Extra‐hepatic manifestations of autochthonous hepatitis E infection
Kathy L. WoolsonAdam ForbesL. VineL. L. BEYNONLorraine M. McElhinneyVasilis PanayiJ.G. HunterR.G. MaddenT. GlasgowAditya KotechaH. C. DaltonL. MihailescuU. WarshowH. HussainiJ PalmerBrendan McLeanBecky HaywoodRichard BendallHarry R. Dalton
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Summary Background Autochthonous (locally acquired) hepatitis E is increasingly recognised in developed countries, and is thought to be a porcine zoonosis. A range of extra‐hepatic manifestations of hepatitis E infection have been described, but have never been systematically studied. Aim To report the extra‐hepatic manifestations of hepatitis E virus. Methods Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1). Results Eight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain‐Barré syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40 years, range 34–92 years, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 0.015) compared to cases without neurological symptoms [median age 64 years (range 18–88 years), median ALT 1135 IU/L]. One patient presented with a cardiac arrhythmia,twelve patients (11.3%) presented with thrombocytopenia, fourteen (13.2%) with lymphocytosis and eight (7.5%) with a lymphopenia, none of which had any clinical consequence. Serum electrophoresis was performed in 65 patients at presentation, of whom 17 (26%) had a monoclonal gammopathy of uncertain significance. Two cases developed haematological malignancies, acute myeloid leukaemia and duodenal plasmacytoma, 18 and 36 months after presenting with acute hepatitis E infection. Conclusions A range of extra‐hepatic manifestations can occur with hepatitis E. Neurological and haematological features of hepatitis E infection are relatively frequent in this UK cohort, and result in significant morbidity which warrants further study.Keywords:
Hepatitis E
Hepatitis E Virus
Lymphocytosis
Elevated transaminases
Hepatitis E Virus
Fulminant hepatitis
Subclinical infection
Acute hepatitis
Hepatitis E
Seroprevalence
Viral Hepatitis
Fulminant
Incubation period
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Background: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are both enterically transmitted, resulting in acute viral hepatitis (AVH) in developing countries. They pose major health problems in our country. This study was done to determine prevalence of HAV and HEV in patients presenting with AVH and the co-infection of HAV and HEV in these patients. Materials and Methods: A cross-sectional study of 1-year duration was conducted in the Department of Microbiology, MAX Hospital Deharadun. A non-random sampling of 315 patients presenting with AVH was considered in the study. On the basis of history, serum samples were analysed for IgM antiHAV and IgM anti-HEV for the detection of HAV and HEV, respectively using commercially available ELISA kits. Results: The seroprevalence of HAV- and HEV-positive patients were 10.79% and 26.66%, respectively. The seroprevalence of both HAV and HEV in patients with acute viral hepatitis was 0.32%. The prevalence of HAV and HEV among males (13% and 27.11%) was higher than in females (7.97% and 26.08%). These infections were predominantly seen during end of monsoons and beginning of winter. Conclusion: The prevalence of HEV is higher than that of HAV. These data will be essential for planning of future vaccination strategies and for better sanitation programme in this part of the country.
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Foodborne viruses are an important threat to food safety and public health. Globally, there are approximately 5 million cases of acute viral hepatitis due to hepatitis A virus (HAV) and hepatitis E virus (HEV) every year. HAV is responsible for numerous food-related viral outbreaks worldwide, while HEV is an emerging pathogen with a global health burden. The reported HEV cases in Europe have increased tenfold in the last 20 years due to its zoonotic transmission through the consumption of infected meat or meat products. HEV is considered the most common cause of acute viral hepatitis worldwide currently. This review focuses on the latest findings on the foodborne transmission routes of HAV and HEV and the methods for their detection in different food matrices.
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Hepatitis E is a viral hepatitis that the hepatitis E virus (HEV) causes. In the early 1980s, the hepatitis E virus was first discovered and identified, and it is one of the important pathogens that cause acute viral hepatitis globally. HEV infection is usually self-limiting, but in some groups of populations, such as pregnant women, patients with chronic liver disease, and the elderly, the prognosis is poor and may result in acute or subacute liver failure or even death. In addition, HEV infection can occur in chronically immunocompromised populations. At present, some regions and countries are not paying enough attention to hepatitis E prevention, diagnosis, and treatment, which suggests that we should study the epidemiology of HEV infection.戊型肝炎是由戊型肝炎病毒（HEV）引起的病毒性肝炎。HEV在二十世纪八十年代初被首次发现鉴定，是在世界范围内引发急性病毒性肝炎的重要病原体之一。HEV感染通常具有自限性，但部分人群如妊娠期妇女、慢性肝病患者、老年人等感染HEV后预后较差，可能发展为急性或亚急性肝衰竭，甚至造成患者死亡。免疫抑制人群还有可能发生慢性HEV感染。目前在部分地区和国家，关于戊型肝炎的预防、诊断与治疗并未得到足够重视，这提示我们应当评估其的流行情况。.
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Hepatitis E virus (HEV), the sole member of the unassigned Genus Hepevirus , caused several largeepidemic outbreaks of acute hepatitis in Asia, Africa and in Mexico. Many of the hepatitis E cases in CentralEurope (2007 in Germany: 72 notified cases) are infections imported from the endemic regions; however,there is increasing evidence of sporadic infections without a history of travel. HEV is mainly transmitted byfaecally contaminated water, but also by contaminated food. HEV strains closely related to human isolateshave been detected in several animal species, especially in pigs, indicating that HEV is a zoonotic virus.Using three different RT-PCR protocols, HEV-RNA was detected in 10 out of 189 serum samplescollected in 1995/1996 from wild boars in Germany. Sequence analysis indicates a close relationship withgenotype 3 isolates of pigs and humans from the Netherlands and Japan. The results indicate that HEV ispresent in Germany since more than 10 years and that wild boar may function as a reservoir for HEV
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Acute viral hepatitis (AVH) caused by enterically transmitted hepatitis A virus (HAV) and hepatitis E virus (HEV) poses a major health problem in developing countries such as India. Despite improving sanitation, heath awareness, and socioeconomic conditions, these infections continue to occur both in sporadic as well as in epidemic forms in different parts of India.The aim of this study is to determine the total as well as age-specific prevalence rates of HAV and HEV in the outbreaks of waterborne hepatitis in districts surrounding Amritsar region of Punjab.The study was conducted in the Virology Research and Diagnostic Laboratory, Government Medical College, Amritsar, during the study period of January 2015-March 2016. Samples from suspected outbreaks of AVH occurring in various districts around Amritsar were included as a part of the study. A total of 95 sera were tested for IgM antibody to HEV and HAV using IgM capture ELISA kit.Out of the total 95 samples received, 73 samples (76.84%) were positive for HAV/HEV. Out of the total positive cases, 65 (68.42%) had HEV infection, 2 (2.1%) had HAV, and 6 cases (6.31%) were coinfected with both HAV and HEV. The 21-30 years age group (25 cases) was identified as the most susceptible group for HEV infection. The coinfected subjects presented a wider range of age distribution (1-10 years: 1; 11-20 years: 3; 21-30 years: 1; 31-40 years: 1). Seasonal distribution of data revealed bimodal peaks for HEV infection.There should be some surveillance system to regularly monitor the portability of drinking water from time to time to avoid such preventable outbreaks in future.
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