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British Medical Bulletin 46:462-480 (1990)
© 1990 The British Council

research-article

Fulminant viral hepatitis

E A Fagan and R Williams

Liver Unit, King's College Hospital London

Abstract

In the United Kingdom and United States of America, fulminant viral hepatitis is due mainly to sporadic (non-parenteral non-A, non-B hepatitis and hepatitis B whereas that caused by hepatitus A virus is very uncommon and by the herpes viruses remains rare. Recent advances in fulminantnon-A, non-B hepatitis have come with the identification and cloning of a virus (27–34 nm) in the enteral variety (hapatitis E) which is prevalent in the Indian sub-continent, North Africa and elsewhere, especially in pregnant women. Virus-like particles (50–70nm) with ultrastructural features similar to the togaviridae and flaviviridae have been identified in some patients with fulminant non-A, non-B hepatitis in the United kingdom. The relation to hepatitis C virus, recently identified as a major cause of chronic post-transfusion (parenteral) non-A, non-B hepatitis, awaits serological analysis. The recent domonstration that persistence of active viral replication can occur in some case of fulminant hepatitis type A and B using monoclonal antibody and molecular biology techniques challenges the classical views on the pathogenesis of these varieties of fulminant viral hepatitis.


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