The etiology of fulminant viral hepatitis was determined in 65 consecutive cases among 1,814 (3.58%) adults with acute viral hepatitis who were admitted to the Infectious Diseases Hospital of Athens from May, 1981 to August, 1983. Radioimmunoassays were used to detect hepatitis B virus, hepatitis A virus and 6-agent markers. Enzyme immunoassay was used to detect anti-HBc IgM. Hepatitis B virus was responsible for 48 (73.9%), non-A, non-B for 16 (24.6%) and hepatitis A virus for one case (1.5%). The use of anti-HBc IgM identified 10 cases of fulminant type B hepatitis among HBsAg negative, anti-HBc and anti-HBs positive patients. Fulminant non-A, non-B hepatitis was superimposed on 10 asymptomatic HBsAg carriers; 6-agent co-infection was diagnosed in two fulminant type B hepatitis cases. These data show that hepatitis B virus is the major cause of fulminant hepatitis in Greece. HBsAg carriers are at high risk for fulminant non-A, non-B hepatitis. &agent does not seem to be as important as in Italy and other countries.
The accurate and rapid diagnosis of the type of viral hepatitis is important for management of the patient and his environment. However, currently available tests fail to establish the etiology of fulminant viral hepatitis in many cases, because of unusual immune responses and the need for accurate diagnosis in a single specimen from the acute phase of the disease (1,2). We have shown that a commercially available anti-p-capture immunoassay for detection of anti-HBc IgM may identify and distinguish between acute and chronic (HBsAg positive) as well as between recent and old (HBsAg negative) hepatitis B virus (HBV) infection (3). The test was helpful in distinguishing non-B hepatitis infection superimposed in HBsAg carriers and simultaneous or single HBV infections. These complex diagnostic situations are more common in Greece, where the prevalence of HBsAg carriers and serologic evidence of past HBV infections are high (4). We tried to establish an accurate etiologic diagnosis in 65 patients with fulminant hepatitis among 1,814 consecutively hospitalized acute viral hepatitis cases.