Acute Hepatitis E Virus Infection Research Articles

Detection and assessment of infectivity of hepatitis E virus in urine

Hepatitis E virus (HEV) is known to be excreted in the stool but there has been no report of its presence in urine. This study investigated the presence of HEV RNA and antigen (HEV-Ag) in urine and its possible transmission. Serum and urine samples from patients with chronic or acute HEV infection and HEV infected monkeys were tested for viral and biochemical markers. Liver and kidney biopsies from the infected monkeys were analyzed by histopathology and immunohistochemistry. The infectivity of HEV from urine was assessed by inoculation into monkeys. HEV RNA and HEV-Ag were detected persistently in the urine of a patient with chronic HEV infection. Subsequently, HEV RNA was detected in the urine of three of the eight (37.5%) acute patients, all of whom had detectable HEV-Ag in their urine. HEV RNA and HEV-Ag were also detectable in the urine of HEV infected monkeys. The ratio of HEV-Ag to RNA in the urine of the infected monkeys was significantly higher than in their sera and feces. The parameters of routine urinalysis remained within the normal ranges in the hepatitis E patients and infected monkeys, however, pathological changes and HEV-Ag were observed in the kidneys of the infected monkeys. Furthermore, one of two monkeys became infected with HEV after inoculation with urine from another infected monkey. HEV infection may result in kidney injury and the urine may pose a risk of transmission. HEV-Ag detection in urine may be valuable for diagnosis of ongoing HEV infection.

Comparative evaluation of three hepatitis E assays

Hepatitis E virus is an emerging concern in immunocompromised patients, who may become chronically infected. This prompted us to assess the performance of two anti-HEV IgG and IgM assays for diagnosing acute HEV infections. The specificities of the assays were estimated by testing samples from 2 to 3 year-old French children and blood donors and their sensitivities by testing 40 immunocompromised patients acutely infected. Both anti-HEV IgM assays were highly specific (99.6% and 100%). The sensitivity of the Adaltis was 87.5%, and that of Wantai was 85%. The specificities of anti-HEV IgG Wantai (97.8%) and Adaltis tests (89.5%, p = 0.1) were similar but the Wantai test was more sensitive (45%) than the Adaltis test (15%, p < 0.001). None of the samples was anti-HEV IgM negative and IgG positive. We conclude that these anti-HEV IgM assays performed well in immunosuppressed subjects with acute hepatitis E and can be used as first line virological tools. Testing for anti-HEV IgG and IgM simultaneously at the acute phase did not improve the diagnostic performance. In contrast, molecular detection of HEV RNA appears essential to exclude an HEV infection in patients who are negative for anti-HEV IgM and to assess the evolution of hepatitis E 3 months thereafter.

Low frequency of acute hepatitis E virus (HEV) infections but high past HEV exposure in subjects from Cambodia with mild liver enzyme elevations, unexplained fever or immunodeficiency due to HIV-1 infection

BackgroundIn Cambodia, previous studies conducted on hepatitis E virus (HEV) infection are scant, sometimes old, and showed inconsistent results. Moreover, there is no data about HEV infection in Cambodian HIV-1-infected patients. ObjectivesTo assess the occurrence of acute HEV infections and the level of past HEV exposure in one Mekong country. Study designUsing anti-HEV IgM and HEV RNA detection, we retrospectively investigated the presence of acute HEV infection in 825 individuals, including 350 subjects with or without fever, 300 subjects with or without liver enzyme elevations (LEE) and 175 antiretroviral treatment (ART)-naïve, severely immunocompromised HIV-1-infected patients. The detection of anti-HEV IgG was also performed to assess ancient HEV exposure. ResultsNine individuals tested positive for anti-HEV IgM yielding an overall rate of 1.1% (95% confidence interval (CI), 0.5–2.0). We did not find significant differences for anti-HEV IgM rates between subjects with unexplained fevers (1.5%) and those with malaria or dengue-associated fever (1.7%) or non-febrile individuals (0%) (P=0.49), and between subjects with (1.5%) and without (2.0%) LEE (P=0.87). No HIV-infected patient tested positive for anti-HEV IgM. HEV RNA was not detected in all tested plasma specimens (n=578). Overall, the anti-HEV IgG prevalence rate was 30.1% (95% CI, 27.0–33.2). ConclusionsThe scarcity of recent HEV infection contrasted with the high level of past HEV exposure. The role of HEV in liver disease is likely minor in Cambodia since no HEV RNA was detected in our studied populations, including HIV-positive patients with severe immunodepression.

