Case ReportHepatitis A related acute liver failure by consumption of contaminated food
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.
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