Year 2017 / Volume 109 / Number 5
Original
Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience

344-349

DOI: 10.17235/reed.2017.4258/2016

Luzdivina Monteserín Ron, Marcos Jiménez Palacios, Pedro Linares Torres, Aleida Miguel Peña, Begoña Álvarez Cuenllas, María Isabel Fernández-Natal, Emilio Valverde Romero, Francisco Jorquera Plaza,

Abstract
Background: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world. Objective: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics. Material and methods: We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed. Results: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as “acute-on-chronic liver failure” (ACLF), one died and the other underwent liver transplantation. Conclusion: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis.
Share Button
New comment
Comments
No comments for this article
References
1. WHO. Inmunizacion, vaccines and biologicals. Hepatitis E. [Online, 19 January 2015]. 2015 World Health Organization.
2. Emerson SU, Anderson D, Arankalle A, et al. Hepevirus. Virus taxonomy: eighth report of the International Committee on Taxonomy of Viruses. London: Elsevier/Academic Press; 2005. p. 853-7.
3. Riveiro-Barciela M, Rodríguez-Frías F, Buti M. Hepatitis E: Dimensión del problema en España. Gastroenterol Hepatol 2012;35:719-24.
4. Galiana C, Fernández-Barredo S, Pérez-Gracia MT. Prevalence of hepatitis E virus (HEV) and risk factors in pig workers and blood donors. Enferm Infecc Microbiol Clin 2010;28:602-7.
5. Teshale EH, Grytdal SP, Howard C, et al. Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda. Clin Infect Dis 2010;50:1006-10.
6. Khuroo MS, Kamili S, Yatto GN. Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area. J Gastroenterol Hepatol 2004;19:778-84.
7. Hewitt PE, Ijaz S, Brailsford SR, et al. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet 2014;384:1766-73.
8. Colson P, Borentain P, Queyriaux B, et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis 2010;202:825-34.
9. Li TC, Chijiwa K, Sera N, et al. Hepatitis E virus transmission from wild boar meat. Emerg Infect Dis 2005;11:1958-60.
10. Lens S, Mensa L, Gambato M, et al. HEV infection in two referral centers in Spain: epidemiology and clinical outcomes. J Clin Virol 2015;63:76-80.
11. Sauleda S, Ong E, Bes M, et al. Seroprevalence of hepatitis E virus (HEV) and detection of HEV RNA with a transcription-mediated amplification assay in blood donors from Catalonia (Spain). Transfusion 2015;55:972-9.
12. Mateos-Lindemann ML, Diez-Aguilar M, Galdamez AL, et al. Patients infected with HIV are at high-risk for hepatitis E virus infection in Spain. J Med Virol 2014;86:71-4.
13. Ditah I, Ditah F, Devaki P, et al. Current epidemiology of hepatitis E virus infection in the United States: low seroprevalence in the National Health and Nutrition Evaluation Survey. Hepatology 2014;60:815-822.
14. Fogeda M, Avellón A, Cilla CG, et al. Imported and autochthonous hepatitis E virus strains in Spain. J Med Virol 2009;81:1743-9.
15. Mateos-Lindemann ML, Diez-Aguilar M, González-Galdamez A, et al. Hepatitis agudas, crónicas y fulminantes por virus de la hepatitis E: 7 años de experiencia (2004-2011). Enferm Infecc Microbiol Clin 2013;31:595-8.
16. Buti M, Clemente-Casares P, Jardi R, et al. Sporadic cases of acute autochthonous hepatitis E in Spain. J Hepatol 2004;41:126-31.
17. Monga R, Garg S, Tyagi P, et al. Superimposed acute hepatitis E infection in patients with chronic liver disease. Indian J Gastroenterol 2004;23:50-2.
18. Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. N Engl J Med; 2012;367:1237-44.
19. Pischke S, Gisa A, Suneetha PV, et al. Increased HEV seroprevalence in patients with autoimmune hepatitis. PLoS One 2014;Jan 21;9:e85330.
20. Dalton HR, Fellows HJ, Stableforth W, et al. The role of hepatitis E virus testing in drug-induced liver injury. Aliment Pharmacol Ther 2007;26:1429-35.
21. Echevarría JM, Fogeda M, Avellón A. Diagnosis of acute hepatitis E by antibody and molecular testing: a study on 277 suspected cases. J Clin Virol 2011;50:69-71.
22. Alric L, Bonnet D, Beynes-Rauzy O, et al. Definitive clearance of a chronic hepatitis E virus infection with ribavirin tratment. Am J Gastroenterol 2011;1562-3.
23. Peters van Ton AM, Gevers TJ, Drenth JP. Antiviral therapy in chronic hepatitis E: a systematic review. J Viral Hepat 2015;Mar 11.
24. Kamar N, Selves J, Mansuy JM, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 2008;358:811-7.
25. González Tallón AI, Moreira Vicente V, Mateos Lindemann ML, et al. Hepatitis crónica E en paciente inmunocompetente. Gastroenterol Hepatol 2011;34:398-400.
Related articles

Editorial

Orthohepevirus C as causal agent of acute hepatitis in Spain

DOI: 10.17235/reed.2022.8993/2022

Letter

A case of COVID-19 with concomitant infection with hepatitis A

DOI: 10.17235/reed.2021.8372/2021

Digestive Diseases Image

Emphysematous hepatitis: a very rare entity with a poor prognosis

DOI: 10.17235/reed.2021.7795/2021

Original

A new pattern in hepatitis A virus infection in an urban population

DOI: 10.17235/reed.2020.6526/2019

Letter

Acute seronegative hepatitis C: two case reports

DOI: 10.17235/reed.2019.5921/2018

Case Report

Glycogenic hepatopathy in young adults: a case series

DOI: 10.17235/reed.2016.3934/2015

Citation tools
Monteserín Ron L, Jiménez Palacios M, Linares Torres P, Miguel Peña A, Álvarez Cuenllas B, Fernández-Natal M, et all. Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience. 4258/2016


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 401 visits.
This article has been downloaded 328 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 07/02/2016

Accepted: 08/01/2017

Online First: 05/04/2017

Published: 03/05/2017

Article revision time: 333 days

Article Online First time: 423 days

Article editing time: 451 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology