Ormarsdottir Sif, Moller Pall Helgi, Oskarsdottir Alma Rut, Hannesson Petur, Love Arthur, Briem Haraldur
Landspitali, University Hospital of Iceland.
Landspitali, University Hospital of Iceland, University of Iceland, Faculty of Medicine.
Laeknabladid. 2018;104(6):283-287. doi: 10.17992/lbl.2018.06.188.
IAim The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves-tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe. Methods All cases of HAV in Iceland during 2017 were reviewed retrospectively. Results Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy. Conclusion The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi-nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis.
目标 冰岛甲型肝炎（HAV）的发病率较低，在过去几十年中每年约有一例。自2016年以来，男男性行为者（MSM）中持续爆发甲型肝炎。本研究的目的是调查2017年在冰岛诊断出的病例是否与欧洲的甲型肝炎疫情有任何关联。方法 回顾性分析2017年冰岛所有甲型肝炎病例。结果 2017年诊断的五例病例中，四例为男男性行为者，一例为女性。2017年夏季同一周出现了三例病例。患者年龄在25至39岁之间。所有男性患者在入院前都与来自欧洲的男性发生过性行为和/或前往过欧洲。所有病例均有甲型肝炎感染的典型体征和症状，所有病例近期感染均通过血清学阳性及排除其他急性肝炎病因得以证实。五名患者中有四名有胆囊壁增厚和水肿的放射学改变迹象，一名患者后来接受了择期胆囊切除术。结论 欧洲男男性行为者中的甲型肝炎疫情在2017年夏季蔓延至冰岛，这凸显了按照冰岛卫生当局的建议对这一风险群体进行疫苗接种的重要性。对这些病例的回顾表明，甲型肝炎患者出现胆囊壁增厚而无胆结石等改变很常见。将这些与甲型肝炎相关的改变的患者与急性非结石性胆囊炎患者区分开来很重要。
