Etiology of fulminant hepatic failure: experience from a tertiary hospital in Bangladesh.
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 hepatocellular 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.
Mahtab
Mamun-Al
MA
Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. shwapnil@agni.com
Rahman
Salimur
S
Khan
Mobin
M
Mamun
Ayub Al
AA
Afroz
Shahrin
S
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D001459:Bangladesh / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000276:immunology; D016751:Hepatitis E / Q000150:complications* / Q000453:epidemiology; D016752:Hepatitis E virus / Q000276:immunology; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D000914:Antibodies, Viral; D006514:Hepatitis B Surface Antigens