Clinical Review of Acute Hepatitis A in a Emergency Center

Kwak, Young Ho; Shin, Jung Ho; Jung, Sung Koo; Rhee, Joong Eui; Suh, Gil Joon; Lee, Chang Hyun; Youn, Yeo Kyu

Abstract

PURPOSE: We conducted this study to evaluate the clinical manifestations of acute hepatitis A in an emergency center.
METHODS
All hepatitis A patients who visited the emergency center of Seoul National University Hospital from October 1999 to March 2002 were analyzed using a retrospective medical record review. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation and their peak values.
RESULTS
A total of 31 patients showed positive for the anti-HAV IgM antibody, and 29 patients had apparent hepatitis A. The number of hepatitis A cases per month in 1999, 2000, 2001, and 2002 were 1.33, 0.25, 0.92, and 4.3, respectively. Among the 29 patients, 15 were brought to the emergency center and constituted the study group. The mean age were 22.3 years old. The most common symptoms were nausea and vomiting (100%), followed by fever (86.7%), anorexia (66.7%). Common signs were jaundice (53.3%) and hepatomegaly (46.7%). Seven patients admitted via the outpatient department were older and had a longer duration of symptoms from onset to diagnosis than the study group. The mean values of the initial laboratory tests were serum aspartate aminotransferase (AST) of 3,044 IU/L, alanine aminotransferase (ALT) of 3,521 IU/L, and a total bilirubin of 4.15 mg/dL. The peak mean values of those variables were 4,067 IU/L, 4,662 IU/L and 7.35 mg/dL, respectively. All patients recoverd without complications.
CONCLUSION
Patients with hepatitis A showed benign clinical features. This study revealed a trend of increasing incidence of hepatitis A in adults and suggested the possibility of an outbreak. Further effort to prevent the propagation of the disease is warranted.