Characterization and Investigation of Risk Factors for Late-Relapsing Hepatitis After Yellow Fever

Characterization and Investigation of Risk Factors for Late-Relapsing Hepatitis After Yellow Fever

Abstract Background Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46–60 days aft...

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Published in:Clinical infectious diseases Vol. 77; no. 4; pp. 565 - 573
Main Authors: Rezende, Izabela Mauricio de, McClure, Max A, Pereira, Leonardo S, Fradico, Jordana R B, Cenachi, Adriana R C, Moura, Alexandre S, Paladino, Luísa L de A, Dutra, Maria Rita T, Alves, Pedro A, Xavier, Marcelo A P, Said, Rodrigo F do C, Ramalho, Dario B, Gama, Thaysa D P, Martins-Filho, Olindo A, Monath, Thomas P, Teixeira-Carvalho, Andréa, Drumond, Betânia P, LaBeaud, Angelle D
Format: Journal Article
Language:English
Published: US Oxford University Press 22-08-2023
Subjects:
Brazil - epidemiology
Disease Outbreaks
Disease Progression
Hepatitis - epidemiology
Hepatitis A - epidemiology
Humans
Major
Risk Factors
Yellow Fever - complications
Yellow Fever - epidemiology
Yellow Fever Vaccine
Brazil
viral persistence
relapsing hepatitis
yellow fever
hepatitis
convalescent phase
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Summary:Abstract Background Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46–60 days after YF symptom onset. Methods Here we have characterized the clinical course and risk factors for LHep-YF using data from a representative cohort of patients who survived YF in Brazil, 2017–2018. A total of 221 YF-positive patients were discharged from the infectious disease reference hospital in Minas Gerais and were followed up at 30, 45, and 60 days post–symptom onset. Results From 46 to 60 days post–symptom onset, 16% of YF patients (n = 36/221) exhibited a rebound of aminotransferases (aspartate aminotransferase or alanine aminotransferase >500 IU/L), alkaline phosphatase, and total bilirubin levels. Other etiologies of liver inflammation such as infectious hepatitis, autoimmune hepatitis, and metabolic liver disease were ruled out. Jaundice, fatigue, headache, and low platelet levels were associated with LHep-YF. Demographic factors, clinical manifestations, laboratory tests, ultrasound findings, and viral load during the acute phase of YF were not associated with the occurrence of LHep-YF. Conclusions These findings provide new data on the clinical course of Late-relapsing hepatitis during the convalescent phase of YF and highlight the need for extended patient follow-up after acute YF. Late-relapsing hepatitis after yellow fever is a clinical picture described around 60 days after the acute yellow fever phase, presenting with nonspecific symptoms, such as fatigue and rebound in aminotransferases, alkaline phosphatase, and total bilirubin values, with a benign final outcome.
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Potential conflicts of interest. A. R. C. C. reports consulting fees from the International Horizon Scanning Initiative’s Horizon Scanning System tracked by ECRI, a global, independent authority on healthcare technology and safety. B. P. D. reports unpaid roles as financial council and vice-president of the Brazilian Society for Virology and as virology chair for the Brazilian Society for Microbiology. All other authors report no potential conflicts of interest.
The Yellow Fever Collaborative Group members are listed in the Notes.
I. M. R., M. A. M., L. S. P., B. P. D., and A. D. L. contributed equally to this work.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
ISSN:1058-4838
1537-6591
1537-6591
DOI:10.1093/cid/ciad249