PTU-114 Prevalence rates of acute hepatitis a (HAV) and hepatitis e (HEV) in surrey, south east england: how many hev cases are being missed?

<h3>Introduction</h3> Rates of infection from Hepatitis E virus (HEV) have risen dramatically since 2010, whilst cases of acute Hepatitis A (HAV) have dropped over the same period, with 691 diagnosed HEV cases in 2013 in England and Wales, compared to 283 cases of HAV. However, despite the rising prevalence of HEV it is widely presumed that HAV testing remains the predominant diagnostic investigations for acute (enteric) hepatitis. <h3>Method</h3> We collected data on HAV (IgM) testing in all patients from January 2012 to 2015 across the Surrey Pathology Partnership, serving a population of 1.1 million. We contrasted HEV (IgM, IgG) testing in this patient group over the same time period in hospital and community settings. <h3>Results</h3> Acute HAV (IgM) testing was ordered in 881 patients; 246 in a community setting and 635 in hospital/GUM practice. The testing indication was poorly documented in most cases, with “raised LFTs”, “Jaundice” and “Hepatitis” as the predominant indicators. HEV testing was requested in 380 patients overall; 31 (12%) in community practice and 349 (92%) in hospital/GUM settings. The majority (79%) of HEV requests were made over the past year (Jan 2014–2015). Acute HAV infection was identified in 30/881 patients, and acute HEV infection in 42 patients with a prevalence of 3.4% and 11% respectively. Evidence of HEV exposure was identified in a further 26 patients (7%), with an overall prevalence rate of 18% for past or present HEV infection. The median age of patients with acute HEV was 56 years, with the majority being male (57%). <h3>Conclusion</h3> Despite the higher number of requests for laboratory testing of HAV over HEV, this study highlights the observation that HEV is in fact more prevalent. Poor uptake of HEV testing, particularly in the community, could be improved by enhanced educational support. 501 patients were not tested for HEV in this study. The additional cost of testing this group would be £5821 (£11.62/test) and this could be justified if one considers the threefold increase in prevalence of HEV compared to HAV infection. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Public Health England, Hepatitis E, symptoms, transmission, treatment and prevention, June 2014 [https://www.gov.uk/government/publications/hepatitis-e-symptoms-transmission-prevention-treatment/hepatitis-e-symptoms-transmission-treatment-and-prevention]

Hepatitis E Virus Infection as a Possible Cause of Acute Liver Failure in Europe

In Western countries, infection with the hepatitis E virus (HEV) is considered to be rare and imported from endemic regions. However, the prevalence of HEV infection has increased among adults in central Europe. HEV infection can cause acute liver failure (ALF), but there have been only a few confirmed cases of HEV-associated ALF in Europe. We investigated the number of cases of indeterminate ALF associated with HEV infection. We performed a retrospective analysis of 80 patients diagnosed with ALF or acute hepatitis at the University Hospital Essen in Germany from November 2006 through December 2013. Clinical data were collected from the hospital databases; archived sera were tested for IgG and IgM against HEV, as well as HEV RNA. Sera from 12 patients (15%) tested positive for IgG against HEV IgG; 7 of these samples did not test positive for HEV IgM or HEV RNA. Sera from 64 patients (80%) did not test positive for IgG or IgM against HEV or HEV RNA. Sera from 8 patients (10%) tested positive for HEV RNA (only 4 of these were positive for HEV IgG) and had clinical findings to support acute HEV infection. In a hospital in Germany, approximately 10% to 15% of patients with ALF had evidence for HEV infection. Serologic tests for IgG against HEV are insufficient to identify or exclude HEV infection; tests for HEV RNA also should be performed on patients with ALF of ambiguous etiology.

