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Etiology of fulminant hepatic failure: experience from a tertiary hospital in Bangladesh |
Mamun-Al Mahtab, Salimur Rahman, Mobin Khan, Ayub Al Mamun and Shahrin Afroz |
Dhaka, Bangladesh
Author Affiliations: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (Mahtab MA, Rahman S, Khan M and Mamun AA); Department of Medicine, Bangladesh Medical College Hospital (Afroz S), Dhaka, Bangladesh
Corresponding Author: Mamun-Al Mahtab, MBBS, MSc, MD, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh (Tel: 880-2-8850371; Fax: 880-2-8826840; Email: shwapnil@agni.com) |
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Abstract 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.
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