title: [Is it necessary to investigate anti-hepatitis A virus (HAV) IgM antibodies when the hepatic enzymogram is normal?].
abstract: Is it necessary to investigate anti-hepatitis A virus (HAV) IgM antibodies when the hepatic enzymogram is normal? Type A viral Hepatitis (HAV) is the most frequent viral hepatitis around the world, especially in low income countries. In order to confirm this disease, a lot of laboratory tests are annually carried out where HAV is endemic. Our objective was to establish the utility of investigating anti-hepatitis A virus (HAV) IgM antibodies for HAV diagnosis in patients with normal levels of serum aspartate and alanine aminotransferases (AST/ALT). All patients (n = 158) received in the laboratory requesting a hepatic enzymograme and anti-HAV IgM were evaluated in a prospective study between October 2005 and March 2006. Anti-HAV IgM assays were carried out by microparticle enzyme immunoassay (MEIA). The quantification of hepatic enzymes was made in a multianalyzer. The most frequent clinical data were: presumption of hepatitis and jaundice (27.5 and 12.7%). Eighty four of the 158 patients (53%) showed elevated values of ALT and AST, whereas 69 patients in this group (82%) were anti-Hav IgM reactive. The remaining 74 patients (47%) showed normal levels of AST/ALT and none of them were anti-HAV IgM reactive, except 7, who were on control of a confirmed HAV infection. Of the anti-HAV IgM reactive group of patientss, 49% were children under 10 years of age. Laboratory HAV confirmatory tests would have to be made in sequential form, the determination of anti-HAV IgM antibodies being unnecessary when normal values of serum aminotransferases are observed.
authors.affiliation: Laboratorio de Atención Primaria en Salud "Dr. E. Claveaux" (Ex Hospital Filtro), Cufré 11700 Montevideo, República Oriental del Uruguay. ccoitinho@yahoo.com
authors.forename: C
authors.initials: C
authors.lastname: Coitinho
authors.forename: D
authors.initials: D
authors.lastname: Marroche
authors.forename: C
authors.initials: C
authors.lastname: Toscanini
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D003955:Diagnostic Tests, Routine / Q000191:economics; D019353:Endemic Diseases; D006506:Hepatitis A / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D035922:Hepatitis A Antibodies / Q000097:blood*; D030041:Hepatitis A virus / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007223:Infant; D008875:Middle Aged; D011446:Prospective Studies; D014583:Uruguay / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D035922:Hepatitis A Antibodies; D007075:Immunoglobulin M; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase