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Serious Hepatitis A: An Analysis of Patients Hospitalized during an Urban Epidemic in the United States

Ira R. Willner, MD; Mark D. Uhl, MD; Scott C. Howard, MD; Ernest Q. Williams, MD; Caroline A. Riely, MD; and Bradford Waters, MD
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From the University of Tennessee, Memphis, Tennessee. Requests for Reprints: Ira R. Willner, MD, Liver Service, Gastroenterology Division, Medical University of South Carolina, 916 Clinical Science Building, 171 Ashley Avenue, Charleston, SC 29425. Current Author Addresses: Dr. Willner: Liver Service, Gastroenterology Division, Medical University of South Carolina, 916 Clinical Science Building, 171 Ashley Avenue, Charleston, SC 29425.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(2):111-114. doi:10.7326/0003-4819-128-2-199801150-00006
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Background: Memphis and Shelby County, Tennessee, experienced an epidemic of hepatitis A in 1994 and 1995. More than 1700 cases were reported.

Objective: To characterize the clinical features of patients hospitalized during a large urban epidemic of hepatitis A.

Design: Retrospective chart review.

Setting: 15 acute care hospitals in Shelby County, Tennessee.

Patients: 256 patients hospitalized with acute hepatitis A.

Measurements: Laboratory findings (such as prothrombin time and bilirubin level), complications, and mortality.

Results: The median patient age was 26 years. Thirty-nine complications occurred in 35 patients. Twenty patients (8%) had extrahepatic complications, and 5 (2%) died. Patients 40 years of age and older were more likely to have serious complications, including death (P = 0.014). Sixty-seven patients (26%) presented with coagulopathy (prothrombin time ≥ 3 seconds prolonged). Fifty-four patients (21%) had a bilirubin level greater than 170 µmol/L (10 mg/dL).

Conclusions: During this epidemic, hepatitis A caused serious illness and death. Complications were more frequent in patients 40 years of age and older, but young, healthy persons were also at risk for severe complications.





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