Hepatitis aguda virus E autóctona. Un diagnóstico en aumento. Análisis clínico-epidemiológico de nuestra experiencia / Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience

Antecedentes: la hepatitis aguda por virus de la hepatitis E (VHE) en Europa era tradicionalmente una infección adquirida por personas que viajaban a zonas endémicas, fundamentalmente Asia y África. Actualmente, cada vez es mayor el número de casos autóctonos esporádicos diagnosticados en Occidente. Objetivo: analizar los casos diagnosticados de hepatitis aguda por virus hepatitis E (VHE) en nuestro medio, identificando las características clínicas-epidemiológicas. Material y método: se recogieron los casos diagnosticados de hepatitis aguda por VHE (IgM anti-VHE positiva y/o ARN-VHE presente en suero) desde enero de 2008 a diciembre 2014. Se analizaron diversas variables clínicas y epidemiológicas y la evolución posterior. Resultados: se encontraron 23 casos, todos ellos naturales de España. Catorce sujetos (60,87%) presentaban ictericia en el momento del diagnóstico y marcada citolisis (aspartato aminotransferasa [AST] 1.106,91 U/l y alanina aminotransferasa [ALT] 1.407,04 U/l). Veintidós casos fueron considerados autóctonos y uno había realizado un viaje a China tres meses antes. El tiempo medio de resolución fue de 11,2 semanas. En total, diez pacientes (43,5%) mostraban algún marcador de autoinmunidad positivo. Dos sujetos estaban diagnosticados de enfermedad hepática crónica previa y fueron catalogados como 'acute-on-chronic liver failure' (ACLF); uno de ellos finalizó en exitus y el otro, en trasplante hepático. Conclusión: la hepatitis aguda por VHE en nuestro medio es una entidad autóctona, probablemente infradiagnosticada, que se manifiesta con ictericia y citolisis. La presencia de marcadores de autoinmunidad positivos supone un epifenómeno que en ocasiones dificulta su diagnóstico (AU)

Background: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world. Objective: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics. Material and methods: We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed. Results: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as 'acute-on-chronic liver failure' (ACLF), one died and the other underwent liver transplantation. Conclusion: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis (AU)

Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience.

BACKGROUND: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world. OBJECTIVE: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics. MATERIAL AND METHODS: We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed. RESULTS: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as "acute-on-chronic liver failure" (ACLF), one died and the other underwent liver transplantation. CONCLUSION: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis.

Déficit de vitamina D en la enfermedad hepática crónica, análisis clínico epidemiológico y tras aporte vitamínico / Vitamin D deficiency in chronic liver disease, clinical-epidemiological analysis and report after vitamin d supplementation

INTRODUCCIÓN: La vitamina D (VD) participa en multitud de funciones extraesqueléticas en el organismo y cada vez es más importante su relación con las enfermedades hepáticas crónicas (EHC). OBJETIVOS: Analizar la prevalencia de déficit o insuficiencia de VD en los pacientes con EHC de nuestra área. Evaluar si el aporte de VD influye en la concentración sérica y se asocia a mejoría de la función hepática. MATERIAL Y MÉTODOS: Realizamos un estudio en 2 fases. En el primer tiempo se analizaron características clínico-epidemiológicas de 94 pacientes con EHC; en un segundo tiempo, se administraron diferentes dosis de calcifediol (25-OH-VD) a aquellos pacientes con déficit (<20ng/mL) e insuficiencia (20-30ng/mL) de VD. Se determinaron concentraciones plasmáticas, variables analíticas y de función hepática (Child-Pugh y MELD) al finalizar el tratamiento y se compararon con los datos basales. RESULTADOS: El 87% de los pacientes tenían concentraciones deficitarias o insuficientes de VD, con una media de 18,8ng/mL, siendo menor en los cirróticos (15,9ng/mL) (p = 0,002) y en la etiología por alcohol. Igualmente la concentración sérica de VD era inversamente proporcionales al grado de función hepática: Child A (16,52ng/mL) vs. C (7,75ng/mL). Tras el aporte con VD, se consiguió normalizar los niveles en el 94% de los pacientes, mejorar significativamente la cifra de plaquetas, de albúmina (p < 0,05) y el grado funcional valorado por la escala de Child-Pugh (p < 0,05). CONCLUSIÓN: Dada la alta prevalencia de déficit o insuficiencia de VD debería plantearse la necesidad de cribado en la población con EHC. El aporte de VD podría ser seguro y eficaz

