Modern Concepts of Acute and Chronic Hepatitis

338 Pages·1989·12.91 MB·English

by  Saul Krugman (auth.), Gary Gitnick M. D. (eds.)

Modern Concepts of
Acute and
Chronic Hepatitis
Modern Concepts of
Acute and
Chronic Hepatitis
Edited by
GARY GITNICK, M. D.
University oj California at Los Angeles
School oj Medicine
Los Angeles, California
PLENUM MEDICAL BOOK COMPANY
NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Modern concepts of acute and chronic hepatitis I edited by Gary Gitnick.
p. cm.
Includes bibliographies and index.
ISBN-13: 978-1-4615-9521-2 e-ISBN-13: 978-1-4615-9519-9
DOl: 10.1007/978-1-4615-9519-9
1. Hepatitis. I. Gitnick, Gary L.
[DNLM: 1. Hepatitis. WI 700 M691]
RC848.H42M63 1989
616.3'623-dc19
DNLM/DLC 88-22557
for Library of Congress CIP
© 1989 Plenum Publishing Corporation
Softcover reprint of the hardcover 1st edition 1989
233 Spring Street, New York, N.Y. 10013
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
This book is dedicated to my family-
my wife Cherna;
our children Neil, Kim, Jill, and Tracy;
and our parents Ann, Sonia, and Jack.
Contributors
Ferruccio Bonino • Division of Gastroenterology, San Giovanni Battista Mo
linette Hospital, 10126 Turin, Italy
John Bartels • Division of Allergy, Immunology, and Infectious Diseases,
University of Medicine and Dentistry of New Jersey, New Brunswick, New
Jersey 08903-0019
Albert J. Czaja • Division of Gastroenterology, Mayo Clinic and Mayo Medi
cal School, Rochester, Minnesota 55905
Gary L. Davis • Division of Gastroenterology, Hepatology, and Nutrition,
University of Florida College of Medicine, Gainesville, Florida 32610
V. J. Desmet • Laboratory of Cytochemistry and Histochemistry, University
Hospital St. Raphael, Catholic University, Leuven, B-3000 Leuven,
Belgium
Stephen M. Feinstone • Laboratory of Infectious Diseases, National Institute
of Allergy and Infectious Diseases, National Institutes of Health, Bethesda,
Maryland 20892
Michael A. Gerber • Department of Pathology, Tulane University School of
Medicine, New Orleans, Louisiana 70112
Gary Gitnick • Department of Medicine, University of California at Los An
geles School of Medicine, Los Angeles, California 90024
David J. Gocke • Division of Allergy, Immunology, and Infectious Diseases,
University of Medicine and Dentistry of New Jersey, New Brunswick,
New Jersey 08903-0019
vii
viii CONTRIBUTORS
George F. Grady • Massachusetts Center for Disease Control, Department of
Public Health, and Department of Medicine, Tufts University School of
Medicine, Boston, Massachusetts 02130
Ian D. Gust • Macfarlane Burnet Centre for Medical Research, Fairfield Hospi
tal, Melbourne, Australia 3078
Raymond S. Koff • Department of Medicine, Framingham Union Hospital,
Framingham, Massachusetts 01701; and Division of Medicine, Boston Uni
versity School of Medicine, Boston, Massachusetts 02118
Ronald L. Koretz • Division of Gastroenterology, Olive View Medical Center,
Sylmar, California 91342; and Department of Medicine, University of Cal
ifornia School of Medicine, Los Angeles, California 90024
Saul Krugman • Department of Pediatrics, New York University Medical Cen
ter, New York, New York 10016
Christopher D. Lind • Division of Gastroenterology, Hepatology, and Nutri
tion, University of Florida College of Medicine, Gainesville, Florida 32610
Jurgen Ludwig • Departments of Medicine and Pathology, Mayo Clinic and
Foundation, Rochester, Minnesota 55905
Ian R. Mackay • Clinical Research Unit of the Walter and Eliza Hall Institute
of Medical Research and the Royal Melbourne University, Victoria 3050,
Australia
Jack Peicher • Department of Gastroenterology, University of Southern Cal
ifornia, Los Angeles, California 90033
Robert P. Perrillo • Gastroenterology Section, Veterans Administration Medi
cal Center; and Division of Gastroenterology, Washington University
School of Medicine, St. Louis, Missouri 63106
Hans Popper • The Lillian and Henry M. Stratton-Hans Popper Department
of Pathology, Mount Sinai School of Medicine of the City University of
New York, New York 10029
Jorge Rakela • Departments of Medicine and Pathology, Mayo Clinic and
Foundation, Rochester, Minnesota 55905
Fredric G. Regenstein • Gastroenterology Section, Veterans Administration
Medical Center; and Division of Gastroenterology, Washington University
School of Medicine, St. Louis, Missouri 63106
Mario Rizzetto • Division of Gastroenterology, San Giovanni Battista Mo
linette Hospital, 10126 Turin, Italy
CONTRIBUTORS Ix
Eugene R. Schiff • Division of Hepatology, University of Miami School of
Medicine, and Hepatology Section, Veterans Administration Medical Cen
ter, Miami, Florida 33125
Roger D. Soloway • Department of Medicine, University of Texas Medical
