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Hepatitis A Virus in Stool During Clinical Relapse

MARIA H. SJOGREN, M.D.; HUGO TANNO, M.D.; OSCAR FAY, Ph.D.; SANTOS SILEONI, Ph.D.; BARRY D. COHEN, B.A.; DONALD S. BURKE, M.D.; and ROBERT J. FEIGHNY, Ph.D.
[+] Article and Author Information

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

▸Requests for reprints should be addressed to Maria H. Sjogren, M.D.; Veterans Administration Medical Center, 151W, 50 Irving Street; Washington, DC 20422.


Washington, D.C.; and Rosario, Argentina


Ann Intern Med. 1987;106(2):221-226. doi:10.7326/0003-4819-106-2-221
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Among 256 patients with acute hepatitis A, 17 (6.6%) had a relapse of the disease between 30 and 90 days after the primary episode. We studied 7 of these patients. Serologic testing showed mean alanine aminotransferase levels of 1668 IU/L during the acute stage, 107 IU/L during the early convalescence, and 1027 IU/L during the relapse. Tests for IgM antibody against hepatitis A virus were positive in the 7 patients at the onset of disease, with decreasing levels in 3 of the 4 patients tested during the evolution of the illness. Stools collected during the relapse phase showed hepatitis A virus by immune electron microscopy, radioimmunoassay, and molecular hybridization using a 32P-labeled cDNA-hepatitis A virus probe. Stools collected from 4 of these patients 6 to 12 months after the onset of disease were negative for the virus. The finding of hepatitis A virus in the stool of these patients during the relapse phase strongly implicates hepatitis A virus as the causative agent of the clinical relapse.

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