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Cholestatic syndrome in viral hepatitis A


Andrey I. Petrov1 / Nikolay T. Vatev2 / Maria V. Atanasova3
1Department of Infectious Diseases, Parasitology and Tropical Medicine
2Department of Hygiene, Ecology and Epidemiology
3Department of Microbiology and Immunology, St. George University Hospital, Medical University, Plovdiv, Bulgaria
Correspondence and reprint request to: A. Petrov, Dept. of Infectious Diseases, Parasitology and Tropical Medicine,Medical University, Plovdiv; E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.;Mob.: +359 888 543 55215A Vassil Aprilov Str, 4002 Plovdiv, Bulgaria

Citation Information: Folia Medica. Volume 54, Issue 1, Pages 30–35, ISSN (Online) 1314-2143, ISSN (Print) 0204-8043, DOI: 10.2478/v10153-011-0075-9, October 2012
Publication History:
Published Online:



AIM: To study the cholestatic forms of viral hepatitis A that are described as unusual and very rare, but that are of great signifi cance because of their severe course and high morbidity rate.

MATERIAL AND METHODS: We describe herein 17 cases of hepatitis A virus (HAV) infection with pronounced cholestasis treated in the Clinic of Infectious Diseases at St. George University Hospital between 2002 and 2006. They are taken from a contingent of 820 patients we studied in the course of the research: of these 400 were cases of sporadic disease and 420 patients were involved in an epidemic outbreak of the disease. All got this diagnosis based on an anti-HAV/IgM test. Eight parameters were analyzed: age, max TBil, max ALT, ALP, GGT, no urobilinogen in urine, ultrasound monitoring of hepatomegaly, and hospital stay.

RESULTS: The 17 patients we discuss here are 2.07% of the total 820 patients with viral hepatitis A (VHA). In 14 the disease had a cholestatic component; 3 cases were a cholestatic form of the disease. The mean hospital stay was 49.1 ± 11.5 days, the longest - 75 days. The hyperbilirubinemia had high levels at the disease climax - the mean concentration was 356.6 μkmol/l, and remained greater than 150 μkmol/l for more than a month. In 10 patients (58.2%) transaminase activity was over 1400 U/l, (mean 2011 U/l).

CONCLUSION: Viral hepatitis A ran with cholestatic syndrome in 2.07%; 23.5% of these cases were classifi ed as severe forms of the disease and 76.5% - as moderate. This is evinced by the enhanced transaminase activity, the elevated TBil, pronounced intoxication, the adynamia, vomiting, headache, the vertigo, all of these items in the objective severity score system we used.