Outcome of hepatitis E virus infection in patients with inflammatory arthritides treated with immunosuppressants: a French retrospective multicenter study.

The clinical presentation and outcome of hepatitis E virus (HEV) infection in inflammatory rheumatic diseases are unknown. We aimed to investigate the severity of acute HEV infection and the risk of chronic viral replication in patients with inflammatory arthritides treated with immunosuppressive drugs.All rheumatology and internal medicine practitioners belonging to the Club Rhumatismes et Inflammation in France were sent newsletters asking for reports of HEV infection and inflammatory arthritides. Baseline characteristics of patients and the course of HEV infection were retrospectively assessed by use of a standardized questionnaire.From January 2010 to August 2013, we obtained reports of 23 cases of HEV infection in patients with rheumatoid arthritis (n = 11), axial spondyloarthritis (n = 5), psoriatic arthritis (n = 4), other types of arthritides (n = 3). Patients received methotrexate (n = 16), antitumor necrosis factor α agents (n = 10), rituximab (n = 4), abatacept (n = 2), tocilizumab (n = 2), and corticosteroids (n = 10, median dose 6 mg/d, range 2–20). All had acute hepatitis: median aspartate and alanine aminotransferase levels were 679 and 1300 U/L, respectively. Eleven patients were asymptomatic, 4 had jaundice. The HEV infection diagnosis relied on positive PCR results for HEV RNA (n = 14 patients) or anti-HEV IgM positivity (n = 9). Median follow-up was 29 months (range 3–55). Treatment included discontinuation of immunosuppressants for 20 patients and ribavirin treatment for 5. Liver enzyme levels normalized and immunosuppressant therapy could be reinitiated in all patients. No chronic infection was observed.Acute HEV infection should be considered in patients with inflammatory rheumatism and elevated liver enzyme values. The outcome of HEV infection seems favorable, with no evolution to chronic hepatitis or fulminant liver failure.

Hepatitis e virus detection in liver tissue from patients with suspected drug-induced liver injury.

Hepatitis E virus (HEV) infection is increasingly recognized as a cause of acute hepatitis in the industrialized world. We aimed to determine the frequency of acute HEV infection in cases of suspected drug-induced liver injury (DILI), mainly a diagnosis of exclusion. To this aim, formalin-fixed paraffin-embedded (FFPE) liver tissues of all cases routinely processed in our institute during a 2 1/2 years period in which DILI was among the differential diagnoses (157 liver biopsies, 1 liver explant) were subjected to semi-nested RT-PCR for the detection of HEV RNA. Histopathology was re-evaluated on all cases tested positive. HEV RNA was detectable in 3 of 158 cases (2%) tested, comprising autochthonic as well as travel-related infections with genotypes 1, 3, and 4 each found once, respectively. Histopathologic findings comprised one case with subtotal hepatic necrosis and two cases of acute (cholestatic) hepatitis not distinguishable from acute hepatitis of other etiology. Thus, the overall frequency of acute HEV infection as determined by detection of HEV RNA in liver tissue is substantially increased in patients with suspected DILI compared to the healthy population, emphasizing the need to actively look for HEV infection in cases of suspected DILI. Molecular testing for HEV RNA in routinely processed FFPE liver tissues can be applied to cases with undetermined HEV status.

Seroprevalence and Incidence of hepatitis E in blood donors in Upper Austria.

