World Journal of Hepatology最新文献

{"title":"Diagnostic value of tissue plasminogen activator-inhibitor complex in sepsis-induced liver injury: A single-center retrospective case-control study.","authors":"Ye Zhou, Long-Ping He, Ying-Han Qi, Yu Huang, Bing-Qin Hu, Jia-Ling Liu, Qing-Bo Zeng, Jing-Chun Song","doi":"10.4254/wjh.v16.i11.1255","DOIUrl":"10.4254/wjh.v16.i11.1255","url":null,"abstract":"<p><strong>Background: </strong>Sepsis often causes severe liver injury and leads to poor patient outcomes. Early detection of sepsis-induced liver injury (SILI) and early treatment are key to improving outcomes.</p><p><strong>Aim: </strong>To investigate the clinical characteristics of SILI patients and analyze the associated risk factors, to identify potential sensitive biomarkers.</p><p><strong>Methods: </strong>Retrospective analysis of clinical data from 546 patients with sepsis treated in the intensive care unit of the 908^th Hospital of Chinese People's Liberation Army Joint Logistic Support Force between May 2018 and December 2022. The patients were divided into the sepsis group (<i>n</i> = 373) and SILI group (<i>n</i> = 173) based on the presence of acute liver injury within 2 hours of admission. We used the random forest algorithm to analyze risk factors and assessed potential diagnostic markers of SILI using the area under the receiver operating characteristic curve, Kaplan-Meier survival curves, subgroup analysis and correlation analysis.</p><p><strong>Results: </strong>Compared with the sepsis group, tissue plasminogen activator-inhibitor complex (t-PAIC) levels in serum were significantly higher in the SILI group (<i>P</i> < 0.05). Random forest results showed that t-PAIC was an independent risk factor for SILI, with an area under the receiver operating characteristic curve of 0.862 (95% confidence interval: 0.832-0.892). Based on the optimal cut-off value of 11.9 ng/mL, patients at or above this threshold had significantly higher levels of lactate and Acute Physiology and Chronic Health Evaluation II score. The survival rate of these patients was also significantly worse (hazard ratio = 2.2, 95% confidence interval: 1.584-3.119, <i>P</i> < 0.001). Spearman's correlation coefficients were 0.42 between t-PAIC and lactate, and 0.41 between t-PAIC and aspartate transaminase. Subgroup analysis showed significant differences in t-PAIC levels between patients with different severity of liver dysfunction.</p><p><strong>Conclusion: </strong>T-PAIC can serve as a diagnostic indicator for SILI, with its elevation correlated with the severity of SILI.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1255-1264"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune hepatitis: Towards a personalized treatment.","authors":"Alejandro Costaguta, Guillermo Costaguta, Fernando Álvarez","doi":"10.4254/wjh.v16.i11.1225","DOIUrl":"10.4254/wjh.v16.i11.1225","url":null,"abstract":"<p><p>Autoimmune hepatitis is an uncommon condition that affects both adults and children and is characterized by chronic and recurrent inflammatory activity in the liver. This inflammation is accompanied by elevated IgG and autoantibody levels. Historically, treatment consists of steroids with the addition of azathioprine, which results in remission in approximately 80% of patients. Despite significant advancements in our understanding of the immune system over the past two decades, few modifications have been made to treatment algorithms, which have remained largely unchanged since they were first proposed more than 40 years ago. This review summarized the various treatment options currently available as well as our experiences using them. Although steroids are the standard treatment for induction therapy, other medications may be considered. Cyclosporin A, a calcineurin inhibitor that decreases T cell activation, has proven effective for induction of remission, but its long-term side effects limit its appeal for maintenance. Tacrolimus, a drug belonging to the same family, has been used in patients with refractory diseases with fewer side effects. Sirolimus and everolimus have interesting effects on regulatory T cell populations and may become viable options in the future. Mycophenolate mofetil is not effective for induction but is a valid alternative for patients who are intolerant to azathioprine. B cell-depleting drugs, such as rituximab and belimumab, have been successfully used in refractory cases and are useful in both the short and long term. Other promising treatments include anti-tumor necrosis factors, Janus kinases inhibitors, and chimeric antigen receptor T cell therapy. This growing armamentarium allows us to imagine a more tailored approach to the treatment of autoimmune hepatitis in the near future.