monitorization of alanine amino transferase (ALT) in hemodialysis patients and serological tests for exclusion of HA V (hepatitis A virus), HBV(hepatitis B virus), CMV (cytomegalovirus) and EBV (Epstein-Barr virus) infections, it was possible to identify 11 cases of non-A, non-B hepatitis among 111 individuals evaluated in a period of 12 months and followed-up for 2 years. Three patterns of ALT activity were observed: an elevation in monophasic peak in 2 patients, biphasic andpolyphasic in 6 patients and elevation in plateau in three others. Patients with the monophasic pattern showed the most elevated levels of ALT. Five patients showed biochemical normalization within approximately 4.8 months after the beginning of acute elevation and 6 evolved with chronic intermittent elevation during the period of study. Hepatitis non-A, non-B was predominantly asymptomatic and anicteric, always preceeded by blood tranfusions and with higher incidence in the 6 first months after hemodialysis.

Non-A Non-B Hepatitis; Hemodialysis; Blood transfusion

ARTIGOS

Ocorrência de hepatites não-anão-B em unidade de hemodiálise

Clarina Takahashi^I; Clara F. T. Yoshida^II; Ana Maria C. Gaspar^II; Marcia L. Baptista^II; Marcos Hoette^I; Frederico Ruzany^I

^IClínica de Doenças Renais - Rio de Janeiro

^IIDepartamento de Virologia - Fundação Oswaldo Cruz - Avenida Brasil, 4365 CEP 21040 - Rio de Janeiro

RESUMO

A monitorização mensal de alanina aminotransferase (ALT) sérica de pacientes em hemodiálise e os testes sorológicos para exclusões de infecções por vírus da hepatite A (HAV), vírus da hepatite B (HBV), citomegalovirus (CMV) e vírus Epstein-Barr (EBV), permitiu-nos identificar 11 casos de hepatites não-A, não-B em 111 indivíduos avaliados durante o período de 12 meses e acompanhados por 2 anos.

Foram observados 3 padrões de atividade de ALT: elevação em pico monofásico em 2, bifásico ou polifásico em 6 e em platô em 3 pacientes. Individíduos com padrão monofásico exibiram os níveis mais elevados de ALT.

Cinco pacientes apresentaram normalização bioquímica persistente 4,8 meses em média após o início da elevação aguda e seis evoluíram com ascensão crônica de ALT durante o período de estudo. A hepatite não-A, não-B foi, predominantemente, assintomática e anictérica, sempre antecedida por transfusões sangüíneas e com maior incidência nos seis primeiros meses de terapia dialítica dos pacientes.

Palavras-chave: Hepatite não-A, não-B. Hemodiálise. Transfusão sagüinea.

ABSTRACT

Through monthly monitorization of alanine amino transferase (ALT) in hemodialysis patients and serological tests for exclusion of HA V (hepatitis A virus), HBV(hepatitis B virus), CMV (cytomegalovirus) and EBV (Epstein-Barr virus) infections, it was possible to identify 11 cases of non-A, non-B hepatitis among 111 individuals evaluated in a period of 12 months and followed-up for 2 years.

Three patterns of ALT activity were observed: an elevation in monophasic peak in 2 patients, biphasic andpolyphasic in 6 patients and elevation in plateau in three others. Patients with the monophasic pattern showed the most elevated levels of ALT.

Five patients showed biochemical normalization within approximately 4.8 months after the beginning of acute elevation and 6 evolved with chronic intermittent elevation during the period of study.

Hepatitis non-A, non-B was predominantly asymptomatic and anicteric, always preceeded by blood tranfusions and with higher incidence in the 6 first months after hemodialysis.

Keywords: Non-A Non-B Hepatitis. Hemodialysis. Blood transfusion.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 5/5/88.

1. Aach RD, Kahn RA. Post-transfusion hepatitis: current perspectives. Annals of Internal Medicine 92: 539-546, 1980.
2. Alter HJ, Purcell RH, Holland PV, AllingDW, Koziol DE. Donor transaminase and recipient hepatitis. Impact on blood transfusion services. Journal of the American Medical Association 246: 630-634, 1981.
3. Alter HJ, Purcell RH, Holland PV, Popper H. Transmissible agent in non-A, non-B hepatitis. Lancet 1:459- 463,1978.
4. Berg PA, Stromp R, Ewers C, Schmeisser W, Dolle W, Flehmig B. Epidemiologie und klinik der Non-A, Non-B hepatitis. Eine retrospektive Studie aus den Jahren 1970-1976. Deutsche Medizinische Wochenschrift 105:751-755, 1980.
5. Berman M, Alter HJ, Ishak KG, Purcell RH, Jones EA. The chronic sequelae of non-A, non-B hepatitis. Annals of Internal Medicine 91:1-6, 1979.
6. Brenner EM, RectorFC. The kidney, vol. II, 2nd Ed, p. 2503, Philadelphia, WB Sauders, 1981.
7. Dienstag JL. Non-A, non-B hepatitis. Advances in Internal Medicine 26: 187-233, 1987.
8. Dienstag JL, Alaama A, Mosley JW, Redeker AG, Purcell RH. Etiology of sporadic hepatitis B surface antigen-negative hepatitis. Annals of Internal Medicine 87:1-6, 1977.
9. Dienstag JL, Stevens CE, Szmuness W. The epidemiology of non-A, non-B hepatitis: emerging patterns. In: (ed.) Gerety RJ. Non-A, non-B hepatitis. Academic Press, New York p. 119-138, 1981.
10. Feinstone SM, Kapikiati AZ, Purcell RH, Alter HJ, Holland PV. Transfusion-associated hepatitis not due to viral hepatitis A or B. New England Journal of Medicine 292: 767-770, 1975.
11. Galbraith RM, Dienstag JL, Purcell RH, Gower RH, Zuckerman AJ, Williams R. Non-A, non-B hepatitis associated with chronic liver disease in a haemodialysis unit. Lancet 1: 951-953, 1979.
12. Gubin N. Spallation of silicone from blood-pump tubing in hemodialysis. New England Journal of Medicine 307: 319, 1982.
13. Hollinger FB, Mosley JW, Szmuness W, Aach RD, Peters RL, Stevens C. Transfusion-transmitted viruses study: experimental evidence for two non-A, non-B, hepatitis agents. Journal of Infectious Diseases 142: 400-407, 1980.
14. Karvountzis GG, Mosley JW, Redeker AG. Serologic characterization of patients with two episodes of acute viral hepatitis. American Journal of Medicine 58:815- 822, 1975.
15. Knodell RG, Conrad ME, Ishak KG. Development of chronic liver disease after acute non-A, non-B post-transfusion hepatitis: role of gamma-globulin prophylaxis in its prevention. Gastroenterology 72: 902-909, 1977.
16. Koretz RL, Stone O, Gitnick GL. The long-term course of non-A, non-B post-transfusion hepatitis. Gastroenterology 79: 893-898, 1980.
17. Leong AS, Disney AP, Gove DW. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis. New England Journal of Medicine 306: 135-140, 1982.
18. Magnius LO, Espmark JA. New specificities in Australia antigen positive sera distinct from the Le Bouvier determinants. Journal of Immunology 109:1117-1021, 1972.
19. Mosley JW, Redeker AG, Feinstone SM, Purcell RH. Multiple hepatitis viruses in multiple attacks of acute viral hepatitis. New England Journal of Medicine 296: 75-78, 1977.
20. Norkrans G, Frosner G, Hermodsson S, Iwarson S. Multiple hepatitis attacks in drug addicts. Journal of the American Medical Association 243:1056-1058,1980.
21. Seaworth BJ, Garrett LE, Stead WW, Hamilton JD. Non-A, non-B hepatitis and chronic dialysis - another dilemma. American Journal of Nephrology 4:235-239, 1984.
22. Schimizu YK, Feinstone SM, Purcell RH, Alter HJ, London WT. Non-A, non-B hepatitis: ultrastructural evidence for two agents in experimentally infected chimpanzees. Science 205: 197-200, 1979.
23. Simon N, Mery JP, Trepo C, Vitvitski L, Courouce AM. A non-A, non-B hepatitis epidemic in a HB antigen-free haemodialysis unit. Demonstration of serological markers of non-A, non-B virus. Proceedings of the European Dialysis and Transplant Association 17: 173-178, 1980.
24. Tabor E, Gerety RJ, Drucker JA, Seeff LB, Hoofnagle JH, Jackson DR, April MDUM, Barker LF, Pineda- Tamondong G. Transmission of non-A, non-B hepatitis from man to chimpanzee. Lancet 1: 463-466, 1978.
25. Tateda A, Kikuchi K, Numazaki Y, Shirachi R, Ishida N. Non-B hepatitis in Japanese recipients of blood transfusions: clinical and serologic studies after the introduction of laboratory screening of donor blood for hepatitis B surface antigen. Journal of Infectious Diseases 139: 511-518, 1979.
26. Tsiquaye KN, Bird RG, Tovey G, Wyke RJ, Williams R, Zuckerman AJ. Further evidence of cellular changes associated with non-A, non-B hepatitis. Journal of Medical Virology 5: 63-71, 1980.
27. Villarejos VM, Visona KA, Eduarte CA, Provost PJ, Hilleman MR. Evidence for viral hepatitis other than type A or type B among persons in Costa Rica. New England Journal of Medicine 293: 1350-1352, 1975.
30. Yoshizawa H, Itoh Y, Iwakiri S, Kitajima K, Tanaka A, Nojiri T, Miyakawa Y, Mayumi M. Demonstration of two different types of non-A, non-B hepatitis by reinjection and cross-challenge studies in chimpanzees. Gastroenterology 81: 107-113, 1981.
28. Ware AJ, Luby JP, Hollinger B, Eigenbrodt EH, Cuthbert JA, Atkins CR, Shorey J, Hull AR, Combes A. Etiology of liver disease in renal-transplant patients. Annals of Internal Medicine 91: 364-371, 1979.
29. Woodman HT, Weiser MM, Venuto R, Walshe J. Outbreak of non-A, non-B hepatitis in a dialysis unit and its characterization. Gastroenterology 79: 1068 (abstr.), 1980.

