title: Acute hepatitis with severe cholestasis and prolonged clinical course due to hepatitis A virus Ia and Ib coinfection.
abstract: BACKGROUND
  Acute viral hepatitis due to hepatitis A virus is a self-limited illness that infrequently has a severe clinical course.
  
  
  METHODS
  We analyzed the virological characteristics of acute hepatitis A in a patient with a severe clinical presentation (peak total and conjugated bilirubin levels, 65.5 mg/dL and 40.1 mg/dL, respectively) and a course of disease that lasted 7 months.
  
  
  RESULTS
  Hepatitis A virus sequencing revealed coinfection with 2 subgenotypes of hepatitis A virus (Ia and Ib) as etiological factors of the illness.
  
  
  CONCLUSIONS
  Hepatitis A virus Ia and Ib coinfection may have accounted for the prolonged and severe course of illness.
authors.affiliation: Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
authors.forename: Domenico
authors.initials: D
authors.lastname: Genovese
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Pisaturo
authors.forename: Stefania
authors.initials: S
authors.lastname: Taffon
authors.forename: Claudio
authors.initials: C
authors.lastname: Argentini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pasquale
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.forename: Felice
authors.initials: F
authors.lastname: Piccinino
authors.forename: Maria
authors.initials: M
authors.lastname: Rapicetta
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
mesh_terms: D000208:Acute Disease; D000328:Adult; D000595:Amino Acid Sequence; D001483:Base Sequence; D002779:Cholestasis / Q000473:pathology / Q000503:physiopathology* / Q000821:virology*; D005838:Genotype; D006506:Hepatitis A / Q000150:complications* / Q000821:virology*; D030041:Hepatitis A virus / Q000235:genetics*; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D012720:Severity of Illness Index