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1225-1242"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is 26S proteasome non-ATPase regulatory subunit 6 a potential molecular target for intrahepatic cholangiocarcinoma?","authors":"Yong-Zhi Zhuang, Li-Quan Tong, Xue-Ying Sun","doi":"10.4254/wjh.v16.i11.1219","DOIUrl":"10.4254/wjh.v16.i11.1219","url":null,"abstract":"<p><p>In this editorial we comment on the article by Tang <i>et al</i> published in the recent issue of <i>World Journal of Hepatology</i>. Drug therapy of intrahepatic cholangiocarcinoma (iCCA) poses an enormous challenge since only a small proportion of patients demonstrate beneficial responses to therapeutic agents. Thus, there has been a sustained search for novel molecular targets for iCCA. The study by Tang <i>et al</i> evaluated the role of 26S proteasome non-ATPase regulatory subunit 6 (PSMD6), a 19S regulatory subunit of the proteasome, in human iCCA cells and specimens. The authors employed clustered regularly interspaced short palindromic repeat (CRISPR) knockout screening technology integrated with the computational CERES algorithm, and analyzed the human protein atlas (THPA) database and tissue microarrays. The results show that <i>PSMD6</i> is a gene essential for the proliferation of 17 iCCA cell lines, and PSMD6 protein was overexpressed in iCCA tissues without a significant correlation with the clinicopathological parameters. The authors conclude that PSMD6 may play a promoting role in iCCA. The major limitations and defects of this study are the lack of detailed information of CRISPR knockout screening, <i>in vivo</i> experiments, and a discussion of plausible mechanistic cues, which, therefore, dampen the significance of the results. Further studies are required to verify PSMD6 as a molecular target for developing novel therapeutics for iCCA. In addition, the editorial article summarizes the latest advances in molecular targeted drugs and recently emerging immunotherapy in the clinical management of iCCA, development of proteasome inhibitors for cancer therapy, and advantages of CRISPR screening technology, computational methods, and THPA database as experimental tools for fighting cancer. We hope that these comments may provide some clues for those engaged in the field of basic and clinical research into iCCA.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1219-1224"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary stalk interruption syndrome complicated with liver cirrhosis: A case report.","authors":"Min Chang, Shi-Yu Wang, Zi-Yu Zhang, Hong-Xiao Hao, Xin-Gang Li, Jing-Jing Li, Yao Xie, Ming-Hui Li","doi":"10.4254/wjh.v16.i11.1348","DOIUrl":"10.4254/wjh.v16.i11.1348","url":null,"abstract":"<p><strong>Background: </strong>Pituitary stalk interruption syndrome (PSIS) is a rare disorder, often characterized by delayed growth and development, short stature, and hypogonadism as the main clinical manifestations. It is not clear whether PSIS can lead to liver cirrhosis.</p><p><strong>Case summary: </strong>This paper reported a case of liver cirrhosis of unknown origin. The patient was admitted to Beijing Ditan Hospital Affiliated to Capital Medical University in November 2023. The diagnosis of PSIS complicated with liver cirrhosis was established after a series of blood tests and pituitary magnetic resonance imaging examination.</p><p><strong>Conclusion: </strong>We also reviewed the literature from both domestic and international sources to deepen the clinical understanding of PSIS in conjunction with liver cirrhosis among medical practitioners.