Fulminant hepatitis is a severe complication of hepatitis A virus infection, however, its mechanism is unknown.
A liver transplantation may be necessary, but frequently patients experience spontaneous recovery.
There are no data on the level of viral replication according to the clinical form of hepatitis A.
A research team from France reviewed the files of 50 patients with acute hepatitis A.
Of the 50 patients, the team determined that 19 had fulminant hepatitis. Of these, 10 patients underwent liver transplantation.
The physicians quantified the hepatitis A virus (HAV) RNA was quantified using real-time PCR on sera obtained at admission.
They determined the virus genotype using phylogenetic analysis of HAV RNA.
| Encephalopathy and low factor V level were significantly related to female gender.|
HAV RNA was detected in serum by RT-PCR in 39 patients.
The team determined that encephalopathy and low factor V level were significantly related to female gender, HAV PCR negativity, low serum HAV RNA level, genotypes other than IA, and acetaminophen intake.
Using multivariate analysis, the team also found that low or undetectable HAV viral load and a high bilirubin level were independently associated with low factor V levels and fulminant hepatitis, and also with death or transplantation.
Dr Guilhermo Rezende's team concluded, "HAV-related liver failure is due to an excessive host response associated with a marked reduction in viral load".
"Serum HAV RNA assay could be of help in the management of severe hepatitis A".