KEVIN M. DE COCK, M.D., M.R.C.P., D.T.M.&H.; DANIEL W. BRADLEY, Ph.D.; NEVILLE L. SANDFORD, M.B.B.S., B.Sc.Med., F.R.A.C.P.; SUGANTHA GOVINDARAJAN, M.D.; JAMES E. MAYNARD, M.D., Ph.D.; ALLAN G. REDEKER, M.D.
Epidemic non-A, non-B hepatitis was diagnosed in three young Pakistani men during a 10-month period at the Los Angeles County-University of Southern California Medical Center. All three patients had recently visited or lived in Karachi, Pakistan. None had serologic markers of hepatitis B virus infection or IgM antibody (acute-phase) to hepatitis A virus. A liver biopsy from one patient showed marked cholestasis and cholangiolar transformation of hepatocytes, a pattern previously described in patients with epidemic non-A, non-B hepatitis. Immune electron microscopy of a stool specimen obtained from this patient 10 days after the onset of symptoms showed virus-like particles, 27 nm in diameter, that were specifically aggregated by antibody contained in acute-phase sera from the three Pakistani patients, from patients with non-A, non-B hepatitis in Burma and Nepal, and from an experimentally infected marmoset. Recognition of three separate cases of probable epidemic-type non-A, non-B hepatitis in patients at one institution during such a short time suggests that Pakistan is endemic for this infection and that the disease may be more commonly spread to the United States than is now presumed.
DE COCK KM, BRADLEY DW, SANDFORD NL, GOVINDARAJAN S, MAYNARD JE, REDEKER AG. Epidemic Non-A, Non-B Hepatitis in Patients from Pakistan. Ann Intern Med. ;106:227–230. doi: 10.7326/0003-4819-106-2-227
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Published: Ann Intern Med. 1987;106(2):227-230.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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