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Unusual Features of Viral Hepatitis in Accra, Ghana

RICHARD H. MORROW JR., M.D., M.P.H., F.A.C.P.; HANS F. SMETANA, M.D.; F. T. SAI, M.D., F.R.C.P. (EDIN), M.P.H.; and JOHN H. EDGCOMB, M.D.
Ann Intern Med. 1968;68(6):1250-1264. doi:10.7326/0003-4819-68-6-1250
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SUMMARY:

A clinical, epidemiological, and histopathological study of viral hepatitis was undertaken in Accra, Ghana, where hepatitis has become a common and severe endemic disease. One hundred thirty-six patients who were admitted to Korle Bu Hospital during a 12-month period and whose diagnosis of viral hepatitis was confirmed by liver biopsy or at postmortem were included in the study. Several unusual features and associations among patients hospitalized with hepatitis are described in this report. Histopathologic examination of liver biopsy sections from these patients revealed a distinctive pattern characterized by a "glandular" transformation of liver cells about bile canaliculi, an increased frequency of cholestasis, and a rarity of acidophilic bodies. Pregnant women had a higher complication rate for hepatitis than the nonpregnant, and they had a high fetal death rate. Patients with hepatitis had twice the frequency of erythrocyte glucose 6-phosphate dehydrogenase (G6PD) deficiency as compared with the general population, and those with the enzyme defect had a longer, more severe course. Men required a longer time to recover from equivalent degrees of liver damage than women, and older patients required a longer time than younger patients. The high acute coma and death rate was associated with immigration, shantytown residency, lower socioeconomic standing, and pregnancy. On the other hand, prolonged jaundice from hepatitis could be attributed to inherent biologic factors such as age, sex, and G6PD deficiency.

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