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1348-1355"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasively differentiate non-alcoholic steatohepatitis by visualizing hepatic integrin αvβ3 expression with a targeted molecular imaging modality.","authors":"Xiao-Quan Huang, Ling Wu, Chun-Yan Xue, Chen-Yi Rao, Qing-Qing Fang, Ying Chen, Cao Xie, Sheng-Xiang Rao, Shi-Yao Chen, Feng Li","doi":"10.4254/wjh.v16.i11.1290","DOIUrl":"10.4254/wjh.v16.i11.1290","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive methods to diagnose non-alcoholic steatohepatitis (NASH), an inflammatory subtype of non-alcoholic fatty liver disease (NAFLD), are currently unavailable.</p><p><strong>Aim: </strong>To develop an integrin αvβ3-targeted molecular imaging modality to differentiate NASH.</p><p><strong>Methods: </strong>Integrin αvβ3 expression was assessed in Human LO2 hepatocytes Scultured with palmitic and oleic acids (FFA). Hepatic integrin αvβ3 expression was analyzed in rabbits fed a high-fat diet (HFD) and in rats fed a high-fat, high-carbohydrate diet (HFCD). After synthesis, cyclic arginine-glycine-aspartic acid peptide (cRGD) was labeled with gadolinium (Gd) and used as a contrast agent in magnetic resonance imaging (MRI) performed on mice fed with HFCD.</p><p><strong>Results: </strong>Integrin αvβ3 was markedly expressed on FFA-cultured hepatocytes, unlike the control hepatocytes. Hepatic integrin αvβ3 expression significantly increased in both HFD-fed rabbits and HFCD-fed rats as simple fatty liver (FL) progressed to steatohepatitis. The distribution of integrin αvβ3 in the liver of NASH cases largely overlapped with albumin-positive staining areas. In comparison to mice with simple FL, the relative liver MRI-T1 signal value at 60 minutes post-injection of Gd-labeled cRGD was significantly increased in mice with steatohepatitis (<i>P</i> < 0.05), showing a positive correlation with the NAFLD activity score (<i>r</i> = 0.945; <i>P</i> < 0.01). Hepatic integrin αvβ3 expression was significantly upregulated during NASH development, with hepatocytes being the primary cells expressing integrin αvβ3.</p><p><strong>Conclusion: </strong>After using Gd-labeled cRGD as a tracer, NASH was successfully distinguished by visualizing hepatic integrin αvβ3 expression with MRI.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1290-1305"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low level of hepatitis B viremia is associated with increased risk of hepatocellular carcinoma in compensated cirrhotic patients.","authors":"Wei-Chun Lin, Ke Lin, Ming-Kai Li, Xiao Liu, Yi-Fei Huang, Xing Wang, Bin Wu","doi":"10.4254/wjh.v16.i11.1321","DOIUrl":"10.4254/wjh.v16.i11.1321","url":null,"abstract":"<p><strong>Background: </strong>Whether patients with compensated cirrhosis and low-level viremia (LLV) of hepatitis B should receive antiviral therapy (AVT) is still controversial, and published results are inconsistent.</p><p><strong>Aim: </strong>To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma (HCC), decompensation, and liver-related events.</p><p><strong>Methods: </strong>The PubMed, EMBASE, and Cochrane Library databases were searched up to March 5, 2023. Outcomes of interest were assessed by pooled hazard ratios (HRs). The study was registered with PROSPERO (CRD42023405345).</p><p><strong>Results: </strong>Six cohort studies representing 3155 patients were included. Compared with patients with undetectable HBV DNA, patients with LLV was associated with increased risk of HCC (HR: 2.06, 95%CI: 1.36-3.13; <i>Q</i>-statistic-<i>P</i> = 0.07, <i>I</i> ² = 51%) regardless of receiving AVT or not (AVT group: HR: 3.14; 95%CI: 1.73-5.69; <i>Q</i>-statistic-<i>P</i> = 0.60, <i>I</i> ² = 0%; un-AVT group: HR: 1.73, 95%CI: 1.09-2.76; <i>Q</i>-statistic-<i>P</i> = 0.11, <i>I</i> ² = 50%). The pooled results showed no statistical association between LLV and decompensation of cirrhosis (HR: 2.06, 95%CI: 0.89-4.76; <i>Q</i>-statistic-<i>P</i> = 0.04, <i>I</i> ² = 69%), and liver-related events (HR: 1.84, 95%CI: 0.92-3.67; <i>Q</i>-statistic-<i>P</i> = 0.03, <i>I</i> ² = 72%), respectively. Grading of Recommendations Assessment, Development and Evaluation assessment indicated moderate certainty for HCC, very low certainty for decompensation of cirrhosis and liver-related clinical events.