Hepatitis A as an etiologic agent of acute liver failure in Latin America.
BACKGROUND
This prospective, multicenter study examined the importance of hepatitis viruses as etiological agents of acute liver failure (ALF) and the outcome of ALF cases in Latin American children and adolescents.


METHODS
The study was conducted for minimum 12 months in 9 centers in Argentina, Brazil, Chile, Colombia, Costa Rica, and Mexico during 2001-2002. Hospitalized patients aged 1-20 years with a suspected diagnosis of ALF were included in the study and tested for serologic markers for hepatitis A, B, and C viruses.


RESULTS
Of the 106 patients enrolled, 88 were included in the analysis. Median age was 5 years, and 55% with ALF were aged 1-5 years. A total of 37 individuals (43%) tested positive for anti-hepatitis A virus (HAV) immunoglobulin M (IgM) as marker of acute HAV infection; one was positive for anti-hepatitis B core antigen IgM and negative for hepatitis B surface antigen. None had markers of hepatitis C virus infection. Mortality rates in the overall study cohort (45%) and for those who tested anti-HAV IgM positive (41%) were similar. Forty-one percent of all patients and 46% of those positive for anti-HAV IgM underwent transplantation. The mortality rate in those with liver transplantation was half of that in patients who were not transplanted (28% versus 57%).


CONCLUSIONS
HAV was the main etiologic agent of ALF in the population studied.
Ciocca
Mirta
M
Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina.
Moreira-Silva
Sandra Fagundes
SF
Alegría
Sylvia
S
Galoppo
Maria Cristina
MC
Ruttiman
Ricardo
R
Porta
Gilda
G
Da Silvera
Themis Reverbel
TR
Rubio
Pilar
P
Macias
Mercedes
M
Cervantes
Yolanda
Y
Avila-Aguero
Maria Luisa
ML
Clemens
Sue Anne Costa
SA
Clemens
Ralf
R
Weil
John
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000401:mortality; D035922:Hepatitis A Antibodies / Q000097:blood; D006510:Hepatitis B Antibodies / Q000097:blood; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007843:Latin America; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D015995:Prevalence; D011446:Prospective Studies
D035922:Hepatitis A Antibodies; D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies; D007075:Immunoglobulin M