Value and limitations of polymerase chain reaction and different serological markers in diagnosis of single and mixed acute viral hepatitis

Abstract EN

Introduction: Hepatitis viruses are endemic in Egypt, Many studies were performed in order to study the pattern of acute viral hepatitis (AVE) and all of them were hospital-based The frequency of viral agents causing hepatitis in the previous studies were conflecting.

Aim: to evaluate the value and limitations of polymerase chain reaction (PCR) and different seromarkers in diagnosis of single and mixed AVE.

Patients: This study was performed in Sallam village near Assiut city.

Active surveillance was performed on 1400 cases using house to house survey and frequent visit to rural health unit.

105 patients with AVH 60 males and 45 females with age ranged from 2 months to 65 years were included in the study.

Methods: All patients had full history, general and abdominal examination including ultrasound liver funtion test and different seromarkers.

Anti hepatitis A virus (anti-HA V) IgM and IgG, HBs Ag, anti HBc IgM, anti HEV IgM and IgG and dithiothreitol (DTT) anti-HCV IgM, cytomegalovirus (CMV) and Epstein Barr virus (EBV) IgM antibodies.

Reverse transcriptase polymerase chain reaction RT-PCR) were performed for HCV and HEV.

Results: HAV was the most frequent cause ofAVH 34 (32.4%), followed by AVE 29 (27.6%), AHB in 9 (8.6%).

Acute hepatitis C (AHC) was diagnosed only in 3 cases (2.9%) one single and two mixed with E virus.

Hepatitis C RNA may be suppressed in mixed viral infection as it occurred in two of our cases who had mixed C/E viruses.

Two cases were diagnosed CMV and one case mixed CMV/EBV.

70 (66.7%,) had single viral infection, while 14 (13.3%) had mixed viral infection and 16 (15.2%) were negative for all viral markers and diagnosed as non A-E hepatitis.

19 cases had clinical and laboratory evidence of AVH, however they hadposittve anti-HCVAb six months prior to inclusion, so they were diagnosed as chronic EC.

6 cases were excluded from the study and diagnosed as drug and toxin induced hepatitis.

Conclusion: PCR and variant seromarkers have an important role in diagnosis of AVH, however they have many limitations particularly in acute hepatitis C and mixed infection.