Patterns of viruses among the jaundice patients admitted in a tertiary care hospital, Chattogram, Bangladesh

Patterns of viruses among the jaundice patients admitted in a tertiary care hospital, Chattogram, Bangladesh | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Patterns of viruses among the jaundice patients admitted in a tertiary care hospital, Chattogram, Bangladesh View ORCID Profile Rajat Sanker Roy Biswas , Sk Md Faisal Abdullah , Shemanta Waddadar , Nabil Asgar Chowdhury doi: https://doi.org/10.1101/2025.01.15.25320599 Rajat Sanker Roy Biswas 1 Department of Medicine, CMOSHMC , Chattogram Roles: Associate Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rajat Sanker Roy Biswas For correspondence: rajatbiswas76{at}yahoo.com Sk Md Faisal Abdullah 2 Department of Medicine, CMOSHMC , Chattogram Roles: Assistant Registrar Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shemanta Waddadar 3 Department of Neurology, MAG Osmani Medical College , Sylhet Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nabil Asgar Chowdhury 4 Department of Medicine, CMOSHMC , Chattogram Roles: Registrar Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Introduction Jaundice is the commonest presenting features of hepatitis and it is a common clinical condition in Bangladesh. As a country of the Asia Pacific region Bangladesh is considered to be a high risk country for developing hepatitis by different hepatotropic viruses. This studyrepresents the patterns and types ofviruses among the patients admitted in a tertiary care hospitals inBangladesh who were presented with jaundice. Methods Present cross sectional observational study done during a one year study period from July 2022 to June 2023 in a tertiary care hospital, Chattogram, Bangladesh among 114 patients. All patients who had clinical jaundice or having serum bilirubin > 2 mg/dl were recruited in the study. Clinical data were collected from all of them and viral serology were also done by ICT or ELISA. Informed written consent were taken from all patients and permission for the study were taken from ERB of the medical college. Results Among 114 study subjects, male were 73(64%) and female were 41(36%) and male to female ratio was 1: 0.56. Among all, maximum were in the age range of <20 years and 21- 30 years which were 46(40.4%) and 44(38.6%) respectively. Regarding clinical features, 109(95.6%) had jaundice and 89(78.1%) had fever and 74(64.9%) had nausea and these were three dominant clinical features found. Viral serology study revealed frequency of HAV, HBV, HCV and HEV infection were 43(37.7%), 9(7.9%), 1(0.9%) and 26(22.8%) respectively. There were viral coinfections with (HAV+HEV), (HAV+HBV) and (HBV + HEV) and it were 8(7.0%), 4(3.5%) and 3(2.6%) respectively. Among all 20(17.5%) cases were tested negative for hepatotropic viruses. Again 6(5.3%) had Anti HBc Positivity and 2(1.8%) cases were found coinfected with HIV. Conclusions In a year round, HAV and HEV are two common viral infection causing jaundice among the locality. HBV had a significant level of infection with low level HCV causing jaundice. Two HIV coinfection is an alarming condition found among the jaundice patients which need further exploration and risk factor evaluations. Introduction Viral hepatitis are common infectious disease in Bangladesh.[ 1 ] Hepatotropic viruses like A, B, C, and E are the common viruses responsible for it. But other uncommon viruses also may cause jaundice but these viruses mostly remain undiagnosed. Viral hepatitis constitutes huge burdento the health care delivery system and it has an economic impact in Bangladesh.[ 1 ] Among the different hepatotropic viruses hepatitis E virus is the leading cause of acute hepatitis in this country.[ 2 ] Forchronic liver disease, hepatitis B virus is one of the main cause and its prevalenceis 5-6% in our country and next to it is hepatitis C and its prevalence is 1%.