BackgroundIn recent years various studies showed, that hepatitis E virus (HEV) is a growing public health problem in many developed countries. Therefore, HEV infections might bear a transmission risk by blood transfusions. The clinical relevance still requires further investigations. The aim of this study was to provide an overview of acute HEV infections in Upper Austrian blood donors as well as a risk estimation of this transfusion-related infection.Methods and FindingsA total of 58,915 blood donors were tested for HEV RNA using a commercial HEV RT-PCR Kit. 7 of these donors (0.01%) were PCR-positive with normal laboratory parameters in absence of clinical signs of hepatitis. Viral load determined by quantitative real-time PCR showed a HEV nucleic acid concentration of 2,217 293,635 IU/ml. At follow-up testing (2–11 weeks after donation) all blood donors had negative HEV RNA results. Additionally, genotyping was performed by amplification and sequencing of the ORF1 or ORF2 region of the HEV genome. All HEV RNA positive donor samples revealed a genotype 3 isolate. For the antibody screening, anti-HEV IgM and IgG were detected by ELISA. Follow up serological testing revealed that no donor was seropositive for HEV IgM or IgG antibodies at time of donation. Moreover, we verified the prevalence of anti-HEV IgG in 1,203 of the HEV RNA negative tested blood donors. Overall 13.55% showed positive results for anti-HEV IgG.ConclusionsIn the presented study, we investigated HEV infections in blood donations of Upper Austria over 1 year. We concluded that 1 out of 8,416 blood donations is HEV RNA positive. Seroprevalence of anti HEV IgG results in an age-related increase of 13.55%. Therefore, based on this data, we recommend HEV-PCR screening to prevent transmission of hepatitis E virus by transfusion.

Pattern of Serum ALT and AST Associated with Hepatitis E Virus (HEV) Infection among Various Populations in Plateau State, Nigeria

Aim: This study was undertaken to determine the effect of HEV on liver function enzymes. HEV is endemic in most developing countries, where the prevalence of HEV IgG antibody can be as high as 50%. Acute HEV infection is known to be a cause of decompensated liver cirrhosis. Several studies have suggested that elevated serum ALT and AST may be markers of hepatitis E virus (HEV) infection. Original Research Article Junaid and Agina; BJMMR, 5(10): 1309-1316, 2015; Article no.BJMMR.2015.149 1310 Study Design: Cross sectional epidemiological survey. Place and Duration: The study was carried out in three geographical zones of Plateau State, over a six month period from July to December, 2012. Methodology: A total of 426 human subjects were recruited for the study; categorized into 4 groups: apparently healthy (190), pregnant women (108), HIV positive patients (80), and animal handlers (48). Blood samples were collected and analyzed for HEV antibodies (IgG and IgM) using ELISA technique. HEV seropositive samples were then subjected to measurement of liver enzymes (ALT and AST), using Randox kits (Randox USA). Results obtained were analyzed using SPSS version 17.0 statistical software. Results: Elevated ALT and AST levels of up to 1.5 folds to 3 folds above normal in seropositive subjects were found. HIV positive subjects and animal handlers recorded the highest elevated ALT level up to twice (2 folds) the upper limit of normal, (21.0±0.0 I.U/L and 19.0±0.0 I.U/L respectively), while apparently healthy subjects had the least elevated ALT level 1.5 folds the upper limit of normal (14.0±0.0 I.U/L). With regards to AST, pregnant women had the highest level of up to 3 folds of the upper limit of normal with mean of 47.7±45.5 I.U/L, followed by apparently healthy subjects with a mean of 36.2±14.2 I.U/L, but least among animal handlers that recorded a mean of 35.0±0.0 I.U/L. Conclusion: Hepatitis E Virus infection is associated with elevated ALT & AST values. However, this association needs further evaluation by researchers.

Hepatitis E-Associated Lower Extremity Weakness: Case Report and Review of Literature

Hepatitis E virus (HEV) infection is a well-known cause of acute hepatitis in developing countries. However, autochthonous (locally acquired) HEV infection is also emerging in industrialized countries. Neurologic signs and symptoms are an emerging extrahepatic manifestation of HEV infection. An association between neurologic manifestations (e.g., Guillain-Barre syndrome, neuralgic amyotrophy, and acute transverse myelitis) and acute HEV infection has been suggested. We present a case of a 26-year-old Hispanic female who presented with lower extremity weakness and elevated liver enzymes who was found to be positive for hepatitis E IgM antibodies. We recommend that clinicians strongly consider the possibility of HEV infection in patients with neurologic disorders, especially those with peripheral nerve involvement and liver abnormalities indicated by blood tests. Patients with unexplained hepatitis should be tested for hepatitis E, whatever their age or travel history. J Med Cases. 2015;6(1):6-7 doi: http://dx.doi.org/10.14740/jmc1843w

Hepatitis E-Associated Lower Extremity Weakness: Case Report and Review of Literature

Hepatitis E virus (HEV) infection is a well-known cause of acute hepatitis in developing countries. However, autochthonous (locally acquired) HEV infection is also emerging in industrialized countries. Neurologic signs and symptoms are an emerging extrahepatic manifestation of HEV infection. An association between neurologic manifestations (e.g., Guillain-Barre syndrome, neuralgic amyotrophy, and acute transverse myelitis) and acute HEV infection has been suggested. We present a case of a 26-year-old Hispanic female who presented with lower extremity weakness and elevated liver enzymes who was found to be positive for hepatitis E IgM antibodies. We recommend that clinicians strongly consider the possibility of HEV infection in patients with neurologic disorders, especially those with peripheral nerve involvement and liver abnormalities indicated by blood tests. Patients with unexplained hepatitis should be tested for hepatitis E, whatever their age or travel history. J Med Cases. 2015;6(1):6-7 doi: http://dx.doi.org/10.14740/jmc1843w

Hepatitis e infection and acute liver failure

Background Hepatitis E (HEV) is uncommon in Australia. Infection is usually mild, does not require treatment, and frequently goes unrecognised. Rarely acute liver failure and death may ensue. Case report A 73-year-old female was admitted with acute LFT derangement and jaundice. She deteriorated following admission, developed respiratory failure, and was transferred to a specialist unit for ongoing care and consideration of liver transplant. She had travelled overseas four months prior to presenting and had a medical history significant for fluctuating monocytosis. She consumed multiple complementary medications and a drug-induced aetiology was suspected. Initial investigations for infectious causes including hepatitis A, B, and C were negative as was autoimmune screening. A liver biopsy demonstrated a viral type hepatitis. Further investigation confirmed HEV infection. Discussion There are 20 million cases of HEV infection globally each year. HEV is usually transmitted through consumption of contaminated water. It is however an uncommon infection in Australia where zoonotic infection plays a major role. An Australian study found antiHEV antibodies in 0.4% of subjects. In another study 8/42 patients with hepatic failure had evidence of acute HEV infection. HEV is an under-recognised infection that should be considered when standard infectious screening remains negative.

HEV infection in two referral centers in Spain; epidemiology and clinical outcomes

Background and objectivesHepatitis E virus (HEV) is one of the major causes of icteric hepatitis worldwide. In industrialized countries it is considered an emerging disease, as a growing number of autochthonous cases have been reported in recent years. Occasional extrahepatic manifestations have been described in the setting of HEV infection. Study designTo characterize the epidemiological pattern and clinical outcomes of new cases of HEV infection diagnosed in two referral centers during the period 2011–2013. ResultsDuring the study period, four cases of self-limited acute hepatitis E after travel to endemic areas were recorded, as well as five cases of HEV infection after solid organ transplantation. Four patients failed to spontaneously clear the virus and received ribavirin monotherapy; all of them had HEV genotype-3. Ribavirin was effective in inhibiting HEV replication, although in one patient a virological relapse occurred after the end of therapy. Finally, we report a case of HEV-genotype-3 related agranulocytosis in an immunocompetent patient, resulting in a fatal outcome; this is the first case reported of its kind. ConclusionDiagnosis of HEV infection needs to be taken into consideration in patients with acute or chronic hepatitis in whom other etiologies have been excluded. Although hematological complications related to acute HEV infection are infrequent, these may affect any of the bone marrow series, even after viral clearance.

P48: Acute HEV infection in liver transplant recipients: safety and efficacy of ribavirin therapy

P48: Acute HEV infection in liver transplant recipients: safety and efficacy of ribavirin therapy

Updating the knowledge of hepatitis E: new variants and higher prevalence of anti-HEV in Argentina

