First Report on Abnormal Renal Function in Acute Hepatitis E Genotype 1 Infection (original) (raw)
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American Journal of Kidney Diseases, 2005
Clinicians often are faced with an increase in liver enzyme levels. In the majority of cases, the cause is found rapidly. Conversely, in a few cases, the etiologic agent remains unknown and requires either liver biopsy or drug-medication modification. We report a case of acute icteric hepatitis associated with renal function impairment related to infection caused by primary hepatitis E virus (HEV) in a renal transplant recipient who lived in a nonclassic endemic area and had not traveled abroad. Clinicians must be aware that in cases of unexplained hepatitis in organ transplant recipients and in the absence of evident drug hepatotoxicity, HEV should be considered as an etiologic agent for hepatitis. Subsequently, HEV serological tests should be performed, HEV RNA should be looked for in acute-phase serum and stool samples, and liver parameters should be monitored closely because HEV might be responsible, in some cases, for fulminant hepatitis. Am J Kidney Dis 45:193-196.
Pathogens
In patients with hepatitis E virus (HEV) infections, extrahepatic, particularly renal and hematological manifestations, are increasingly reported in the medical literature but have never been studied compared to a control cohort. We retrospectively analyzed medical records of consecutive patients that were diagnosed with acute hepatitis E (AHE) (n = 69) or acute hepatitis A (AHA) (n = 46) at the University Medical Center Hamburg Eppendorf from January 2009 to August 2019 for demographical, clinical, and laboratory information. Patients with AHE had significantly lower median levels of ALAT (798 U/L) and total bilirubin (1.8 mg/dL) compared to patients with AHA (2326 U/L; p < 0.001 and 5.2 mg/dL; p < 0.001), suggesting a generally less severe hepatitis. In contrast, patients with AHE had significantly higher median serum creatinine levels (0.9 mg/dL vs. 0.8 mg/dL; p = 0.002) and lower median estimated glomerular filtration rate (eGFR) (91 mL/min/1.73 m2 vs. 109 mL/min/1.73 m2; ...
Hepatitis E – effect on the liver and beyond
Romanian Journal of Infectious Diseases, 2018
Introduction. Hepatitis E is an acute liver disease caused by E hepatitis virus (HEV), representing a global public health problem comparable with other transmissible infections. Aim. The purpose of this paper is to present the epidemiological, clinical, biological and evolutive aspects of HEV infection. Material and method. An estimated 20 million infections are annually reported worldwide with higher prevalence rates recorded in SouthEast Asia (over 60% of infections and over 65% of HEV related deaths). In Romania the incidence of HEV in 2009 was 12%, the frequency of infection being limited to the anti-HEV specific IgG antibodies seroprevalence. Results. HEV transmission is predominantly by digestive tract (especially contaminated water) but also by blood, plasma, organ transplant. The incubation period ranges from 21 to 45 days, onset of gastrointestinal simptoms, fever, influenza-like syndrome, asthenia, skin rush, weight loss, abdominal pain, dehydration. The state period is characterized by sclero-tegumentary jaundice (75% cases), skin pruritus, steathoresis, dark urine and pale stools. HEV can cause extrahepatic manifestations (neurological, renal lesions, pancreatitis and haematological disturbencies). Farmacological treatment of HEV infection includes Peg-Inf, Ribavirin and also newest DAAs agents. Discussions. In most patients hepatitis E causes a self-limited disease that lasts for several weeks. Acute infection is generally asymptomatic and is caused by genotype 1 in young people, while genotypes 3 and 4 generally affect immunosuppressed patients. Chronic infection is caused by genotypes 3 and 4 in immunosuppressed pacients (transplanted, HIV-positive and haematological patients) and has a lower incidence and mortality. Evolution of viral hepatitis E may be severe and fulminant due to acute liver failure. A recombinant vaccine approved in China in 2011 opens up prospects for the specific prevention measures in areas identified as being at risk to limit the consequences of hepatitis E virus infection in the general population and exposed groups. Conclusions. Hepatitis E management involves the therapy of chronic infection in immunosuppressed patients, the extrahepatic manifestations and also acute severe HEV infections.
