nan Mamun-Al-Mahtab

Prevalence and Risk Factors of Asymptomatic Hepatitis C Virus Infection in Bangladesh

OBJECTIVESnThere are paucity of information about prevalence and risk factor of hepatitis C virus (HCV) in Bangladesh.nnnMETHODSnBlood was collected from 1018 randomly selected subjects from a semi-urban area of Bangladesh. Anti-HCVs were checked in the blood twice using a third-generation commercial kit. The data of the questionnaires were analyzed to find possible risk factors.nnnRESULTSnNine of the 1018 subjects (88%) were tested positive for anti-HCV. The HCV-positive subjects were >28 years old. Major risk factors for HCV infection were treatment by unqualified and traditional practitioners, history of mass-vaccination against smallpox, hair cutting and shaving by barbers, and body piercing. However, known risk factors such as blood transfusion, surgery, invasive therapy, and intravenous drug use were not detected in any HCV-infected subjects.nnnCONCLUSIONnControl of HCV infection in Bangladesh may be difficult because the risk factors are related to normal tradition and culture of Bangladeshi people.

Precore/Core Promoter Mutant Hepatitis B Virus Produces More Severe Histologic Liver Disease than Wild Type Hepatitis B Virus

Introduction: The aim of this study is to compare Knodell and HAI scores in patients with wild type and precore/core promoter mutant CHB to see if there is any difference in severity of liver injury between these two types of HBV. Methods: We did percutaneous liver biopsies of 155 CHB patients. 102 (65.8%) of them were infected wild type HBV and the rest 53 (34.2%) were infected with precore/core promoter mutant CHB. Results: 11/53 (20.8%) patients with precore/core promoter mutant CHB had moderate to severe CH (HAI score 8–18). In contrast, moderate to severe CH was seen in 19/102 (18.6%) patients with wild type CHB. Fibrosis score was >2 in 15/53 (28.3%) precore/core promoter mutant CHB as opposed to 20/102 (19.6%) patients with wild type CHB. Conclusion: The study shows that precore/core promoter mutant HBV produces more severe histologic liver disease compared to wild type HBV.

Genotypes of HCV in Bangladesh: Experience from a Tertiary Centre

Introduction: Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide including Bangladesh. Approximately 0.84% of our population is infected with HCV. Genotypes of HCV are important in the determination of treatment duration and in predicting the response to treatment in HCV infection. Methodology: 61 consecutive patients who presented to us with chronic hepatitis C (CHC) and who could afford treatment and having no features of decompensation were included in the study. Results: Of the 61 study subjects, 46 were males and 15 females. They were between 12 and 70 years of age. Of them 41% had genotype 3, 31% had mixed genotypes 3 + 4 and 21% had genotype 1. Patients also had genotypes 2, 4, 5 and mixed genotypes 5 + 6, the figure being 1.6% in each case. Conclusion: Genotype 3 is the commonest HCV genotype in Bangladesh, while we also have a high prevalence of mixed HCV genotypes.

Early termination of immune tolerance state of hepatitis B virus infection explains liver damage.

AIMnTo assess an early termination of immune tolerance state of chronic hepatitis B virus infection in Bangladesh and its clinical significance.nnnMETHODSnFrom a series of 167 treatment-naive chronic hepatitis B patients aged between 12 to 20 years (mean ± SD; 17.5 ± 2.8 years), percutaneous liver biopsies of 89 patients who were all hepatitis B e antigen negative at presentation were done. Of them, 81 were included in the study. They had persistently normal or raised serum alanine aminotransferase (ALT) values. A precore mutation (PCM) study was accomplished in 8 patients who were randomly selected.nnnRESULTSnForty-four (53.7%) patients had significant necroinflammation (HAI-NI > 7), while significant fibrosis (HAI-F ≥ 3) was seen in 15 (18.5%) patients. Serum ALT (cut off 42 U/L) was raised in 29 (35.8%) patients, while low HBV DNA load (< 10(5) copies/mL) was observed in 57 (70.4%) patients. PCM was negative in all 8 patients.nnnCONCLUSIONnThis study indicates that the current concept of age-related immune tolerance state of HBV infection deserves further analyses in different population groups.

