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Hepatitis in Campylobacter jejuni enteritis
Abstracts / Digestive and Liver Disease 49(4S) (2017) e243–e286
P025 Hepatitis in Campylobacter jejuni enteritis M. Casolino 2 , A. Marseglia 1,∗ , M.R. Pastore 1 , M. Pellegrino 1 , A. Dirodi 2 , F.R. Consiglio 2 , L. Russo 1 , M.C. Sacco 1 1
U.O.C. di Pediatria, Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo (FG), Italy 2 Scuola di Specializzazione in Pediatria, Università degli Studi di Foggia, Italy Introduction: Campylobacter jejuni is one of the main causes of bacterial enteritis among children under 2 years in developed countries. In neonates and young infants, bloody diarrhea without fever can be the only manifestation of infection; however Campylobacter infection is associated with a spectrum of extraintestinal diseases including bacteremia, meningitis, cardiac complications. Case: A 2-month-old infant was admitted to the hospital for bloody diarrhea, loss of appetite in the absence of vomiting. She feed with formula from birth. At admission, she had a good general condition, temperature was 36 ◦ C with normal physical examination. Biochemical tests showed hypertransaminasemia: alanine aminotransferase (ALT) 644 U/l, aspartate aminotransferase (AST) 910 U/I; gamma glutamyltranspeptidase (GT) 276 U/I, phosphatase Alkaline 399 U/I, normal level of total bilirubin and moderate increase of C-reactive protein. Liver ultrasound was negative. Screening for hepatitis B, hepatitis A and C, Cytomegalovirus and Epstein Barr virus were negative. Two coprocultures were performed and were positive to Campylobacter jejuni. A treatment with clarithromycin was administered. Liver abnormalities were completely normalized within a week. Conclusion: The presence of hepatitis in the course of Campylobacter enteritis is previously described in adult patients. In the pediatric age, cases of hepatitis have been reported in the context of sepsis by C. jejuni. However, the observation of this association in infants with enteritis without sepsis has not been previously reported. We present the case of a 2-month-old infant with hepatitis/hypertransaminasemia associated with Campylobacter enteritis without concomitant septicemia. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.029 P026 Hepatitis C virus resistance associated variant to paritaprevir/ombitasvir/ritonavir in a 16-year-old adolescent D. Serranti 1 , G. Indolfi 1 , E. Bartolini 1 , S. Ricci 2,∗ , M. Resti 1 1
UO di Pediatria Medica, Epatologia Pediatrica, AOU Meyer, Firenze, Italy 2 UO di Pediatria Medica, Immunologia Pediatrica, AOU Meyer, Firenze, Italy Background: The direct active antiviral (DAA) combination of paritaprevir/ombitasvir/ritonavir has been demonstrated to be effective in 100% of children with chronic hepatitis C virus genotype 1 or 4 aged 12–18 years and treated for 12 weeks. There is no paediatric experience in development and management of resistance to DAA therapies. Methods: We describe a 16-year-old patient with chronic hepatitis C, genotype 4, who developed compensated cirrhosis (PLT 95,000/L, albumin 3.6 g/dL, alpha-fetoprotein 150 IU/mL, liver
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stiffness by FibroScan: 23 kPa). Due to the clinical condition of the patient, it was decided for the off-label use of the combination paritaprevir/ombitasvir/ritonavir. Results: The child experienced a virological breakthrough at week 4 of treatment. The resistance associated substitutions (RASs) analysis showed the presence of NS5A basal RASs 28V and 93C and NS3 on-treatment RAS 168H. Conclusions: We described the first child treated with the combination of paritaprevir/ombitasvir/ritonavir who developed a virological resistance. RASs may be present at the moment of the infection by hepatitis C virus or develop during therapy. The study of RASs is not generally indicated before starting treatment with DAAs in adults, but can influence the choice of the combination to be used for retreatment. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.030 P027 Liver transplantation in metabolic diseases: A single center experience R. Angelico 1,∗ , D. Liccardo 2 , M.S. Basso 2 , M. Candusso 2 , A. Pietrobattista 2 , F. Sbravati 2 , C. Grimaldi 1 , M.C. Saffioti 1 , A. Maiorana 3 , S.M. Bernabei 3 , C. Dionisi Vici 3 , G. Torre 2 , M. Spada 1 1 Dip. Chirurgia Epatobiliopancreatica e Trapianti Addominali, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy 2 Dip. Epatogastroenterologia, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy 3 Dip. Patologie Metaboliche, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
