Late-Relapsing Hepatitis after Yellow Fever

One patient presented hyporexia, asthenia, adynamia, and jaundice two months after acute yellow fever (YF) onset; plus laboratory tests indicating hepatic cytolysis and a rebound of alanine and aspartate transaminases, and total and direct bilirubin levels. Laboratory tests discarded autoimmune hepatitis, inflammatory or metabolic liver disease, and new infections caused by hepatotropic agents. Anti-YFV IgM, IgG and neutralizing antibodies were detected in different times, but no viremia. A liver biopsy was collected three months after YF onset and tested positive for YFV antigens and wild-type YFV-RNA (364 RNA-copies/gram/liver). Transaminases and bilirubin levels remained elevated for five months, and the arresting of symptoms persisted for six months after the acute YF onset. Several serum chemokines, cytokines, and growth factors were measured. A similar immune response profile was observed in the earlier phases of the disease, followed by more pronounced changes in the later stages, when transaminases levels returned to normal. The results indicated viral persistence in the liver and continual liver cell damage three months after YF onset and reinforced the need for extended follow-ups of YF patients. Further studies to investigate the role of possible viral persistence and the immune response causing relapsing hepatitis following YF are also necessary.

[1]  E. Sabino,et al.  Predictors of mortality in patients with yellow fever: an observational cohort study. , 2019, The Lancet. Infectious diseases.

[2]  J. Molina,et al.  Hepatitis Rebound after Infection with Yellow Fever Virus , 2019, Emerging infectious diseases.

[3]  B. Pinsky,et al.  Yellow Fever Virus: Diagnostics for a Persistent Arboviral Threat , 2018, Journal of Clinical Microbiology.

[4]  Sudhir Kumar,et al.  MEGA7: Molecular Evolutionary Genetics Analysis Version 7.0 for Bigger Datasets. , 2016, Molecular biology and evolution.

[5]  M. Grobusch,et al.  Comparison of the PRNT and an immune fluorescence assay in yellow fever vaccinees receiving immunosuppressive medication. , 2016, Vaccine.

[6]  K. Falk,et al.  One-step real-time RT-PCR assays for serotyping dengue virus in clinical samples , 2015, BMC Infectious Diseases.

[7]  H. Margolis,et al.  Analytical and Clinical Performance of the CDC Real Time RT-PCR Assay for Detection and Typing of Dengue Virus , 2013, PLoS neglected tropical diseases.

[8]  H. Margolis,et al.  Correction: Analytical and Clinical Performance of the CDC Real Time RT-PCR Assay for Detection and Typing of Dengue Virus , 2013, PLoS Neglected Tropical Diseases.

[9]  P. Patel,et al.  Development of one-step quantitative reverse transcription PCR for the rapid detection of flaviviruses , 2013, Virology Journal.

[10]  P. Patel,et al.  Advanced Yellow Fever Virus Genome Detection in Point-of-Care Facilities and Reference Laboratories , 2012, Journal of Clinical Microbiology.

[11]  V. Dua,et al.  Molecular characterization of chikungunya virus from Andhra Pradesh, India. , 2009, The Indian journal of medical research.

[12]  T. Monath,et al.  Yellow fever: an update. , 2001, The Lancet. Infectious diseases.

[13]  G. Edington,et al.  A clinicopathological study of human yellow fever. , 1972, Bulletin of the World Health Organization.

[14]  J. Oudart,et al.  [Proteinuria, proteinaemia, and serum transaminase activity in 23 confirmed cases of yellow fever]. , 1970, Bulletin of the World Health Organization.