INTRODUCTION: Vitamin D (VD) is known to have multiple extra-skeletal health functions. There is emerging interest in exploring the relationship between vitamin D and chronic liver disease (CLD). OBJECTIVES: To determine the prevalence of VD deficiency in patients with CLD in our setting and to assess whether VD supplementation influences plasma levels and is associated with improved liver function. MATERIAL AND METHODS: We conducted a study in 2 phases. First, we analysed clinical and epidemiological characteristics in 94 patients with CLD; second, different doses of calcifediol (25-OH-VD) were administered to patients with VD deficiency (<20ng/mL) and insufficiency (20-30ng/mL). Plasma concentrations and liver function (Child-Pugh and MELD) at the end of treatment were compared with baseline data. RESULTS: Deficient or insufficient VD levels were found in 87% of the patients, with an average concentration of 18.8ng/mL. Levels were lower in patients with cirrhosis (15.9ng/mL) (P=.002) and in alcoholic liver disease. VD levels were inversely proportional to the degree of liver function: Child A (16.52ng/mL) vs C (7.75ng/mL). After VD supplementation, optimal serum levels were achieved in 94% of patients and significant improvements were observed in platelet count, albumin levels (P<.05) and functional status assessed by the Child-Pugh scale (P<.05). CONCLUSION: Given the high prevalence of VD deficiency or insufficiency, the need for screening should be considered in the population with CLD. VD supplementation could be safe and effective

Reactivación de tuberculosis pulmonar durante el tratamiento con triple terapia de la hepatitis C / Reactivation of pulmonary tuberculosis during treatment with triple therapy for hepatitis C

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Hemorragia digestiva alta secundaria a un proceso linfoproliferativo infrecuente / Upper gastrointestinal bleeding due to an uncommon lymphoproliferative process

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[Vitamin D deficiency in chronic liver disease, clinical-epidemiological analysis and report after vitamin d supplementation]. / Déficit de vitamina D en la enfermedad hepática crónica, análisis clínico epidemiológico y tras aporte vitamínico.

INTRODUCTION: Vitamin D (VD) is known to have multiple extra-skeletal health functions. There is emerging interest in exploring the relationship between vitamin D and chronic liver disease (CLD). OBJECTIVES: To determine the prevalence of VD deficiency in patients with CLD in our setting and to assess whether VD supplementation influences plasma levels and is associated with improved liver function. MATERIAL AND METHODS: We conducted a study in 2 phases. First, we analysed clinical and epidemiological characteristics in 94 patients with CLD; second, different doses of calcifediol (25-OH-VD) were administered to patients with VD deficiency (<20ng/mL) and insufficiency (20-30ng/mL). Plasma concentrations and liver function (Child-Pugh and MELD) at the end of treatment were compared with baseline data. RESULTS: Deficient or insufficient VD levels were found in 87% of the patients, with an average concentration of 18.8ng/mL. Levels were lower in patients with cirrhosis (15.9ng/mL) (P=.002) and in alcoholic liver disease. VD levels were inversely proportional to the degree of liver function: Child A (16.52ng/mL) vs C (7.75ng/mL). After VD supplementation, optimal serum levels were achieved in 94% of patients and significant improvements were observed in platelet count, albumin levels (P<.05) and functional status assessed by the Child-Pugh scale (P<.05). CONCLUSION: Given the high prevalence of VD deficiency or insufficiency, the need for screening should be considered in the population with CLD. VD supplementation could be safe and effective.

Hepatitis asociada a acetato de glatirámero / Hepatitis induced by glatiramer acetate

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Vitamin D levels and bone turnover markers are not related to non-alcoholic fatty liver disease in severely obese patients / Los niveles de vitamina D y marcadores de recambio óseo no se encuentran relacionados con el hígado graso no alcóholico en obesos mórbidos

Background: Morbidly obese patients usually present vitamin D deficiency or secondary hyperparathyroidism. Low vitamin D levels have been recently related to non-alcoholic fatty liver disease (NAFLD). The aim of this study was to analyse the relationship between vitamin D, bone turnover markers and non-alcoholic fatty liver disease and metabolic syndrome in severely obese patients. Methods: One hundred and ten patients who underwent bariatric surgery were included. Liver biopsy was taken during surgery. Two univariate analyses were carried out in order to i) analyse the relationship between liver histology and vitamin D-bone turnover markers (intact parathyroid hormone (PTH), osteocalcin and Carboxy-terminal collagen crosslinks) and ii) establish the association between metabolic syndrome components-insulin resistance (HOMA) and vitamin D-bone turnover markers. Results: 70% of the patients had lower levels of vitamin D or secondary hyperparathyroidism. None of the components of liver histology were associated with levels of vitamin D or with bone turnover parameters. Patients with metabolic syndrome showed lower levels of PTH and osteocalcin (72,42 (29,47) vs 61.25(19.59) p-Value: 0.022; 19.79 (10.43) vs 16.87(10.25) p-Value: 0,028, respectively). HOMA was not related to Vitamin D or bone turnover markers. Conclusion: Low levels of vitamin D or hyperparathyroidism are common in severely obese patients. Vitamin D and bone metabolism markers were associated neither to NAFLD nor with metabolic syndrome in our series of obese morbid patients (AU)