Branch, Galveston, Texas 77550-2778
Andrew Stolz • Department of Medicine, UCLA School of Medicine, Los
Angeles, California 90024; and Wadsworth Veterans Administration Cen
ter, Los Angeles, California 90073
Swan N. Thung • The Lillian and Henry M. Stratton-Hans Popper Depart
ment of Pathology, Mount Sinai School of Medicine of the City University
of New York, New York 10029
Victor M. Villarejos • International Center for Medical Research and Training,
Louisiana State University, San Jose, Costa Rica
Barbara G. Werner • Massachusetts Center for Disease Control, Department
of Public Health, and Department of Medicine, Tufts University School of
Medicine, Boston, Massachusetts 02130
Preface
The literature of medicine continues to expand at a remarkable pace. The number
of papers and monographs published has increased dramatically in the past five
years. Nowhere has this increase been as dramatic as in the field of acute and
chronic hepatitis. Why then should there be still another book?
Despite the sheer volume of words published, it is still difficult to find in
anyone volume a compilation of all of the most significant work. Most mono
graphs have considered either chronic or acute hepatitis, not both. Few works
have addressed both the clinician and the basic scientist. This book addresses
both of these audiences and considers both of these diseases. It was designed to
provide an authoritative but concise assessment of our changing concepts of
acute and chronic hepatitis. It covers what is currently known and, based on the
most convincing research, believed about these diseases. To fulfill this ambitious
goal, only authors with international reputations in their fields of expertise were
invited to contribute.
In the evolution of our current thoughts on the pathogenesis and manage
ment of acute and chronic hepatitis, our ideas have changed several times. This
book presents the facts as they are known today and, in areas where all the facts
are not established, presents the well-founded opinions of those considered to be
authorities. The authors present established and usually confirmed data and do
not deal extensively with areas of speculation or unconfirmed material.
Accordingly, the reader of this text will not find an extensive discussion of
the utilization of interferon in the management of acute or chronic hepatitis
simply because the available data remain too uncertain to offer reliable guide
lines. On the other hand, the book does describe new and as yet incompletely
developed topics such as the use of the hepatitis B virus DNA assay and the
development of an unconfirmed assay for non-A, non-B hepatitis. The former
subject is covered here because a number of groups have contributed sufficient
findings to justify its discussion within the limits of the available data. The latter
xii PREFACE
is presented because although the data have not been confirmed, the material,
while controversial, is of such far-reaching interest that the authors and editor felt
justified in including it.
This text attempts then to reach a balance between that which is currently
accepted and thought to be established and that which is new and of reasonable
importance.
Mrs. Susan Dashe was responsible for the administrative organization of
this text. She worked diligently to bring together the chapters in a timely manner
and to assist the editor in the overall development of the book. I am grateful to
her for her superb efforts and her dedication to the development of this text.
Gary Gitnick, M.D.
Los Angeles
Contents
I. Acute Hepatitis
1. History of Acute Viral Hepatitis ............................ 3
SAUL KRUGMAN
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Hepatitis A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Hepatitis D Virus ............................................ 7
Non-A, Non-B Hepatitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Epidemic Non-A, Non-B Hepatitis .............................. 7
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2. The Clinical Features of Acute Viral Hepatitis. . . . . . . . . . . . . . . . 11
RAYMOND S. KOFF
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Inapparent Asymptomatic Hepatitis .............................. 12
Symptomatic Hepatitis ........................................ 13
Prodromal Features ......................................... 13
Icteric and Convalescent Phases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Clinical Variants ............................................. 17
Cholestatic Hepatitis ........................................ 17
Relapsing Hepatitis ......................................... 17
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
xiii