</p><p><strong>Conclusion: </strong>LLV in compensated cirrhotic patients is associated with increased risk of HCC, higher tendency for hepatic decompensation and liver-related events. Closer screening of HCC should be conducted in this population.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1321-1330"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overexpression of proteasome 26S subunit non-ATPase 6 protein and its clinicopathological significance in intrahepatic cholangiocarcinoma.","authors":"Zhong-Qing Tang, Yu-Lu Tang, Kai Qin, Qi Li, Gang Chen, Yu-Bin Huang, Jian-Jun Li","doi":"10.4254/wjh.v16.i11.1282","DOIUrl":"10.4254/wjh.v16.i11.1282","url":null,"abstract":"<p><strong>Background: </strong>Currently, intrahepatic cholangiocarcinoma (ICC) poses a continuing, significant health challenge, but the relationship has yet to be established between ICC and the proteasome 26S subunit non-ATPase 6 (PSMD6).</p><p><strong>Aim: </strong>To investigate the protein expression and clinicopathological significance of PSMD6 in ICC.</p><p><strong>Methods: </strong>The potential impact of the <i>PSMD6</i> gene on the growth of ICC cell lines was analyzed using clustered regularly interspaced short palindromic repeat knockout screening technology. Forty-two paired specimens of ICC and adjacent non-cancerous tissues were collected. PSMD6 protein expression was determined by immunohistochemistry. Receiver operating characteristic curve analysis was performed to validate PSMD6 expression level, and its association with ICC patients' various clinicopathological characteristics was investigated.</p><p><strong>Results: </strong>The <i>PSMD6</i> gene was found to be essential for the growth of ICC cell lines. PSMD6 protein was significantly overexpressed in ICC tissues (<i>P</i> < 0.001), but showed no significant association with patient age, gender, pathological grade, or tumor-node-metastasis stage (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>PSMD6 can promote the growth of ICC cells, thus playing a pro-oncogenic role.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1282-1289"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method.","authors":"Juan G Acevedo-Haro, Waddah Mohamed, Prebashan Moodley, Oliver Bendall, Kris Bennett, Nigel Keelty, Sally Chan, Sam Waddy, Joanne Hosking, Wayne Thomas, Robert Tilley","doi":"10.4254/wjh.v16.i11.1265","DOIUrl":"10.4254/wjh.v16.i11.1265","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous bacterial peritonitis (SBP) is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality. Making an accurate early diagnosis of this infection is key in the outcome of these patients. The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid (AF). There is a lack of data comparing the traditional cell count method with a current automated cell counter. Moreover, current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.</p><p><strong>Aim: </strong>To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria: Positive AF culture and signs/symptoms of peritonitis.</p><p><strong>Methods: </strong>Retrospective analysis including two cohorts: Cross-sectional (cohort 1) and case-control (cohort 2), of patients with decompensated cirrhosis and ascites. Both cell count methods were conducted simultaneously. Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.</p><p><strong>Results: </strong>A total of 137 cases with 5 positive-SBP, and 85 cases with 33 positive-SBP were included in cohort 1 and 2, respectively. Positive-SBP cases had worse liver function in both cohorts. The automated method showed higher sensitivity than the manual cell count: 80% <i>vs</i> 52%, <i>P</i> = 0.02, in cohort 2. Both methods showed very good specificity (> 95%). The best cutoff using the automated cell counter was polymorph ≥ 0.2 cells × 10⁹/L (equivalent to 200 cells/mm³) in AF as it has the higher sensitivity keeping a good specificity.</p><p><strong>Conclusion: </strong>The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity. SBP definition, using the automated method, as polymorph cell count ≥ 0.2 cells × 10⁹/L in AF would need to be considered in patients admitted with decompensated cirrhosis.