[ 3 ] Hepatitis A also prevailing in our country and its frequency increases during rainy season. Epidemic and sporadic outbreaks of acute hepatitis in low-income countries, such as Bangladesh, are commonly caused by HAV and HEV, which are predominantly transmittedvia the fecal–oral route [ 4 ]. The clinical manifestations of HAV infection vary from asymptomatic infection to acute liver failure (ALF), but do not lead to chronic hepatitis. Hepatitis A causes mild-to-severe manifestations, includingfever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine,and jaundice. Clinical manifestations of HAV depend on the age of the patients; mildsymptoms are observed in children and severe infections in adults [ 5 ]. These four maintypes of hepatitis viruses are of greatestconcern because of the burden of illness and death they cause and the potential for outbreaks andepidemic spread Bangladesh. In particular, types B and C lead to chronic disease in hundreds of millions ofpeople and, together, are the most common cause of liver cirrhosis and cancer[ 6 ]. Little data are available on hepatitis prevalence in Bangladesh specially in the context of Chattogram, southern part of Bangladesh [ 7 ]. So, present study is aimed to observe the frequency of different hepatotropic viruses causing hepatitis in our context. Methods Present cross sectional observational study was conducted in a tertiary care hospital of Chattogram during a one year study periods from July 2022 to June 2023 among 114 patients. Patients with clinical jaundice or serum bilirubin <2 mg/dl with clinical diagnosis of hepatitis were the study subjects. After explanation of the study procedure informed written consent was taken from all patients to be included in the study. After getting the clinical data on a case record form, 5 ml of venous blood was collected to test the presence of hepatotropic viral markers like HAV, HBV, HCV and HEV. Testing was done by immunochromatographic(ICT) methods or Enzyme Linked Immunosorbent Assay(ELISA) for using standard testing kits available in the testing labs, CMOSHMC. Patients those were positive for HBV were undergone HIV testing also by ICT. All testing were done in clinical pathology and microbiology department of Chattogram Maa O Shishu Hospital and data were included in the Microsoft Excel for further analysis. Ethical clearance was obtained from the ERB of CMOSHMC to conduct the study. Funding of the study was provided by the CMOSHMC research fund from the yearly allocation to move research further forward. Results Table 1 showing gender and age distributions of study patients where male were 73(64%) and female were 41(36%), male to female ratio was 1: 0.56. Maximum were in the age range of 60 years were 3(2.6%) only. View this table: View inline View popup Download powerpoint Table 1: Age and gender distributions of the study patients Table 2 showing different clinical features of study patients where 109(95.6%) had jaundice and 89(78.1%) had fever and 74(64.9%) had nausea and these were three dominant clinical features. Regarding other features vomiting 7(6.1%), abdominal pain 66(57.9%), headache 4(3.5%), anorexia 30(24.4%) diarrhea 10(8.8%), fatigue 20(17.5%) and H/O liver disease were 8(7.0%) View this table: View inline View popup Download powerpoint Table 2: Clinical features of the patients Table 3 showing frequency of HAV, HBV, HCV and HEV infection were 43(37.7%), 9(7.9%), 1(0.9%) and 26(22.8%) respectively. There were viral coinfections with (HAV+HEV), (HAV+HBV) and (HBV + HEV) and those were 8(7.0%), 4(3.5%) and 3(2.6%) respectively. Among all, 20(17.5%) cases were tested negative for hepatotropic viruses. Again 6(5.3%) had Anti HBc positivity and 2(1.8%) cases were found coinfected with HIV. View this table: View inline View popup Download powerpoint Table 3: Virologic patterns of hepatitis(N-114) Discussion In the present study, among 114 hepatitis cases analyzed, frequency of HAV, HBV, HCV and HEV infection were 43(37.7%), 9(7.9%), 1(0.9%) and 26(22.8%) respectively. Limited data are available on hepatitis prevalence