Tandon B N, Krishnamurthy L, Koshy A, Tandon H D, Ramalingaswami V, Bhandari J R, Mathur M M, Mathur P D
Gastroenterology. 1977 Mar;72(3):488-94.
An epidemic of jaundice probably due to toxic hepatitis occurred in three adjoining districts of Northwest India during the period November and December, 1974. The dogs of the villages were affected first, then the human beings. Detailed clinical features, appropriate laboratory tests, and liver biopsies were studied. A retrospective epidemiological survey was carried out. The disease had a subacute onset starting with high fever, followed by rapidly progressive jaundice. Ascites appeared simultaneously and soon became quite massive. Hepatomegaly was recorded when ascites decreased. Liver function tests suggested cholestatic jaundice. The mortality rate in the hospital was 10%. Clinical features in dogs were similar, but mortality was almost 100%. Liver histology was characterized by (1) edema and collagenization of the central veins, never with thrombosis, (2) cholangiolar proliferation, (3) moderate to severe ballooning of the hepatocytes, (4) perisinusoidal fibrosis, (5) cholestasis, and finally, (6) cirrhosis with reverse lobulation. Etiology of this epidemic of hepatitis could not be unequivocally established. Critical analysis of the data suggests that some food toxin may have been a factor in the outbreak of this unusual epidemic of toxic hepatitis.
1974年11月至12月期间，印度西北部三个毗邻地区爆发了一场可能由中毒性肝炎引起的黄疸疫情。村庄里的狗首先受到影响，然后是人类。对详细的临床特征、适当的实验室检查和肝脏活检进行了研究，并开展了回顾性流行病学调查。该病呈亚急性起病，先是高热，随后黄疸迅速进展。同时出现腹水，且很快变得相当大量。当腹水减少时记录到肝脏肿大。肝功能检查提示胆汁淤积性黄疸。医院的死亡率为10%。狗的临床特征相似，但死亡率几乎为100%。肝脏组织学特征为：（1）中央静脉水肿和胶原化，无血栓形成；（2）胆小管增生；（3）肝细胞中度至重度气球样变；（4）窦周纤维化；（5）胆汁淤积；最后，（6）伴有反位肝小叶的肝硬化。此次肝炎疫情的病因尚不能明确确定。对数据的批判性分析表明，某种食物毒素可能是此次不寻常的中毒性肝炎疫情爆发的一个因素。