Introduction. Hepatitis E is a disease of global distribution, with significant morbidity and mortality, whose scope and burden continue to emerge in low endemic countries.Material and methods. In 2012, we studied the prevalence of anti-HEV antibodies in 202 adult serum samples. We also analyzed samples from 143 patients with acute non-A-C hepatitis from January 2011 to December 2013. Acute HEV infections were diagnosed with anti-HEV IgM and/or HEV RNA. HEV RNA was also investigated in 94 swine fecal samples. HEV RNA was sequenced and characterized.Results. We found higher values of prevalence than those previously reported in the 1990s. The overall prevalence of anti-HEV IgG antibodies was 15.4%. The prevalence was 10.6% in the 123 adults voluntarily screened on World Hepatitis Day 2012 in Buenos Aires city and 14.8, 16.7 and 35.7% respectively in the smaller groups of healthcare workers, blood donors and HIV-positive patients from different regions of the country. Nine acute HEV infections were diagnosed in the three years analyzed. We characterized new human variants of subgenotype 3a and 3i. New subgenotype 3i variants were found in swine from two distant provinces closely related to the human ones.Conclusions. These results enlarge the knowledge of HEV and contribute with new information. However, higher values of prevalence found in small groups need to be confirmed in larger studies. Many aspects of the spectrum of the disease and the reservoirs and routes of transmission are still unknown and thus deserve additional research.

Hepatitis E in Germany--an under-reported infectious disease.

At least 17% of the population in Germany has been infected with the hepatitis E virus (HEV); thus, HEV infections are more frequent than was previously assumed. However, fewer than 500 HEV infections were reported to the Robert Koch Institute in 2013. Review of pertinent literature retrieved by a selective search in PubMed. Persons living in Germany generally acquire hepatitis E infection within the country by consuming infected and undercooked pork; in rare cases, hepatitis E infections are imported from the tropics. HEV can be transmitted via blood products, blood transfusions, and organ transplantation. More than 99% of HEV infections are asymptomatic and self-limiting, but there are also severe cases with acute liver failure. Immunosuppressed persons can develop chronic HEV infection, potentially leading, within a few years, to liver cirrhosis with life-threatening sequelae. Moreover, HEV infection may be associated with extrahepatic manifestations such as Guillain-Barré syndrome. In two retrospectively evaluated case series, ribavirin was found to be active against HEV and can be used to treat either acute or chronic HEV infection. Hepatitis E must be considered in the differential diagnosis of elevated hepatic enzyme levels and of systemic and neurological conditions of uncertain origin. The infection is usually self-limiting but can take a severe course in immunosuppressed persons. In such cases, ribavirin can be used as an antiviral treatment.

Incidence and natural history of hepatitis E virus coinfection among HIV-infected patients.

To know the prevalence, incidence and factors associated with hepatitis E virus (HEV) infection in HIV-infected individuals in Spain, as well as to provide information on the natural history of HIV/HEV coinfection. Prospective cohort study. Serum HEV IgG antibodies were tested in 613 HIV-infected patients at baseline and 2 years thereafter. Positive samples were tested for HEV-RNA. In patients with seroconversion, changes in liver function tests, serum HEV IgM antibodies and HEV RNA in samples collected between the baseline and the final time points were analyzed. One hundred and sixty-one (26%) patients tested positive for serum HEV IgG antibodies at baseline. HEV exposure was more common in men than in women (28 vs. 18%; P = 0.022) and increased linearly with age: 16, 26 and 44% in younger than 40, from 40 to 49 and older than 50 years, respectively (P = 0.000002). One patient bore the serum HEV-RNA at baseline. Eighteen (4%) HEV-seronegative patients seroconverted during the follow-up. None of the factors predicted seroconversion. One patient with seroconversion developed acute hepatitis and four mild hypertransaminasemia without another apparent cause. No case of seroconversion evolved to chronic HEV infection. Seroreversion was detected in 19% of the HEV-seropositive patients at baseline. Patients with seroreversion showed more commonly CD4 cell counts below 500 cells/μl than those who remained seropositive (77 vs. 46%; P = 0.004). Exposure to HEV among HIV-infected patients in Spain is very common, and this increases with age. Evolution to chronic infection is extremely unusual. Most cases of acute HEV infection seem to be clinically and biochemically unexpressive, therefore going unnoticed.