Datas de Publicação

Publicação nesta coleção
28 Maio 2013
Data do Fascículo
Set 1988

Histórico

Aceito
05 Maio 1988
Recebido
05 Maio 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aach RD, Kahn RA. Post-transfusion hepatitis: current perspectives. Annals of Internal Medicine 92: 539-546, 1980.

[2] 2. Alter HJ, Purcell RH, Holland PV, AllingDW, Koziol DE. Donor transaminase and recipient hepatitis. Impact on blood transfusion services. Journal of the American Medical Association 246: 630-634, 1981.

[3] 3. Alter HJ, Purcell RH, Holland PV, Popper H. Transmissible agent in non-A, non-B hepatitis. Lancet 1:459- 463,1978.

[4] 4. Berg PA, Stromp R, Ewers C, Schmeisser W, Dolle W, Flehmig B. Epidemiologie und klinik der Non-A, Non-B hepatitis. Eine retrospektive Studie aus den Jahren 1970-1976. Deutsche Medizinische Wochenschrift 105:751-755, 1980.

[5] 5. Berman M, Alter HJ, Ishak KG, Purcell RH, Jones EA. The chronic sequelae of non-A, non-B hepatitis. Annals of Internal Medicine 91:1-6, 1979.

[6] 6. Brenner EM, RectorFC. The kidney, vol. II, 2nd Ed, p. 2503, Philadelphia, WB Sauders, 1981.

[7] 7. Dienstag JL. Non-A, non-B hepatitis. Advances in Internal Medicine 26: 187-233, 1987.

[8] 8. Dienstag JL, Alaama A, Mosley JW, Redeker AG, Purcell RH. Etiology of sporadic hepatitis B surface antigen-negative hepatitis. Annals of Internal Medicine 87:1-6, 1977.

[9] 9. Dienstag JL, Stevens CE, Szmuness W. The epidemiology of non-A, non-B hepatitis: emerging patterns. In: (ed.) Gerety RJ. Non-A, non-B hepatitis. Academic Press, New York p. 119-138, 1981.

[10] 10. Feinstone SM, Kapikiati AZ, Purcell RH, Alter HJ, Holland PV. Transfusion-associated hepatitis not due to viral hepatitis A or B. New England Journal of Medicine 292: 767-770, 1975.

[11] 11. Galbraith RM, Dienstag JL, Purcell RH, Gower RH, Zuckerman AJ, Williams R. Non-A, non-B hepatitis associated with chronic liver disease in a haemodialysis unit. Lancet 1: 951-953, 1979.

[12] 12. Gubin N. Spallation of silicone from blood-pump tubing in hemodialysis. New England Journal of Medicine 307: 319, 1982.

