Etiology of fulminant hepatic failure:experience from a tertiary hospital in Bangladesh

• Published in: Hepatobiliary & pancreatic diseases international Vol. 7; no. 2; pp. 161 - 164
• Main Authors: Mahtab, Mamun-Al, Rahman, Salimur, Khan, Mobin, Mamun, Ayub Al, Afroz, Shahrin
• Format: Journal Article
• Language: English
• Published: Singapore 01.04.2008
• Subjects: Adolescent; Adult; Antibodies, Viral - analysis; Bangladesh - epidemiology; Enzyme-Linked Immunosorbent Assay; failure; Female; flood; Follow-Up Studies; fulminant; hepatic; hepatitis; Hepatitis B - complications; Hepatitis B - epidemiology; Hepatitis B Surface Antigens - analysis; Hepatitis B virus - immunology; Hepatitis E - complications; Hepatitis E - epidemiology; Hepatitis E virus - immunology; Hospitals, Public - statistics & numerical data; Humans; Incidence; Liver Failure, Acute - epidemiology; Liver Failure, Acute - etiology; Male; Pregnancy; Prognosis; Retrospective Studies; Risk Factors; virus; Bangladesh
• ISSN: 1499-3872

BACKGROUND: Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the country was under water for more than a month, leading to sewage contamination of the water supply. The aim of this study was to investigate the etiology of FHF in Bangladesh. METHODS: In this retrospective study, 23 patients with FHF who presented with severe impairment of hepato- cellular function (i.e. encephalopathy, coagulopathy and jaundice) within 6 months of onset of symptoms were included. There were 17 men and 6 women, aged from 18 to 32 years. Four of the women were pregnant. Patients were tested for markers for common hepatotrophic viruses. A relevant history was taken and the Patient Record Book of the Unit was reviewed. RESULTS: 56.52% patients (13/23) had HEV infection, and all were anti-HEV IgM-positive tested by ELISA. HBV infection was detected in 34.78% patients (8/23), all of whom were tested positive for either HBsAg or anti-HBs IgM by ELISA. 8.7% patients (2/23) had a positive history for intake of alcohol and/or drugs. CONCLUSIONS: Acute HEV infection is the leading cause of FHF in Bangladesh. Sewage contamination of the water supply following floods contributes to a higher incidence of HEV infection. HBV infection is also important.