in Bangladesh specially from southern part of Chittagong[ 7 ].But according to WHO, Bangladesh is one of the countries or areas with moderate to high risk ofhepatitis A and hepatitis B [ 7 ]. Bangladesh is considered to be a country wherehepatitis A infection is hyperendemic with 100% of children ≤ 6 years of age exposed and immuneto HAV[ 8 ] As a South East Asian country Bangladesh is considered endemic forhepatitis B virus (HBV) infection [ 9 ]. It was found that HEV carries alow mortality of 0.5-4% among the general populations but this figure approaches >75% in developing countries, such asBangladesh, in the second/third trimester of pregnancy, and in patients with fulminant hepaticFailure[ 10 ]. In Bangladesh,information about prevalence of HBV infection is scarce, and there is no available data on HDVinfection[ 11 ].In a study done among the HCWs, HBsAg positivity was found to be 8% in Bangladesh.[ 3 ]. A study conducted in Dhaka,Bangladesh by Ashraf et al .[ 12 ] found that the HBsAgprevalence of 6.5% among the common population 3%among healthy adults and children and 3.5% amongpregnant women; however, a much lower rate (0.8%)was observed among schoolchildren. Among the HBV positive patients, two cases were also positive for HIV. Since both the hepatitis B virus and the HIV virusshare similar transmission routes, it isnot surprising that there is a high frequency of coinfection[ 13 ]. HBV infection is itself a dynamic disease and coinfectionwith HIV considerably complicates itsdiagnosis and management because the more rapiddevelopment of circulated HBV virus in the body.But co-infection with HBV is a preventable cause ofchronic liver disease among HIV-infected patients.[ 14 , 15 ]There were viral coinfections found in our study where (HAV+HEV), (HAV+HBV) and (HBV + HEV) and it were 8(7.0%), 4(3.5%) and 3(2.6%) respectively. HAV and HEV shares common routes of transmission[ 1 ] but coinfection with HBV with those may be incidental findings as routes of HBV transmission is not as same as the HAV or HEV. It needs further study in future. Gender distributions revealed, malewere 73(64%) and female were 41(36%), male to female ratio was 1: 0.56. More hepatitis patients were in the age range of <20 years and 21- 30 years which were 46(40.4%) and 44(38.6%) respectively. In an earlier study regarding age range found more hepatitis were aggregated in younger age groups.[ 16 ] Evaluations of different clinical features of study patients, 109(95.6%) had jaundice and 89(78.1%) had fever and 74(64.9%) had nausea and these were three dominant clinical features. Regarding others features vomiting 7(6.1%), abdominal pain 66(57.9%), headache 4(3.5%), anorexia 30(24.4%) diarrhea 10(8.8%), fatigue 20(17.5%) and H/O liver disease were 8(7.0%). In a study done byBattaet al.[ 17 ]found the sign and symptoms developed by the hepatitisaffected patients were classical sign and symptoms. Theyfound Jaundice (28.57%) and weight loss (28.57%) were mostcommon with loss of appetite (10.71%). It was an interestingobservation that 5.71 % of patients reported to have itchy skin.Itchiness is developed in particularly hepatitis A patients as aresult of cholestasis. So in the present study setting these are some common history andexamination findings among the patients of hepatitis and theseare as expected.[ 1 ] A significant number of patients of hepatitis were found virologically negative. So possibilities of other non hepatotropic viruses or different causes of hepatitis may be related with this findings and it needs further exploration and it may be an interesting topic of future research. Conclusion HAV and HEV infections are the most common causes of acute hepatitisin Bangladesh as also found in our study. However, the real magnitude of HAV and HEV infections and HAV andHEVrelated acute hepatitis is under-recognized in Bangladesh, requiring further attention. HBV and HCV are two further threats for chronic hepatitis though former one is highly prevailing then the later