Introduction: Metabolic liver diseases are now a common indication for liver transplantation (LT) mainly as enzyme replacement therapy. Methods: Retrospective review of all pediatric LT performed for metabolic diseases in a single institution between December 2008 and June 2017. Results: Out of 186, 34(18.3%) children underwent LT for metabolic diseases for tyrosinemia (5 cases), primary oxalosis (7), Wilson’s disease (3), Maple syrup urine disease (MSUD) (5), argininosuccinic aciduria (3), ornithine transcarbamylase deficiency (3), propionic academia (2), methylmalonic academia (2), familial hypercholesterolemia (1), a1-antritripsin (1), LAL deficiency (1), and ethylmalonic academia (1). The mean age was 8.1 (8 m–16 yrs) yrs, mean weight 27 (8.6–49) kg; mean time on waiting list 83 (2–310) days. Living donor LTs were performed in 7 (20.6%) patients; 22 (64.7%) children received a split graft, 12 (35.3%) whole grafts. 7 (20.6%) children received also kidney transplant (5 combined liver-kidney; 2 sequential kidney transplant). One MSUD liver was used for a domino transplant in a pediatric recipient. Except for one (2.9%), all children had a progressive normalization of blood aminoacid levels, receiving normal protein intake in 2 weeks. The mortality rate was 5.8%, due to PNF (1) and cardiovascular event (1). Post-operative complications were: acute rejection (8); post- transplant acute tubular necrosis (1); re-laparotomy for hemorrhage (3), bowel obstruction (1) and biliary leak (1). One child affected by propionic acidemia faced progressive neurological disorder (drug-resistant epilepsy), while all the others showed neurological improvement or stability and a better quality of life. Liver function tests have been stable during the entire follow-up [83.3 (1–102) months].
P025 Hepatitis in Campylobacter jejuni enteritis M. Casolino 2 , A. Marseglia 1,∗ , M.R. Pastore 1 , M. Pellegrino 1 , A. Dirodi 2 , F.R. Consiglio 2 , L. Russo 1 , M.C. Sacco 1 1
U.O.C. di Pediatria, Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo (FG), Italy 2 Scuola di Specializzazione in Pediatria, Università degli Studi di Foggia, Italy Introduction: Campylobacter jejuni is one of the main causes of bacterial enteritis among children under 2 years in developed countries. In neonates and young infants, bloody diarrhea without fever can be the only manifestation of infection; however Campylobacter infection is associated with a spectrum of extraintestinal diseases including bacteremia, meningitis, cardiac complications. Case: A 2-month-old infant was admitted to the hospital for bloody diarrhea, loss of appetite in the absence of vomiting. She feed with formula from birth. At admission, she had a good general condition, temperature was 36 ◦ C with normal physical examination. Biochemical tests showed hypertransaminasemia: alanine aminotransferase (ALT) 644 U/l, aspartate aminotransferase (AST) 910 U/I; gamma glutamyltranspeptidase (GT) 276 U/I, phosphatase Alkaline 399 U/I, normal level of total bilirubin and moderate increase of C-reactive protein. Liver ultrasound was negative. Screening for hepatitis B, hepatitis A and C, Cytomegalovirus and Epstein Barr virus were negative. Two coprocultures were performed and were positive to Campylobacter jejuni. A treatment with clarithromycin was administered. Liver abnormalities were completely normalized within a week. Conclusion: The presence of hepatitis in the course of Campylobacter enteritis is previously described in adult patients. In the pediatric age, cases of hepatitis have been reported in the context of sepsis by C. jejuni. However, the observation of this association in infants with enteritis without sepsis has not been previously reported. We present the case of a 2-month-old infant with hepatitis/hypertransaminasemia associated with Campylobacter enteritis without concomitant septicemia. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.029 P026 Hepatitis C virus resistance associated variant to paritaprevir/ombitasvir/ritonavir in a 16-year-old adolescent D. Serranti 1 , G. Indolfi 1 , E. Bartolini 1 , S. Ricci 2,∗ , M. Resti 1 1
