急性肝衰竭(ALF)是一种严重的临床疾病,死亡率很高。虽然有几个因素会导致ALF,病毒性肝炎仍然是主要原因之一。甲型肝炎病毒(HAV)和戊型肝炎病毒(HEV),通常会导致自我限制的急性疾病,是罕见但新出现的ALF原因,特别是当两种病毒都感染同一个人时。这两种嗜肝病毒共享肠道途径,并且最通常通过粪便-口腔途径传播。HAV/HEV合并感染对急性肝炎预后的影响尚不完全清楚。但是双重感染会进一步加剧肝脏损伤,导致暴发性肝衰竭(FHF)的死亡率高于单一病毒感染。这里,我们介绍了一例32岁男性,既往无肝脏疾病,他到急诊科就诊,有两周的黄疸史,腹痛,还有肝肿大.一被录取,他患有2级脑病。经过彻底的调查,甲型肝炎和戊型肝炎的共同感染被确定为他的ALF的主要原因。患者接受了强化治疗和干预,包括透析.不幸的是,患者的生存是不可能的,由于缺乏移植器官的可用性,这是目前唯一确定的治疗选择。此病例报告强调了及时诊断的重要性,及时干预,以及移植在肝衰竭存活中的可及性,因为它仍然是急性肝衰竭的唯一明确治疗方法。此外,它提供了关于HAV和HEV暴发性共感染的现有文献的简要概述,包括流行病学,临床特征,发病机制,诊断,治疗,与甲型肝炎和戊型肝炎合并感染相关的危险因素及其在ALF中的作用。并强调了确定高危人群和实施疫苗接种等适当防控措施的重要性,实行良好的个人卫生和环境卫生,避免食用受污染的食物和水。
Acute liver failure (ALF) is a severe clinical condition with a high mortality rate. Although several factors can cause ALF, viral hepatitis remains one of the leading causes. Hepatitis A virus (HAV) and hepatitis E virus (HEV), which typically cause self-limiting acute disease, are rare but emerging causes of ALF, especially when both viruses infect the same individual. Both of these hepatotropic viruses share an enteric route and are most commonly transmitted through the fecal-oral route. The impact of HAV/HEV co-infection on acute hepatitis prognosis is not entirely understood, but dual infection can further exacerbate liver damage, leading to fulminant hepatic failure (FHF) with a higher mortality rate than a single virus infection. Here, we present a
case of a 32-year-old male with no prior liver disease who presented to the emergency department with a two-week history of jaundice, abdominal pain, and hepatomegaly. Upon admission, he was disoriented with grade 2 encephalopathy. After a thorough investigation, co-infection with hepatitis A and E was identified as the primary cause of his ALF. The patient underwent intensive medical treatment and interventions, including dialysis. Unfortunately, the patient\'s survival was not possible due to the absence of availability of a transplanted organ, which is currently the only definitive treatment option. This
case report underscores the significance of prompt diagnosis, timely intervention, and the accessibility of transplantation in the survival of liver failure, as it remains the sole definitive treatment for acute liver failure. Moreover, it provides a concise overview of the current literature on fulminant co-infection of HAV and HEV, including epidemiology, clinical characteristics, pathogenesis, diagnosis, treatment, and risk factors associated with co-infection of hepatitis A and E and their role in causing ALF. It also highlights the significance of identifying high-risk populations and implementing appropriate prevention and control measures such as vaccination, practising good hygiene and sanitation, and avoiding the consumption of contaminated food and water.