Case Report
Hepatitis A related acute liver failure by consumption of contaminated food

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Abstract

We present a patient with no medical history admitted for jaundice and dark coloured urine. Further investigations revealed hepatitis A related acute liver failure while the patient had no travel history, nor contact with infected individuals. After admission, the patient deteriorated fulfilling the King's College criteria for acute liver failure. Two days after admission, he underwent liver transplantation and recovered. Careful investigation identified imported semi-dried tomatoes as the source of the hepatitis A infection. This patient was part of a foodborne hepatitis A outbreak in the Netherlands in 2010 affecting 13 patients. Virus sequence analysis of our patient's virus showed a strain commonly found in Turkey. Hepatitis A related acute liver failure is rare, but is associated with a poor prognosis. In developed countries, the incidence of hepatitis A is low, but foodborne outbreaks are emerging. Further, we review the literature on recent foodborne hepatitis A outbreaks in developed countries, hepatitis A related acute liver failure, and hepatitis A vaccine.

Section snippets

Why this case is important

The hepatitis A virus (HAV) is a RNA virus transmitted via the faecal–oral route and is the most common cause of acute viral hepatitis in the world. Typically, patients present with non-specific symptoms such as fever, malaise, nausea, vomiting and flu-like symptoms accompanied with dark urine and jaundice [1]. Hepatitis A is a self-limiting disease, but is accountable for an estimated 3.1% of acute liver failures [2].

The incidence of HAV infections is low in developed regions (Western Europe,

Case report

A 39-year old man with no medical history was admitted to the Erasmus MC University Medical Centre Rotterdam (Rotterdam, The Netherlands) in January 2010. His symptoms started one week earlier with malaise, nausea, and vomiting. Since two days, he noted jaundice and dark coloured urine. He did not have fever, and had not travelled for several months. Nobody in his surroundings was sick. We did physical examination on admission, and found a disorientated man with jaundice and flapping tremor

Other similar and contrasting cases in the literature

The transmission of HAV by contaminated food or water is known phenomenon, but was considered rare in Western countries [1]. However, a population-based surveillance study from the US showed that food or waterborne outbreaks were responsible for approximately 7.2% of reported hepatitis A cases [4]. One of the largest Western foodborne hepatitis A outbreak affecting at least 601 individuals was reported in the US in 2003 [5]. In this outbreak, contaminated green onions from Mexico were

Discussion

The impact of these emerging foodborne hepatitis A outbreaks in developed regions should not be underestimated. The Australian outbreak resulted in at least 200 additional hepatitis A cases and was despite public health intervention an ongoing problem. Furthermore, the outbreaks were responsible for many hospitalizations, several liver transplantations and even deaths. Importantly, the risk on acute liver failure and mortality increases with advancing age or the presence of chronic liver

Funding

None received.

Competing interests

None declared.

Ethical approval

Not required.

Patient consent

Obtained.

Author contributions

Heng Chi: drafting of the article, and finalising the article. Els Haagsma: patient care, drafting of the article, and finalising the article. Annelies Riezebos-Brilman: drafting of the article, virus sequence analysis, drafting of the article, and finalising the article. Arie van den Berg: patient care, and finalising the article. Herold Metselaar: patient care, and finalising the article. Robert de Knegt: patient care, drafting of the article, and finalising the article.

Acknowledgement

The authors would like to thank Harry Vennema for his contributions to the virus sequence analysis.

References (21)

  • R.S. Koff et al.

    Lancet

    (1998)
  • K.H. Jacobsen et al.

    Hepatitis A virus seroprevalence by age and world region, 1990 and 2005

    Vaccine

    (2010)
  • P. Rosenthal

    Cost-effectiveness of hepatitis A vaccination in children, adolescents, and adults

    Hepatology

    (2003)
  • R.M. Taylor et al.

    Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes

    Hepatology

    (2006)
  • R.M. Klevens et al.

    The evolving epidemiology of hepatitis a in the United States: incidence and molecular epidemiology from population-based surveillance, 2005–2007

    Arch Intern Med

    (2010)
  • C. Wheeler et al.

    An outbreak of hepatitis A associated with green onions

    N Engl J Med

    (2005)
  • E.J. Donnan et al.

    A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009

    Clin Infect Dis

    (2012)
  • N. Fournet et al.

    Another possible food-borne outbreak of hepatitis A in The Netherlands indicated by two closely related molecular sequences, July to October 2011

    Euro Surveill

    (2012)
  • M. Petrignani et al.

    Update: a food-borne outbreak of hepatitis A in the Netherlands related to semi-dried tomatoes in oil, January–February 2010

    Euro Surveill

    (2010)
  • C. Gallot et al.

    Hepatitis A associated with semidried tomatoes, France, 2010

    Emerg Infect Dis

    (2011)
There are more references available in the full text version of this article.

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