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Epidemic Non-A, Non-B Hepatitis in Patients from Pakistan

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.; and ALLAN G. REDEKER, M.D.
[+] Article and Author Information

▸Correspondence should be addressed to Kevin M. De Cock, M.D.; Special Pathogens Branch, Division of Viral Diseases, Centers for Disease Control, 1600 Clifton Road N.E.; Atlanta, GA 30333.


Downey, California; and Atlanta, Georgia


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(2):227-230. doi:10.7326/0003-4819-106-2-227
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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.

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