[13] 13. Hollinger FB, Mosley JW, Szmuness W, Aach RD, Peters RL, Stevens C. Transfusion-transmitted viruses study: experimental evidence for two non-A, non-B, hepatitis agents. Journal of Infectious Diseases 142: 400-407, 1980.

[14] 14. Karvountzis GG, Mosley JW, Redeker AG. Serologic characterization of patients with two episodes of acute viral hepatitis. American Journal of Medicine 58:815- 822, 1975.

[15] 15. Knodell RG, Conrad ME, Ishak KG. Development of chronic liver disease after acute non-A, non-B post-transfusion hepatitis: role of gamma-globulin prophylaxis in its prevention. Gastroenterology 72: 902-909, 1977.

[16] 16. Koretz RL, Stone O, Gitnick GL. The long-term course of non-A, non-B post-transfusion hepatitis. Gastroenterology 79: 893-898, 1980.

[17] 17. Leong AS, Disney AP, Gove DW. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis. New England Journal of Medicine 306: 135-140, 1982.

[18] 18. Magnius LO, Espmark JA. New specificities in Australia antigen positive sera distinct from the Le Bouvier determinants. Journal of Immunology 109:1117-1021, 1972.

[19] 19. Mosley JW, Redeker AG, Feinstone SM, Purcell RH. Multiple hepatitis viruses in multiple attacks of acute viral hepatitis. New England Journal of Medicine 296: 75-78, 1977.

[20] 20. Norkrans G, Frosner G, Hermodsson S, Iwarson S. Multiple hepatitis attacks in drug addicts. Journal of the American Medical Association 243:1056-1058,1980.

[21] 21. Seaworth BJ, Garrett LE, Stead WW, Hamilton JD. Non-A, non-B hepatitis and chronic dialysis - another dilemma. American Journal of Nephrology 4:235-239, 1984.

[22] 22. Schimizu YK, Feinstone SM, Purcell RH, Alter HJ, London WT. Non-A, non-B hepatitis: ultrastructural evidence for two agents in experimentally infected chimpanzees. Science 205: 197-200, 1979.

[23] 23. Simon N, Mery JP, Trepo C, Vitvitski L, Courouce AM. A non-A, non-B hepatitis epidemic in a HB antigen-free haemodialysis unit. Demonstration of serological markers of non-A, non-B virus. Proceedings of the European Dialysis and Transplant Association 17: 173-178, 1980.

[24] 24. Tabor E, Gerety RJ, Drucker JA, Seeff LB, Hoofnagle JH, Jackson DR, April MDUM, Barker LF, Pineda- Tamondong G. Transmission of non-A, non-B hepatitis from man to chimpanzee. Lancet 1: 463-466, 1978.

[25] 25. Tateda A, Kikuchi K, Numazaki Y, Shirachi R, Ishida N. Non-B hepatitis in Japanese recipients of blood transfusions: clinical and serologic studies after the introduction of laboratory screening of donor blood for hepatitis B surface antigen. Journal of Infectious Diseases 139: 511-518, 1979.

[26] 26. Tsiquaye KN, Bird RG, Tovey G, Wyke RJ, Williams R, Zuckerman AJ. Further evidence of cellular changes associated with non-A, non-B hepatitis. Journal of Medical Virology 5: 63-71, 1980.

[27] 27. Villarejos VM, Visona KA, Eduarte CA, Provost PJ, Hilleman MR. Evidence for viral hepatitis other than type A or type B among persons in Costa Rica. New England Journal of Medicine 293: 1350-1352, 1975.

[28] 30. Yoshizawa H, Itoh Y, Iwakiri S, Kitajima K, Tanaka A, Nojiri T, Miyakawa Y, Mayumi M. Demonstration of two different types of non-A, non-B hepatitis by reinjection and cross-challenge studies in chimpanzees. Gastroenterology 81: 107-113, 1981.

[29] 28. Ware AJ, Luby JP, Hollinger B, Eigenbrodt EH, Cuthbert JA, Atkins CR, Shorey J, Hull AR, Combes A. Etiology of liver disease in renal-transplant patients. Annals of Internal Medicine 91: 364-371, 1979.

[30] 29. Woodman HT, Weiser MM, Venuto R, Walshe J. Outbreak of non-A, non-B hepatitis in a dialysis unit and its characterization. Gastroenterology 79: 1068 (abstr.), 1980.