title: Serological markers of autoimmunity in children with hepatitis A: relation to acute and fulminant presentation.
abstract: OBJECTIVE
  Hepatitis A virus (HAV) infection tends to be a self-limiting disease without serious sequelae, but fulminant hepatitis, with a high mortality, develops in 0.1-0.2% of the cases. Sometimes, HAV infection precipitates autoimmune hepatitis (AIH). We aimed to assess the frequency and clinical significance of serologic markers of autoimmunity during hepatitis A infection with an acute or fulminant presentation compared with those in AIH.
  
  
  METHODS
  The study included 126 children: 46 with HAV infection (33 with acute and 13 with fulminant presentation), 53 with AIH, and 27 healthy controls. In all, we measured autoantibodies titer (antinuclear antibody, antismooth muscle antibody, and liver kidney microsomal antibody-1) and serum gammaglobulins.
  
  
  RESULTS
  Autoantibodies were detected in the majority of HAV (63.1%) and AIH (79.2%) groups, but in none of the controls. Gammaglobulins were significantly higher in the HAV group (1.93±0.57 g/dl) than in the controls (1.32±0.29 g/dl), but lower than that in the AIH group (2.93±1.2 g/dl) (P<0.0001 for all). In the HAV group, gammaglobulins were significantly higher in those with fulminant (2.21±0.46 g/dl) than in those with acute presentation (1.82±0.57 g/dl) (P=0.019), but comparable with that in AIH (P=0.095). Gammaglobulins correlated significantly with disease severity in both HAV and AIH groups.
  
  
  CONCLUSIONS
  Hypergammaglobulinemia and a high occurrence of autoantibodies are encountered in HAV infection. This may support the immunological basis of its pathogenesis. Moreover, the higher gammaglobulins in fulminant HAV, with an insignificant difference from that in AIH, suggest that a more aggressive immunological reaction is related to this presentation.
authors.affiliation: aYassin Abdel-Ghaffar Charity Center for Liver Disease and Research bDepartment of Pediatrics, Faculty of Medicine, Ain Shams University cPediatric Department, National Hepatology and Tropical Medicine Research Institute, Cairo Departments of dPediatric Hepatology eClinical Pathology, National Liver Institute, Menofiya University, Menofiya, Egypt.
authors.forename: Tawhida Y
authors.initials: TY
authors.lastname: Abdel-Ghaffar
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Sira
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sira
authors.forename: Tahany A
authors.initials: TA
authors.lastname: Salem
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: El-Sharawy
authors.forename: Suzan
authors.initials: S
authors.lastname: El Naghi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006506:Hepatitis A / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D061705:Image-Guided Biopsy; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D005719:gamma-Globulins / Q000378:metabolism*
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D005719:gamma-Globulins