in our country and Chattogram. Coinfection with HBV and HIV needs further attention. Data Availability All data produced in the present study are available upon reasonable request to the authors References 1. ↵ Biswas RSR , Hasan FH , Sultana A , Uddin MK , Chowdhury D , Rosy SN , Mamun SMH . A Documentation of Hepatitis Outbreak in Chittagong Chattagram Maa-O-Shishu Hospital Medical College Journal , 2018 ; 17 ( 2 ): 2 – 7 OpenUrl 2. ↵ Biswas RSR , Syduzzamanm S , Mamun , SMH , Biswas SK , Sultana N , Sequeira A , Bishop J. Viral Load and Genotype of Recent Hepatitis E Virus Outbreak in Chittagong, Bangladesh . J Sci Soc , 2020 ; 47 ( 3 ): 144 – 147 OpenUrl 3. ↵ Biswas RSR , Karim MN , Bhattacharjee B. Hepatitis B virus infection and vaccination status among healthcare workers of a tertiary care hospital in Bangladesh . J Sci Soc 2015 ; 42 : 176 – 9 . OpenUrl 4. ↵ Khan A I , Salimuzzaman M , Islam MT , Afrad MH , Shirin T , Jony MHK , Alam MA , Rahman M , Flora MS , Qadri F. Nationwide Hospital-Based Seroprevalence of Hepatitis A and Hepatitis E Virus in Bangladesh . Ann. Glob. Health 2020 ; 86 : 29 – 35 OpenUrl PubMed 5. ↵ Shin , E.C. ; Jeong , S.H. Natural History, Clinical Manifestations, and Pathogenesis of Hepatitis A . Cold Spring Harb. Perspect. Med . 2018 ; 8 : 21 – 26 OpenUrl 6. ↵ WHO-Hepatitis . 2011 . Available at: http://www.who.int/topics/hepatitis/en/ [Accessed on July 30, 2022 ]. 7. ↵ Gibney L. , Saquib N. , Metzger J. , Choudhury P. , Siddiqui M.A. , Hassan M.S. Human immunodeficiency virus, hepatitis B, C and D inBangladesh’s trucking industry: prevalence and risk factors . Int. J.Epidemiol . 2001 ; 30 ( 4 ): 878 – 884 . OpenUrl CrossRef PubMed Web of Science 8. ↵ WHO-GAR . Global Alert and Response: Hepatitis . 2011 Available at http://gamapserver.who.int/mapLibrary/ Files/Maps/ Global_HepA_ITHRisk Map.png (hepatitis A) and http://gamapserver.who.int/mapLibrary/Files/ Maps/Global_HepB_ITHRiskMap.png (hepatitis B) [Accessed on July 30, 2022 ]. 9. ↵ Saha S.K. , Saha S. , Shakur S. , Hanif M. , Habib M.A. , Datta S.K. , Bock H.L. Community-based cross-sectional seroprevalence study ofhepatitis A in Bangladesh . World J Gastroenterol . 2009 ; 15 ( 39 ): 4932 – 4937 . OpenUrl CrossRef PubMed Web of Science 10. ↵ Chaudhry M.A. , Rizvi F. , Afzal M. , Ashraf M.Z. , Niazi S. , Beg A. , Kharal T.H. Frequency of Risk Factors for Hepatitis B (HBV) andHepatitis C Virus (HCV) . Ann. Pak. Inst. Med. Sci . 2010 ; 6 ( 3 x): 161 – 163 . OpenUrl 11. ↵ Mahtab M.A. , Rahman S. , Khan M. , Karim M.F. HEV Infectionas an Aetiologic Factor for Acute Hepatitis: Experience from a TertiaryHospital in Bangladesh . J Health PopulNutr . 2009a ; 27 ( 1 ): 14 – 19 . OpenUrl 12. ↵ Zaki M.H. , Darmstadt G.L. , Baten A. , Ahsan C.R. , Saha S.K. Seroepidemiology of Hepatitis B and Delta Virus Infections inBangladesh . J Trop Pediatr . 2003 ; 49 ( 6 ): 371 – 374 . OpenUrl CrossRef PubMed Web of Science 13. ↵ Ashraf H , Alam NH , Rothermundt C , Brooks A , Bardhan P , Hossain L , et al. Prevalence and risk factors of hepatitis B and C virus infections in animpoverished urban community in Dhaka, Bangladesh . BMC Infect Dis 2010 ; 10 : 208 OpenUrl PubMed 14. ↵ Thio CL , Seaberg EC , Skolasky R , Jr. , Phair J , Visscher B , Munoz A , et al. HIV-1, hepatitis B virus, and riskof liver-related mortality in the Multicenter CohortStudy (MACS) . Lancet 2002 ; 360 ( 9349 ): 1921 – 1926 . OpenUrl CrossRef PubMed Web of Science 15. ↵ Tumpa SI , Mamun AA HIV/HBV Co-infection - A Global Challenge . Bangladesh Journal of Medical Science 2015 ; 14 ( 4 ): 316 – 322 OpenUrl 16. ↵ Parvin MN , Uddin R , Chowdhury SA . Hepatitis in Bangladesh: Pattern and treatmentoptions Journal of Applied Pharmaceutical Science 2011 ; 1 ( 6 ): 118 – 121 OpenUrl 17. ↵ Batta A. Viral hepatitis and enzyme study . Int J Cur Bio Med Sci . 2011 ; 1 ( 2 ): 41 – 43 . OpenUrl View the discussion thread. Back to top Previous Next Posted January 16, 2025. 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