Serum Interleukin-10 Level in Patients with Chronic Hepatitis B Infection

Background/Aims: Preferential production of immunoregulatory cytokines may play an important role in the pathogenesis of chronic hepatitis B. Patients with chronic hepatitis B infection were evaluated to determine whether serum interleukin-10 (IL-10) levels were changed and whether the degree of these changes in serum levels correlated with HBV DNA levels, histologic activity index (HAI) or serum aminotransferase levels (ALT). Methodology: 15 patients diagnosed of chronic hepatitis B (wild type) with raised ALT, 15 inactive HBsAg carriers, 15 healthy people with resolved acute hepatitis B, and 15 healthy controls without any hepatitis marker positivity were included in the study. Serum IL-10 levels were measured. The associations between liver pathology, HBV DNA and ALT levels were assessed. Result: IL-10 is elevated more in chronic hepatitis B with positive HBeAg and raised ALT in comparison to asymptomatic carrier, resolved acute hepatitis B and control. Conclusions: IL-10 production is increased in chronic hepatitis B patients with HBeAg positivity and raised ALT as compared to other groups (p < 0.01). No correlation between HBV DNA, HAI or ALT could be established through this study. However, as IL-10 is increased in chronic hepatitis B infection with HBeAg positivity, the HBe antigen may be responsible for the raised IL-10 levels.

Study of hepatic histomorphology in HBeAg+ and HBeAg− patients with CHB: Experience from Bangladesh

Abstract Objective To compare Knodell and HAI scores in patients with wild type and pre-core/core promoter mutant CHB to see if there is any difference in severity of liver injury between these two types of HBV. Methods We did percutaneous liver biopsies of 155 CHB patients. Of them 102 (65.8%) were infected wild type HBV and the rest 53 (34.2%) were infected with pre-core/core promoter mutant CHB. Results 11/53 (20.8%) patients with pre-core/core promoter mutant CHB had moderate to severe CH (HAI score 8-18). In contrast, moderate to severe CH was seen in 19/102 (18.6%) patients with wild type CHB. Fibrosis score was >2 in 15/53 (28.3%) pre-core/core promoter mutant CHB as opposed to 20/102 (19.6%) patients with wild type CHB. Conclusions The study shows that pre-core/core promoter mutant HBV produces more severe histological liver disease compared to wild type HBV.

Ciprofloxacin-induced Stevens-Johnson syndrome: First report from Bangladesh

Abstract Stevens-Johnson syndrome, otherwise known as erythema multiforme majus, was first described in 1922 by Stevens and Johnson as a febrile illness with stomatitis, purulent conjunctivitis, and skin lesions. Case report: We report a 28-year-old married woman who presented with fever and was advised ciprofloxacin tablet. After taking two doses of the tablet, she developed papulo-vesicular rash involving the trunk and the upper and lower limbs, including mucous membranes. She also developed a painful red eye. She eventually developed jaundice and her case was ultimately diagnosed as ciprofloxacin-induced Stevens-Johnson syndrome. Discussion: Medications appear to be the most common cause of Stevens-Johnson syndrome. It commonly affects multiple organs. Treatment for Stevens-Johnson syndrome is as diverse as the symptoms and it should be begun by withdrawing any offending agent identified. Conclusion: Stevens-Johnson syndrome is a potentially fatal multiorgan disease. This aspect of the condition is bes...

A case of primary biliary cirrhosis: First report from Bangladesh

Abstract Primary biliary cirrhosis (PBC) is a rare autoimmune liver disease, not infrequent in the West, but hardly reported from the East. We report a case of PBC for the first time from Bangladesh. The patient was an elderly woman presenting with vague complaints. The diagnosis was confirmed by antibody testing and histopathology, whereas other possible causes of cirrhosis were also excluded.

HBeAg negative chronic hepatitis B: an overview.

Over 350 million people worldwide are infected with hepatitis B virus (HBV), and patients with HBeAg-negative chronic hepatitis B constitute a major proportion of this population. Mutant varieties of HBV resulting from mutations in the precore or core promoter region of the viral genome give rise to HBeAg-negative CHB, and these cases must be differentiated from the inactive carrier state. These patients with HBeAg-negative CHB must be managed judiciously and in certain situations kept under close follow-up instead of rushing to treatment. However, this does not mean advocating adoption of a too conservative approach, allowing many to proceed to irreversible and progressive liver disease. This article provides an overview of the management of HBeAg-negative chronic hepatitis B.

Lamivudine causes reduction of histological activity index and viral load in liver biopsies in patients with chronic hepatitis B infection

Abstract The aim of this study was to compare the histological activity index and viral load, which one response more with lamivudine, an anti-viral agent used for treating chronic hepatitis B infected patients. Materials and methods Following the defined case selection protocol a total of 39 CHB cases were enrolled in the study. After initial evaluation they received with lamivudine orally for 52 weeks. Repeat biopsy could be obtained in 16 cases. 16 patients were analysed in this study. All patients had a liver biopsy at the beginning of the study before starting the drug. Lamivudine was given orally at a dose of 100 mg once daily for 52 weeks. A second liver biopsy was taken for comparison at the end of week 52. Biopsy materials were stained with Haematoxylin and Eosin staining as a routine procedure. Immunohistochemical staining for both surface and core antigens by using antibodies against these antigens were done as special staining. In routine staining biopsies were scored according to Knodells Hi...