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1265-1281"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elimination of hepatitis B as a public health threat: Addressing the challenge and taking action.","authors":"Lei Ma, Hui-Chun Xing","doi":"10.4254/wjh.v16.i11.1361","DOIUrl":"10.4254/wjh.v16.i11.1361","url":null,"abstract":"<p><p>Despite the significant efforts made in recent years, the latest data from the World Health Organization indicates that there are substantial challenges in achieving the elimination of hepatitis B virus (HBV) infection by 2030. The article in the <i>World Journal of Hepatology</i> by Ismael <i>et al</i> highlighted the limited accessibility to screening and antiviral treatment for HBV infection in eastern Ethiopia. Therefore, the editorial comments on this article will focus on the current challenges and recent efforts in the prevention and treatment of chronic hepatitis B, particularly emphasizing the expansion of screening and antiviral therapy, as well as feasible strategies to improve accessibility for HBV testing, antiviral therapy, and adherence enhancement.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1361-1364"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver failure after <i>Bacillus cereus</i> food poisoning, an under-recognized entity: A case report.","authors":"Olivier Chatelanat, Mikaël de Lorenzi-Tognon, Laurent Spahr, Abdessalam Cherkaoui, Roger Stephan, Marie Ongaro, Laurent Kaiser, Nicolas Goossens","doi":"10.4254/wjh.v16.i11.1339","DOIUrl":"10.4254/wjh.v16.i11.1339","url":null,"abstract":"<p><strong>Background: </strong><i>Bacillus cereus</i> (<i>B. cereus</i>) is known to cause 2 types of foodborne diseases; the diarrheal and emetic syndromes. They are largely underreported due to their usually self-limiting course. Rare and sometimes fatal cases of liver failure, pulmonary hemorrhage and cerebral oedema have been reported mainly in children and young adults. We present here a case of liver failure associated with <i>B. cereus</i> food poisoning in a middle-aged patient.</p><p><strong>Case summary: </strong>A 48-year-old female patient presented to the emergency department for emesis, diarrhea, chills without fever, asthenia and diffuse abdominal cramps that started less than 30 minutes after eating a rice salad. Her past medical history was relevant for cholecystectomy and a cured Hashimoto's disease. She did not take any medication, drugs and declared a consumption of one glass of wine per week. In the emergency department, she was treated with acetaminophen, metoclopramide, ondansetron, and an intravenous normal saline infusion. Blood gas analysis revealed a metabolic acidosis with hyperlactatemia, coagulation revealed a low prothrombin activity [32 %; normal values (N): 70-140] and a low Factor V activity (15%; N: > 70). Transaminases were elevated with hyperbilirubinemia, elevated lipase and rhabdomyolysis. N-acetylcysteine treatment was introduced. Abdominal echography revealed no signs of chronic hepatopathy or hepatomegaly. Day after the admission, psychomotor activity improved, transaminases and lipase started decreasing. Rhabdomyolysis gradually worsened to peak on day 3. Screening tests for liver disease were negative for viral and autoimmune cause of liver failure. Stools cultures were positive for colonies of the <i>B. cereus</i> group which were also identified in the rice salad samples processed whereas blood cultures were negative. The patient's condition improved gradually including her liver function parameters and psychomotor activity which allowed her discharged home on day 9.</p><p><strong>Conclusion: </strong>We describe a rare case of hepatocellular dysfunction due to a foodborne <i>B. cereus</i> intoxication in an adult patient. Even if it is uncommon, the severity of liver dysfunction reported and mechanism of the cereulide toxin toxicity on liver suggest that acetaminophen should be avoided in case of a foodborne intoxication and n-acetylcysteine could be a potential therapy helping to prevent hepatocytes necrosis due to the oxidative stress induced by mitochondrial dysfunction.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"16 11","pages":"1339-1347"},"PeriodicalIF":2.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}