UO di Pediatria Medica, Epatologia Pediatrica, AOU Meyer, Firenze, Italy 2 UO di Pediatria Medica, Immunologia Pediatrica, AOU Meyer, Firenze, Italy Background: The direct active antiviral (DAA) combination of paritaprevir/ombitasvir/ritonavir has been demonstrated to be effective in 100% of children with chronic hepatitis C virus genotype 1 or 4 aged 12–18 years and treated for 12 weeks. There is no paediatric experience in development and management of resistance to DAA therapies. Methods: We describe a 16-year-old patient with chronic hepatitis C, genotype 4, who developed compensated cirrhosis (PLT 95,000/L, albumin 3.6 g/dL, alpha-fetoprotein 150 IU/mL, liver
e253
stiffness by FibroScan: 23 kPa). Due to the clinical condition of the patient, it was decided for the off-label use of the combination paritaprevir/ombitasvir/ritonavir. Results: The child experienced a virological breakthrough at week 4 of treatment. The resistance associated substitutions (RASs) analysis showed the presence of NS5A basal RASs 28V and 93C and NS3 on-treatment RAS 168H. Conclusions: We described the first child treated with the combination of paritaprevir/ombitasvir/ritonavir who developed a virological resistance. RASs may be present at the moment of the infection by hepatitis C virus or develop during therapy. The study of RASs is not generally indicated before starting treatment with DAAs in adults, but can influence the choice of the combination to be used for retreatment. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.030 P027 Liver transplantation in metabolic diseases: A single center experience R. Angelico 1,∗ , D. Liccardo 2 , M.S. Basso 2 , M. Candusso 2 , A. Pietrobattista 2 , F. Sbravati 2 , C. Grimaldi 1 , M.C. Saffioti 1 , A. Maiorana 3 , S.M. Bernabei 3 , C. Dionisi Vici 3 , G. Torre 2 , M. Spada 1 1 Dip. Chirurgia Epatobiliopancreatica e Trapianti Addominali, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy 2 Dip. Epatogastroenterologia, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy 3 Dip. Patologie Metaboliche, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
Introduction: Metabolic liver diseases are now a common indication for liver transplantation (LT) mainly as enzyme replacement therapy. Methods: Retrospective review of all pediatric LT performed for metabolic diseases in a single institution between December 2008 and June 2017. Results: Out of 186, 34(18.3%) children underwent LT for metabolic diseases for tyrosinemia (5 cases), primary oxalosis (7), Wilson’s disease (3), Maple syrup urine disease (MSUD) (5), argininosuccinic aciduria (3), ornithine transcarbamylase deficiency (3), propionic academia (2), methylmalonic academia (2), familial hypercholesterolemia (1), a1-antritripsin (1), LAL deficiency (1), and ethylmalonic academia (1). The mean age was 8.1 (8 m–16 yrs) yrs, mean weight 27 (8.6–49) kg; mean time on waiting list 83 (2–310) days. Living donor LTs were performed in 7 (20.6%) patients; 22 (64.7%) children received a split graft, 12 (35.3%) whole grafts. 7 (20.6%) children received also kidney transplant (5 combined liver-kidney; 2 sequential kidney transplant). One MSUD liver was used for a domino transplant in a pediatric recipient. Except for one (2.9%), all children had a progressive normalization of blood aminoacid levels, receiving normal protein intake in 2 weeks. The mortality rate was 5.8%, due to PNF (1) and cardiovascular event (1). Post-operative complications were: acute rejection (8); post- transplant acute tubular necrosis (1); re-laparotomy for hemorrhage (3), bowel obstruction (1) and biliary leak (1). One child affected by propionic acidemia faced progressive neurological disorder (drug-resistant epilepsy), while all the others showed neurological improvement or stability and a better quality of life. Liver function tests have been stable during the entire follow-up [83.3 (1–102) months].