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Mukadi-Kakoni P, Munyeku-Bazitama Y, Kashitu-Mujinga G, Manwana-Pemba M, Zenga-Bibi N, Okitale-Talunda P, Mbelu-Kabongo C, Domai-Mbuyakala F, Pukuta-Simbu E, Mutantu-Nsele P, Kubo Y, Makiala-Mandanda S, Ahuka-Mundeke S, Ariyoshi K, Muyembe-Tamfum JJ. Revealing viral hepatitis epidemiology in the Democratic Republic of Congo: insights from yellow fever surveillance reanalysis. Trop Med Health 2025; 53:17. [PMID: 39910399 PMCID: PMC11800490 DOI: 10.1186/s41182-025-00687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Accepted: 01/16/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Yellow fever surveillance systems are designed to identify cases of acute febrile jaundice, a clinical syndrome used to monitor the emergence of yellow fever outbreaks. However, this syndrome has diverse etiologies, particularly viral hepatitis. This study investigates the seroepidemiology of viral hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) among cases initially suspected to be yellow fever, aiming to elucidate the epidemiology of viral hepatitis in the Democratic Republic of Congo (DRC) and provide insights for improving public health interventions. METHODS A retrospective cross-sectional study was conducted using serum samples collected between 2017 and 2018 through national yellow fever surveillance in the DRC. Samples from individuals testing negative for yellow fever were tested for IgM antibodies against HAV, HBc, HCV, and HEV and HBs antigen using validated ELISA kits. Acute HBV infection was defined by both HBc IgM and HBs antigen positivity. Multivariable logistic regression was used to assess the association of demographic, geographic, and environmental factors with each hepatitis type. RESULTS Among 1239 participants (58.8% male; median age: 16 years), seroprevalence was 16.1, 11.2, 5.0, and 3.1% for HAV, HBV, HCV and HEV, respectively. HAV prevalence was highest in the youngest age group and rural residents. In contrast, the youngest group was most protected from HBV. HCV prevalence was highest in the oldest age groups. HEV exhibited higher prevalence during the dry season and in a humid subtropical climate. Several provinces were identified as hotspots of HAV, HCV and HEV. CONCLUSIONS Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province.
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Affiliation(s)
- Patrick Mukadi-Kakoni
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Yannick Munyeku-Bazitama
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of the Congo
| | - Gracia Kashitu-Mujinga
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Niclette Zenga-Bibi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Patient Okitale-Talunda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Christelle Mbelu-Kabongo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fleurette Domai-Mbuyakala
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Pierre Mutantu-Nsele
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yoshinao Kubo
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Biologie Médicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Wang Y, Motz BM, Strand MS, Martinie JB, Vrochides D, Baker E, Iannitti DA. Hepatolithiasis caused by right hepatic artery branches forming an arterial ring compressing the common hepatic duct. J Surg Case Rep 2022; 2022:rjac492. [PMID: 36329778 PMCID: PMC9624198 DOI: 10.1093/jscr/rjac492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Anatomic variations of the hepatic artery do not usually cause biliary obstruction. We present a 51-year-old male who developed biliary obstruction and hepatolithiasis due to extrinsic compression of the common hepatic duct (CHD) by an arterial ring formed by the anterior and posterior branches of the right hepatic artery. We performed a surgical bile duct exploration and used intraoperative direct cholangioscopy to guide clearance of hepatolithiasis. Herein, we review the existing literature on CHD compression caused by topographical variants of the hepatic artery and discuss diagnostic and treatment strategies.
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Affiliation(s)
- Yifan Wang
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Benjamin M Motz
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Matthew S Strand
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Erin Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - David A Iannitti
- Correspondence address. Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA. Tel: (704) 355-4062; Fax: (704) 355-4965; E-mail:
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Takeda Y, Onoyama T, Sakamoto Y, Kawahara S, Hamamoto W, Koda H, Yamashita T, Matsumoto K, Isomoto H. A Case of Right Hepatic Artery Syndrome Diagnosed by Using SpyGlassDS TM System. Yonago Acta Med 2020; 63:372-375. [PMID: 33253336 DOI: 10.33160/yam.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
We report the case of a 68-year-old woman who had abdominal pain and slightly elevated biliary enzymes. Magnetic resonance cholangiopancreatography detected biliary duct stenosis, while contrast-enhanced magnetic resonance imaging showed that the right hepatic artery transversed the extrahepatic bile duct at the level of bifurcation of the bile duct. We performed endoscopic retrograde cholangiopancreatography and peroral cholangioscopy with the SpyGlass DS™ system. Then, mild extrinsic pulsatile compression of the bile duct was observed at stricture level with an intact bile duct epithelium. Therefore, she was diagnosed with right hepatic artery syndrome and underwent cholecystectomy. Six months later, her biliary enzyme level decreased, and the recurrence of pain gradually decreased.
