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Hepatitis E: an emerging disease. INFECTION GENETICS AND EVOLUTION 2014; 22:40-59. [PMID: 24434240 DOI: 10.1016/j.meegid.2014.01.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/09/2013] [Accepted: 01/04/2014] [Indexed: 02/07/2023]
Abstract
Currently, the infection with the hepatitis E virus represents the most frequent cause for acute hepatitis and jaundice in the world. According to WHO estimations, around two billion people, representing one third of the world's population, live in endemic areas for HEV and, therefore, are at risk of infection. In developed countries, the circulation of the virus in both human and animal (swine, boar, deer) sewage has been confirmed; however, the incidence rate is low compared to that of developing countries where outbreaks of acute hepatitis transmitted via the fecal-oral route are originated, more frequently in the flooding season or after natural disasters, combined with deficient sanitary conditions. There are currently 4 known genotypes of HEV. Genotypes 1 and 2 are isolated in all human epidemic outbreaks in developing countries, while genotypes 3 and 4 are isolated not only in humans but also in animals, in both developing and industrialized countries. These data support genotypes 3 and 4 having zoonotic nature. The diagnosis of this disease is based in the detection of anti-HEV IgG and IgM in blood serum using enzyme-linked immunosorbent methods. However, the method that best confirms the diagnosis is the RT-PCR, which detects HEV RNA in blood serum and also provides the genotype. The clinical course is generally that of an acute hepatitis which in some cases may require hospitalization and that, in transplant patients or HIV infected individuals can become a chronic hepatitis. Furthermore, the virus constitutes an important risk for pregnant women. The hepatitis E can present a wide range of symptoms, from a subclinical case to chronic liver disease with extrahepatic manifestations. For this reason, the diagnostic is challenging if no differential diagnosis is included. There is no specific antiviral drug for hepatitis E, but satisfactory results have been observed in some patients treated with pegylated interferon alfa2a and/or ribavirin. This revision is an update of all the molecular, epidemiological, clinic and preventive knowledge on this emergent disease up to date.
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Moisset X, Vitello N, Bicilli E, Courtin R, Ferrier A, Taithe F, Lahaye C, Hssain AA, Garrouste C, Pierre C. Severe bilateral amyotrophic neuralgia associated with major dysphagia secondary to acute hepatitis E. F1000Res 2013; 2:259. [PMID: 24555112 PMCID: PMC3886787 DOI: 10.12688/f1000research.2-259.v2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Several acute neurological syndromes can be triggered by immune events. Hepatitis E virus (HEV), an emerging infectious disease, can be one of these triggers. CASE REPORT We report the case of a 36-year-old man that presented nausea and a dull abdominal pain for a week and then felt an acute neuralgic pain involving both shoulders that lasted for 8 to 10 hours. Immediately after, the patient presented a severe bilateral muscular weakness of the proximal part of both upper limbs, corresponding to an amyotrophic neuralgia. Two days after the shoulder pain, the patient presented a dysphagia necessitating tube feeding. A blood sample confirmed hepatitis caused by hepatitis E virus (HEV; genotype 3F). Oral feeding resumed progressively after five months. The patient was fully independent for the activities of daily living but was still unable to work after six months. CONCLUSION Amyotrophic neuralgia and hepatitis E are both under-diagnosed. It is noteworthy that HEV can trigger amyotrophic neuralgia. Antiviral drugs, oral steroids and intravenous immunoglobulins can be proposed, but the optimal treatment has not yet been determined.
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Affiliation(s)
- Xavier Moisset
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Neuro-Dol, Inserm U1107, Douleur Trigéminale et Migraine, Faculté de Chirurgie Dentaire, F-63000, F-63000, France
| | - Nicolas Vitello
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France
| | - Elodie Bicilli
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Romain Courtin
- CHU Clermont-Ferrand, Service d'Ophtalmologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Anna Ferrier
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Frederic Taithe
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Clément Lahaye
- CHU Clermont-Ferrand, Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Ali Ait Hssain
- CHU Clermont-Ferrand, Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Cyril Garrouste
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France ; CHU Clermont-Ferrand, Service de Néphrologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France
| | - Clavelou Pierre
- CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Neuro-Dol, Inserm U1107, Douleur Trigéminale et Migraine, Faculté de Chirurgie Dentaire, F-63000, F-63000, France ; Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France
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Pérez-Gracia MT, Mateos Lindemann ML, Caridad Montalvo Villalba M. Hepatitis E: current status. Rev Med Virol 2013; 23:384-98. [PMID: 24038432 DOI: 10.1002/rmv.1759] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/22/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
Abstract
Acute hepatitis E is a very common disease in developing countries, to the point that, according to World Health Organization estimates, one third of the world's population has been exposed to HEV. It also causes outbreaks in refugee camps or after natural disasters such as floods or earthquakes. Sporadic cases of acute hepatitis have been observed in practically all European countries and other developed geographical areas, not only in travelers from endemic countries but also in people with no risk factors. But, lately, new aspects of this infection are appearing in industrialized countries such as the possibility of the disease becoming chronic in transplant patients, the immunocompromised in general, and even in patients with previous liver disease who are immunocompetent. In this comprehensive review, we summarize the current knowledge on HEV infection.
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Affiliation(s)
- María Teresa Pérez-Gracia
- Área de Microbiología. Departamento Farmacia. Instituto de Ciencias Biomédicas. Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Moncada Valencia, Spain
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