Abstract
Background: Approximately 3% of the world population is infected with Hepatitis C virus, with the highest prevalence noted in Africa and Asia. In India, the prevalence of Hepatitis C virus infection ranges from 0.3% to 0.4% of the general population in different parts of the country, where it accounts for 0-12.8% of acute hepatitis, 10-20% of chronic liver disease and 10-15% of Hepatocellular Carcinoma. Several extra hepatic manifestations have been reported in hepatitis C infection. According to different studies, 40-74% of patients infected with the virus develop atleast one of the extrahepatic manifestations during the course of the disease. Extrahepatic manifestations may be the only and the first signal of an HCV infection, as many patients may not show any hepatic symptoms. Hence, detection of extrahepatic manifestation may help in easly diagnosis and initiation of treatment. So this study was undertaken to find out the prevalence and the common extrahepatic manifestations of Hepatitis C infection in a teritiary care centre in south Kerala, Government T D Medical College Alappuzha.
Materials and Methods: This study included a total of 95 patients diagnosed as HCV infected, attending the medical/ Gastroenterology wards/ OPD of the institution. It was a cross sectional study carried out over a period of 1 year regarding the clinical charecteristics of Hepatitis C infected patients.
Results: Extrahepatic Manifestations were seen in around 47.37% of the total sample population. They included neurological, renal, rheumatological and skin manifestations. Skin manifestations were the commonest. However Essential mixed cryoglobulinemia could not be detected due to the absence of a well set up laboratory facility.
Conclusion: Beyond the liver, HCV is a multifaceted disease. Some of the extrahepatic manifestations are due to immune reaction and some are due to chronic inflammation. Recognition of the extrahepatic manifestation is of paramount importance in early diagnosis of the disease.
Keywords: Hepatitis C, extrahepatic manifestations.
References
- Waheed, Y., T. Shafi, S.Z. Safi and I. Qadri, 2009. Hepatitis C in Pakistan. A systematic review of prevalence, genotype and risk factors. World J Gastroenterol,15:5647-5653.
- Wasley, A.D. and M.J. Alter, 2000. Epidemiology of hepatitis C. Semin Liver Dis., 20: 1-16.
- Shah, N.H. and G. Shabbir, 2002. A review of published literature on hepatits B and C virus prevalence in Pakistan. J. Coll Physicians Surg. Pakistan, 12: 368-371.
- Faridullah, S.M., I.A. Malik and I. HussainI, 2002. Increasing prevalence of chronic hepatitis and associated risk factors. Pakistan J. Med. Research, 41: 46-50.
- Gretch, D.R., C.E. Bacchi and L. Corey, 1995. Persistent hepatitis C virus infection after liver transplantation: clinical and virological features. Am. J. Hepatol., 22: 1-9.
- Degos, F., 1996. Natural history of hepatitis C virus infection. Nephrol Dial Transplant, 11(suppl 4): 16
- Arankalle VA. Epidemiology of HCV infection in India: a comprehensive analysis. In: Sarin SK, Okuda K eds. Hepatitis B and C– carrier to cancer. Harcourt India Pvt. Ltd. India. 2002;201–
- Alter MJ. World Epidemiology of Hepatitis C. Hepatitis Annual Update. 2004;77–92.
- Amarapurkar D. Natural history of hepatitis C virus infection. J Gastroenterol Hepatol. 2000;15:105–110
- Simmonds, P., 2001. Fleming Lecture: the origin and evolution of hepatitis viruses in humans. J. Gen. Virol., 82: 693-712.
- Agnello, V., 2000. Mixed cryoglobulinemia and other extra hepatic manifestations of HCV infection. In: Hepatitis C. Eds., T.J. Liang and J.H. Hoofnagle. New York: Academic Press, pp: 295-315.
- Cacoub, P., C. Renou and E. Rosenthal, 2000. Extrahepatic manifestations associated with hepatitis C virus infection. A prospe-ctive multicenter study of 321 patients. Group ed’Etude et de Recherche en Mede-cine Interne et Maladies Infectieuses sur le Virus de l’Hepatite C. Medicine., 79: 47-56.
- Cacoub, P., T. Poynard and P. Ghillani, 1999. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC group. Multidepar-tment Virus C Arthritis Rheum,42:2204-2212
- Pascual, M., L. Perrin, E. Giostra and J.A. Schifferli, 1990. Hepatitis C virus in patients with cryoglobulinemia type II. J. Infect Dis., 162: 569-570.
- Ferri, C., M. Monti and L. La Civita, 1993. Infection on peripheral blood momonuclear cells by hepatitis C virus in mixed cryoglobulinemia. Blood., 82: 3701-3704.
- Agnello, V. and F.G. De Rosa, 2004. Extrahepatic disease manifestations of HCV infection: some current issues. J. Hepatol., 40: 341-352.
Corresponding Author
Suresh Raghavan MD
Professor, Department of Medicine, Government T D Medical College, Alappuzha
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.220
