Acute Hepatitis B In Patients With And Without Hepatic Schistosomiasis ”follow Up Study ”:

Fawzy Megahed H.khalil

Hepatitis B infection and schistosomiasis are the most commoncauses of liver disease in Egypt the association of the two conditions isa common event. While schistosoma mansoni infection does notseverly affect hepatocyte function, the presence of hepatitis-B virusinfection may lead to chronic active or chronic persistent hepatitis.So the effect of their combination on the morbidity and mortality ofthe affected population is more than single disease alone.In this work, it was aimed to compare the course and outcome ofacute viral hepatitis B alone and with hepatic schistosomiasis.The sUbjects of our study included 100patients with acute hepatitis-B which were selected from patients admitted to hospital with a recentonset of acute hepatitis. We selected 50 patients with hepaticSchistosomiasis and 50 non- schistosomal patients for our follow upstudy.We followed them every three month from the start of acutehepatitis-B to the 12th month, clinically, Biochemically andserologically. Our patients were subjected to :_1- Full clinical history including that of schistosomiasis, use of drugs,alcohol intake, parenteral injection and previous attack of jaundice.2- Full clinical examination.3- Urine and stool examination.4- Sigmoidoscopy and rectal biopsy for schistosoma ova.5- Liver function tests including, serum bilirubin, SGOT, SGPT,alkaline phosphatase and prothrombin activity.6- HBV markers inclUding, HBSAg, anti-HBS, anti-HBC(IgM), HBe-Agand delta agent.7- Liver biopsies for all cases.The age of our patients ranged from 14- 26 years (first group), 27 _43years (Znd group) and from 44 - 59 years (third group)The results of our study showed that:1. Acute hepatitis B tend to affect young age more.2. The development of pathologic hepatosplenomegaly wassignificantly higher in schistosomal than in non- schistosomalpatients after AHB.3. The development of ascites was significantly higher in schistosomalthan in non-schistosomal hepatic affection after AHB.SUMMARY & CONCLUSION4. The liver functions were more bad in schistosomal patients afterAHB.5. The incidence of delta co-infection and delta super-infection weresignificantly higher in schistosomal patients and inactiveschistosomal more than patients with inactive schistosomiasis withmale predominance.6. The liver functions were more affected in patients with deltainfection than in those with HBV infection alone.7. The persistent HBS-antigenemia was significantly higher in theschistosomal patients.8. Persistent HB5-antigenemia was found to be greater in males than infemales.9. Persistent HBS-antigenemia was found to be greater in youngpatients.10- Patients with active schistosomiasis when treated by praziquantelshowed better clearance of HBSAg.11- Patients with HBV infection alone showed better clearance ofHBSAg than those infected with delta agent.12- Schistosomal patients retained e-antigen for longer periods withhigher degree of infectivity.13- Bleeding from oesophageal varices was significantly higher inschistosomal patients and patients with delta infection.14- Histopathologic studies showed higher incidence of chronic activehepatitis, chronic persistent hepatitis and cirrhosis in schistosomalpatients especially those with persistent HB5-antigenemia and inpatients with delta infection than in those with HBV infectionalone.15. The mortality was significantly higher in schistosomal patientswith delta infection.from the above results of our study we can conclude and recomendthe followings:-1- Viral hepatitis B and schistosomiasis constitute a major healthproblem in our community.2- The clinical and biochemical aspects are worse in schistosomal thanin non- schistosomal patients after AHB.3- The incidence of chronic liver diseases is higher in schistosomalthan in non- schistosomal patients when infected by HB virus.-113 -4- The concomitant affection by schistosomiasis and HB virus isassociated with higher morbidity and mortality than HB virusinfection alone.5- schistosomiasis may predispose to delta infection which may beresponsible for the higher incidence of variceal bleeding in cases ofmixed schistosomiasis and HB virus infection than in pure HBVinfection alone.6- Delta infection is associated with a worse outcome and a higher rateof morbidity and mortality.7- Patients with dual infections (HBV and schistosomiasis) are athigher risk in spreading HBV as they act as a reservoir for HBVand are more likely to be HBe-Ag positive.8- The chronicity after AHB being worse in the younger schistosomalmales.9- The effective treatment of schistosomiasis ameliorates and improvesthe course and outcome of both schistosomiasis and HBV.10- HB vaccine should be given in a large scale and until becomeavailable, it should be given to the risky populations whereyounger schistosomal males included.11- Every efforts should be done in the prophylactic and therapeuticprograms against schistosomiasis and viral hepatitis.