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Affiliation(s)
- Yohei Takeda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Takumi Onoyama
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yuri Sakamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Shiho Kawahara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Wataru Hamamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Hiroki Koda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Taro Yamashita
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Kazuya Matsumoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Bove V, Tringali A, Prades LF, Perri V, Barbaro B, Costamagna G. Right hepatic artery syndrome: report of three cases and literature review. Scand J Gastroenterol 2019; 54:913-916. [PMID: 31282775 DOI: 10.1080/00365521.2019.1632926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Anatomical variations of the hepatic artery have been described as responsible for the onset of jaundice or stone formation. We present three cases of intrahepatic stones secondary to a compression of the proximal common bile duct (CBD) by the right hepatic artery (RHA). Three consecutive patients (males, mean age 65 years) with symptoms of cholangitis and intra-hepatic stones admitted between October 2017 and June 2018 with a final diagnosis of CBD compression from the RHA. The three patients underwent ERCP and biliary sphincterotomy with extraction of intra-hepatic stones; after stone removal cholangiograhy showed CBD compression just below the main hepatic confluence which was confirmed to be secondary to RHA compression on subsequent MRI. The patients remained asymptomatic after 12 months mean follow-up. Compression of the CBD by the RHA might be responsible for intra-hepatic stone formation. Endoscopic treatment is feasible and effective on short-term follow-up.
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Affiliation(s)
- Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Laura Flor Prades
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
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Gadia CLB, Manirakiza A, Tekpa G, Konamna X, Vickos U, Nakoune E. Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008-2010. BMC Infect Dis 2017; 17:735. [PMID: 29187150 PMCID: PMC5707826 DOI: 10.1186/s12879-017-2840-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/19/2017] [Indexed: 12/29/2022] Open
Abstract
Background Febrile jaundice results clinically in generalized yellow coloration of the teguments and mucous membranes due to excess plasma bilirubin, accompanied by fever. Two types are found: conjugated and unconjugated bilirubin jaundice. Jaundice is a sign in several diseases due to viruses (viral hepatitis and arbovirus), parasites (malaria) and bacteria (leptospirosis). In the Central African Republic (CAR), only yellow fever is included on the list of diseases for surveillance. The aim of this study was to identify the other pathogens that can cause febrile jaundice, for better management of patients. Methods Between 2008 and 2010, 198 sera negative for yellow fever IgM were randomly selected from 2177 samples collected during yellow fever surveillance. Laboratory analyses targeted four groups of pathogens: hepatitis B, C, delta and E viruses; dengue, chikungunya, Zika, Crimean–Congo haemorrhagic fever, West Nile and Rift Valley arboviruses; malaria parasites; and bacteria (leptospirosis). Results Overall, 30.9% sera were positive for hepatitis B, 20.2% for hepatitis E, 12.3% for hepatitis C and 8.2% for malaria. The majority of positive sera (40.4%) were from people aged 16–30 years. Co-infection with at least two of these pathogens was also found. Conclusion These findings suggest that a systematic investigation should be undertaken of infectious agents that cause febrile jaundice in the CAR.
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Affiliation(s)
| | - Alexandre Manirakiza
- Institut Pasteur of Bangui, Epidemiology Service, PO Box 923, Bangui, Central African Republic.
| | - Gaspard Tekpa
- Hôpital de l'Amitié, Ministry of Public Health, Population and AIDS Control, PO Box 883, Bangui, Central African Republic
| | - Xavier Konamna
- Institut Pasteur of Bangui, Virology Department, PO Box 923, Bangui, Central African Republic
| | - Ulrich Vickos
- Institut Pasteur of Bangui, Virology Department, PO Box 923, Bangui, Central African Republic
| | - Emmanuel Nakoune
- Institut Pasteur of Bangui, Virology Department, PO Box 923, Bangui, Central African Republic
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Abstract
Various benign and malignant conditions could cause biliary obstruction. Compression of extrahepatic bile duct (EBD) by right hepatic artery was reported as a right hepatic artery syndrome but all cases were compressed EBD from stomach side. Our case compressed from dorsum was not yet reported, so it was thought to be a very rare case. We present here the first case of bile duct obstruction due to the compression of EBD from dorsum by right hepatic artery.
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Affiliation(s)
- Kazumi Miyashita
- First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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