Antecedentes: los pacientes con obesidad mórbida presentan frecuentemente déficit de vitamina D o hiperparatiroidismo secundario. Presentar niveles bajos de vitamina D se ha asociado recientemente con el hígado graso no alcohólico (EHNA). El objetivo de este estudio fue analizar la relación de la vitamina D y los marcadores de recambio óseo con el hígado graso no alcohólico y el síndrome metabólico, en pacientes con obesidad mórbida. Métodos: Ciento diez pacientes sometidos a cirugía bariátrica fueron incluidos, obteniéndose una biopsia hepática durante la cirugía. Dos análisis univariados se llevaron a cabo con el fin de: i) analizar la relación de la histología hepática con la vitamina D y marcadores de recambio óseo (hormona paratiroidea intacta (PTH), osteocalcina y enlaces cruzados de colágeno carboxi-terminal) y ii) establecer la asociación de los componentes del síndrome metabólico y resistencia a la insulina (HOMA) con los marcadores de recambio óseo y vitamina D. Resultados: El 70% de los pacientes presentaron niveles bajos de vitamina D o hiperparatiroidismo secundario. Ninguno de los componentes de la histología hepática resultó asociado con los niveles de vitamina D o con los parámetros de recambio óseo. Los pacientes con síndrome metabólico mostraron un nivel menor de PTH (72,42 (29,47) vs 61,25 (19,59) Valor p: 0.022) y de osteocalcina 19,79 (10,43) vs 16,87 (10,25) p-valor: 0.028). El HOMA no resultó relacionado con la vitamina D o con los marcadores de recambio óseo. Conclusión: Niveles bajos de vitamina D e hiperparatiroidismo secundario son hallazgos frecuentes en pacientes con obesidad mórbida en nuestro medio. Los marcadores de la vitamina D y recambio óseo no resultaron asociados con el hígado graso no alcohólico, ni con el síndrome metabólico en nuestra serie de pacientes obesos mórbidos (AU)

Vitamin D levels and bone turnover markers are not related to non-alcoholic fatty liver disease in severely obese patients.

BACKGROUND: Morbidly obese patients usually present vitamin D deficiency or secondary hyperparathyroidism. Low vitamin D levels have been recently related to non-alcoholic fatty liver disease (NAFLD). The aim of this study was to analyse the relationship between vitamin D, bone turnover markers and non-alcoholic fatty liver disease and metabolic syndrome in severely obese patients. METHODS: One hundred and ten patients who underwent bariatric surgery were included. Liver biopsy was taken during surgery. Two univariate analyses were carried out in order to i) analyse the relationship between liver histology and vitamin D-bone turnover markers (intact parathyroid hormone (PTH), osteocalcin and Carboxy-terminal collagen crosslinks) and ii) establish the association between metabolic syndrome components-insulin resistance (HOMA) and vitamin D-bone turnover markers. RESULTS: 70% of the patients had lower levels of vitamin D or secondary hyperparathyroidism. None of the components of liver histology were associated with levels of vitamin D or with bone turnover parameters. Patients with metabolic syndrome showed lower levels of PTH and osteocalcin (72,42 (29,47) vs 61.25(19.59) p-Value: 0.022; 19.79 (10.43) vs 16.87(10.25) p-Value: 0,028, respectively). HOMA was not related to Vitamin D or bone turnover markers. CONCLUSION: Low levels of vitamin D or hyperparathyroidism are common in severely obese patients. Vitamin D and bone metabolism markers were associated neither to NAFLD nor with metabolic syndrome in our series of obese morbid patients.

Antecedentes: los pacientes con obesidad mórbida presentan frecuentemente déficit de vitamina D o hiperparatiroidismo secundario. Presentar niveles bajos de vitamina D se ha asociado recientemente con el hígado graso no alcohólico (EHNA). El objetivo de este estudio fue analizar la relación de la vitamina D y los marcadores de recambio óseo con el hígado graso no alcohólico y el síndrome metabólico, en pacientes con obesidad mórbida. Métodos: Ciento diez pacientes sometidos a cirugía bariátrica fueron incluidos, obteniéndose una biopsia hepática durante la cirugía. Dos análisis univariados se llevaron a cabo con el fin de: i) analizar la relación de la histología hepática con la vitamina D y marcadores de recambio óseo (hormona paratiroidea intacta (PTH), osteocalcina y enlaces cruzados de colágeno carboxi-terminal) y ii) establecer la asociación de los componentes del síndrome metabólico y resistencia a la insulina (HOMA) con los marcadores de recambio óseo y vitamina D. Resultados: El 70% de los pacientes presentaron niveles bajos de vitamina D o hiperparatiroidismo secundario. Ninguno de los componentes de la histología hepática resultó asociciado con los niveles de vitamina D o con los parámetros de recambio óseo. Los pacientes con síndrome metabólico mostraron un nivel menor de PTH (72,42 (29,47) vs 61,25 (19,59) Valor p: 0.022) y de osteocalcina 19,79 (10,43) vs 16,87 (10,25) p-valor: 0.028). El HOMA no resultó relacionado con la vitamina D o con los marcadores de recambio óseo. Conclusión: Niveles bajos de vitamina D e hiperparatiroidismo secundario son hallazgos frecuentes en pacientes con obesidad mórbida en nuestro medio. Los marcadores de la vitamina D y recambio óseo no resultaron asociados con el hígado graso no alcohólico, ni con el síndrome metabólico en nuestra serie de pacientes obesos mórbidos.

Fiebre y hepatitis aguda por citomegalovirus en enfermedad de Crohn / Fever and acute cytomegalovirus hepatitis in Crohn’s disease

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