Abstract
Every year, there are an estimated 20 million hepatitis E virus (HEV) infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. HEV is largely circulating in the west and is associated with several hepatic and extrahepatic diseases. HEV Genotype 1 and 2 infections are waterborne and causative for epidemics in the tropics, while genotype 3 and 4 infections are zoonotic diseases and are mainly transmitted by ingestion of undercooked pork in industrialized nations. The clinical course of these infections differs: genotype 1 and 2 infection can cause acute illness and can lead to acute liver failure (ALF) or acute on chronic liver failure (ACLF) with a high mortality rate of 20% in pregnant women. In contrast, the majority of HEV GT-3 and -4 infections have a clinically asymptomatic course and only rarely lead to acute on chronic liver failure in elderly or patients with underlying liver disease. Immunosuppressed individuals infected with genotype 3 or 4 may develop chronic hepatitis E, which then can lead to life-threatening cirrhosis. Furthermore, several extra-hepatic manifestations affecting various organs have been associated with ongoing or previous HEV infections but the causal link for many of them still needs to be proven. There is no approved specific therapy for the treatment of acute or chronic HEV GT-3 or -4 infections but off-label use of ribavirin has been demonstrated to be safe and effective in the majority of patients. However, in approximately 15% of chronically HEV infected patients, cure is not possible.
Highlights
Hepatitis E is infectious disease caused by the hepatitis E virus (HEV), a positive strand RNA virus with worldwide prevalence
Cases of HEV induced acute-on-chronic liver failure (ACLF) in patients with underlying liver diseases seem to be similar to the hepatitis A virus (HAV) induced cases of ACLF
This study indicates that HEV infection in these really special, weakened, hematological patients might present an additional hit and might lead to death of patients in combination with the crucial underlying diseases
Summary
Hepatitis E is infectious disease caused by the hepatitis E virus (HEV), a positive strand RNA virus with worldwide prevalence. Rat HEV has been detected for the first time in Great Britain [23] This distinct HEV species seems to be able to infect humans and even cause chronic hepatitis E in immunosuppressed patients as recently reported from Hong Kong [24]. Very recently the first case of rat hepatitis associated acute hepatitis in an immunocompetent patient in Canada was reported [25]. The great majority of infections with HEV leads to a clinically silent disease course. Many individuals seroconvert without any symptoms or laboratory signs of hepatitis, such as increased alanine aminotransferase (ALT) or aspartate aminotransferase (AST) values In contrast to these asymptomatic HEV infections, a minority of patients develops an increase of transaminases caused by viral hepatitis. In 2018 the European Association for the Study of the Liver (EASL) released their clinical practice guidelines on hepatitis E [41]
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