Degree Of Proteinuria In Post-Icteric State Of Hepatitis E Virus (Hev) Infected Patients
2012
Introduction: Nephropathies, as one of the multiple extrahepatic features of Hepatitis E virus (HEV) infection, can occur in clinically improved HEV hepatitis patients which in majority of the cases remain clinically silent for a long period. By the time these are reported, patients have already developed renal insufficiency which may even lead to renal replacement therapy. Proteinuria, a simple test in practice, can be a useful tool for early detection of the underlying renal impairment. Objective: The aim of this study was to detect the presence of proteinuria and to evaluate the degree of proteinuria in HEV-hepatitis patients during post-icteric state. Materials and Methods: This cross sectional study was conducted on 50 diagnosed patients of clinically improved HEV-hepatitis at the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) with active cooperation of the Department of Hepatology, BSMMU, between July 2006 and June 2007. Cases were chosen carefully, to exclude the acute state of illness and the patients of HEV were selected during their third or fourth follow-up, in their post-icteric phase. The study subjects were grouped according to equal age ranges in group-I (18-26 year) and group-II (27-35 year).
Acute Hepatitis E in a Young Male
Cureus, 2019
Hepatitis E (Hep E) is a type of liver disease caused by hepatitis E virus (HEV), which is a singlestranded ribonucleic acid (RNA) virus. This mainly spreads through the intake of contaminated food and water. Here we present a case of a 30-year-old male with complaints of dark-colored urine and yellow discoloration of eyes (jaundice) for the past few days. He also had associated mild abdominal pain, nausea, and loss of appetite. On further inquiry, he pointed out that his drinking water was from an unfiltered source, and had unsatisfactory sanitary conditions at home. On physical examination, he was deeply jaundiced. His laboratory results showed deranged liver function tests (LFTs) and positive serology for HEV. He was managed conservatively and was discharged after improvement in his condition. On follow-up after one month, complete normalization of liver enzymes and symptoms was seen. This case report highlights the significance of better sanitation and personal hygienic habits in the prevention of HEV infection.
Indian Journal of Gastroenterology, 2014
Background Hepatitis E virus (HEV) infection is highly endemic in India, being the most common cause of acute hepatitis; however, no case of chronic infection has been reported. All the human isolates of HEV from India till date have belonged to genotype 1. In contrast, in non-endemic areas, genotype 3 is the most prevalent, and persistent HEV infection has been reported among solid-organ transplant recipients. Whether persistent infection occurs with genotype 1 HEV is unclear. We therefore looked for evidence of HEV infection among renal transplant recipients with elevated alanine transaminase (ALT). Methods Renal transplant recipients receiving immunosuppressive therapy were screened for ALT levels, irrespective of time duration since renal transplant. For those with ALT levels equal to or exceeding 50 IU/mL on at least two occasions ≥3 weeks apart, serum was tested for HEV RNA using a sensitive real-time reverse transcription polymerase chain reaction assay. For those testing positive, HEV genotyping and follow up for duration of viral persistence were planned. Results Of the 275 patients studied, 49 (17.8 %, 44 male, median age=39.5 years) had elevated ALT levels (median= 62 [range=50-477]IU/L). None of these 49 patients had detectable HEV RNA in the serum using an assay with detection sensitivity of 300 copies of RNA/mL of specimen. Conclusion Our data indicate that persistent HEV infection is an infrequent cause of ALT elevation in Indian renal transplant recipients who are receiving immunosuppressive drugs. This suggests that infection with genotype 1 HEV may have either no or low potential to cause persistent infection.
The Clinical Perspective on Hepatitis E
Viruses
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 ...