Risk factors and molecular characterization of acute sporadic symptomatic hepatitis E virus infection in Thailand

ObjectiveTo report clinical outcomes and viral genotypes of acute symptomatic hepatitis E virus (HEV) infection in Thailand. MethodsForty patients with acute symptomatic HEV infection were recruited during 2009-2013. Clinical, demographic and laboratory data were collected. Diagnosis was accomplished by detection of anti-HEV IgM and/or HEV RNA in the serum or stool. HEV genotypes were classified by direct sequencing of RT-PCR products and phylogenetic analysis. ResultsThe high risk group, comprising immune-compromised, liver cirrhosis and very elderly (>80 years) patients (17 cases), had higher levels of serum alkaline phosphatase at presentation compared with the low risk group. Two fatal cases resulted from acute hepatitis E in the high risk group. Initial clinical presentation did not show statistically significant differences. In six cases (6/40), the virus could be detected in serum or stool by RT-PCR and sequencing. Upon molecular characterization, the viruses were classified as HEV genotype 3f and were in the same cluster as Thai swine HEV. ConclusionsOur data showed that acute HEV infection has various clinical presentations and outcomes. Higher levels of serum alkaline phosphatase were observed in high risk patients. All isolated viruses were identified as HEV genotype 3f possibly originating from swine.

Occurrence of hepatitis E virus infection in acute hepatitis in Thailand

Hepatitis E virus (HEV) infection is one of the enterically transmitted types of hepatitis. The present study was undertaken to estimate the occurrence of HEV infection in sporadic acute hepatitis in Thailand. Serum samples were obtained from 614 suspected acute hepatitis patients at two large hospitals in Bangkok during 2008, 2009, and 2011. Acute hepatitis E was identified by the presence of anti-HEV IgM (4.8%) using indirect ELISA kits and/or HEV RNA (4.5%) by a semi-nested reverse transcription-polymerase chain reaction assay. HEV IgM was the most common marker for detection (77%) at diagnosis, either by positive HEV IgM alone or together with HEV RNA, whereas HEV RNA alone was detected in 23% of patients. Overall, 4.2% of cases (26 out of 614) were acute HEV infection with the highest attack rate in the elderly age group. In addition, nucleotide sequence analysis of five HEV samples revealed 92.8-99.8% homology. All viruses were clustered into HEV genotype 3 and were similar genetically to swine HEV strains previously detected in the same area. Therefore, the occurrence of HEV infection with closely related to swine genotype 3 was approximately 4-5% of acute hepatitis cases in Thailand. Anti-HEV IgM was the most common marker at diagnosis.

Hepatitis E infection in patients with severe acute alcoholic hepatitis.

Hepatitis E virus (HEV) infection is a known cause of acute-on-chronic liver failure in developing countries, but its implication in Western countries remains unknown. HEV burden in the setting of severe acute alcoholic hepatitis (AAH) was assessed. Patients admitted for severe AAH from 2007 to 2013, with available sera and histologically proven AAH, were included and managed according to current European guidelines. At admission, clinical and biological characteristics were collected; HEV serology and RNA detection were retrospectively performed. Eighty-four patients were included. Mean age was 50.8 ± 9.6 years, 65.5% were male, 91.7% were cirrhotic and 33.3% presented with encephalopathy. Mean MELD and Maddrey scores were respectively 32.4 ± 11.4 and 73.3 ± 37. Liver biopsy showed mild, moderate and severe hepatitis in 25 (29.8%), 23 (27.4%) and 32 (38.1%) patients respectively. Steroids were given to 61 patients (72.6%) of whom 35 (57.4%) presented corticoresistance (mean Lille score: 0.78 ± 0.21). During hospitalization, 24 patients (28.6%) died and 11 (13.1%) were transplanted. Three patients (3.6%) presented markers of acute HEV infection and 21 (25%) markers of past HEV infection. Patient with acute infection were men, cirrhotic, and 2/3 presented with encephalopathy. Steroids were given to two patients without any response. The third patient died. None were transplanted. A substantial proportion of patients with severe AAH had markers of acute HEV infection, with similar clinical presentation and outcomes. Larger studies are needed to evaluate HEV impact on AAH management, resistance to steroids, and outcome.