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Orosz L, Sárvári KP, Dernovics Á, Rosztóczy A, Megyeri K. Pathogenesis and clinical features of severe hepatitis E virus infection. World J Virol 2024; 13:91580. [PMID: 38984076 PMCID: PMC11229844 DOI: 10.5501/wjv.v13.i2.91580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 06/24/2024] Open
Abstract
The hepatitis E virus (HEV), a member of the Hepeviridae family, is a small, non-enveloped icosahedral virus divided into eight distinct genotypes (HEV-1 to HEV-8). Only genotypes 1 to 4 are known to cause diseases in humans. Genotypes 1 and 2 commonly spread via fecal-oral transmission, often through the consumption of contaminated water. Genotypes 3 and 4 are known to infect pigs, deer, and wild boars, often transferring to humans through inadequately cooked meat. Acute hepatitis caused by HEV in healthy individuals is mostly asymptomatic or associated with minor symptoms, such as jaundice. However, in immunosuppressed individuals, the disease can progress to chronic hepatitis and even escalate to cirrhosis. For pregnant women, an HEV infection can cause fulminant liver failure, with a potential mortality rate of 25%. Mortality rates also rise amongst cirrhotic patients when they contract an acute HEV infection, which can even trigger acute-on-chronic liver failure if layered onto pre-existing chronic liver disease. As the prevalence of HEV infection continues to rise worldwide, highlighting the particular risks associated with severe HEV infection is of major medical interest. This text offers a brief summary of the characteristics of hepatitis developed by patient groups at an elevated risk of severe HEV infection.
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Affiliation(s)
- László Orosz
- Department of Medical Microbiology, University of Szeged, Szeged 6720, Csongrád-Csanád, Hungary
| | - Károly Péter Sárvári
- Department of Medical Microbiology, University of Szeged, Szeged 6720, Csongrád-Csanád, Hungary
| | - Áron Dernovics
- Department of Medical Microbiology, University of Szeged, Szeged 6720, Csongrád-Csanád, Hungary
| | - András Rosztóczy
- Department of Internal Medicine, Division of Gastroenterology, University of Szeged, Szeged 6725, Csongrád-Csanád, Hungary
| | - Klára Megyeri
- Department of Medical Microbiology, University of Szeged, Szeged 6720, Csongrád-Csanád, Hungary
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Subramaniam S, Fares-Gusmao R, McGivern DR. Quantification of Hepatitis E Virus ORF2 Protein by a Novel Sandwich ELISA. Viruses 2024; 16:393. [PMID: 38543759 PMCID: PMC10974087 DOI: 10.3390/v16030393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 05/23/2024] Open
Abstract
Hepatitis E virus (HEV) causes acute hepatitis in humans, which can progress to chronicity in immunosuppressed individuals. Almost all reported HEV infections are caused by Paslahepevirus balayani genotypes 1-4. The structural ORF2 protein is the major antigen detected in the blood of HEV-infected individuals. ELISA assays to detect IgM antibodies to HEV are the first-line diagnostic tests; however, they showed variable performance with frequently discordant results. A qualitative HEV antigen (ORF2) ELISA is currently available for research use. Here, we report a novel quantitative sandwich ELISA to measure HEV ORF2 protein in 3 matrix types. An optimal pair of capture and detection antibodies was selected among 12 unique combinations tested. A sandwich ELISA protocol was developed using these mAbs and biotin-streptavidin technology. The protocol was further optimized to quantify ORF2 antigen in different matrices by interpolating from a standard curve with a linear range of 3.17 to 50.8 femtomoles/mL. Using this method, ORF2 protein was detected in the cell culture medium of Huh7 cells as early as 2-3 days after transfection with HEV genome RNA and in a medium of human hepatocytes infected with HEV. ORF2 antigen was readily detected in the first 2 weeks post-HEV infection in gerbil sera. In immunosuppressed gerbils, ORF2 was detected up to 6 weeks, and the levels were significantly higher between 3 and 6 weeks post-infection. HEV ORF2 antigen levels showed a strong positive correlation with HEV RNA levels in both cell culture medium and gerbil sera. Our novel sandwich ELISA detected at least 7.3 femtomoles/mL ORF2 protein in human plasma spiked with cell culture propagated HEV and detected ORF2 protein in human plasma samples that tested positive for HEV RNA but negative for anti-HEV antibodies. Further, the assay was nonreactive, with negative human plasma, and HBV or HCV-positive human plasma demonstrating specificity. Overall, our ORF2 antigen ELISA will be useful for quantifying ORF2 antigen in cell culture medium, gerbil serum, and human plasma. Further studies are warranted to evaluate its utility in HEV clinical diagnosis.
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Affiliation(s)
| | | | - David R. McGivern
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; (S.S.); (R.F.-G.)
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Stahl Y, Kabar I, Heinzow H, Maasoumy B, Bremer B, Wedemeyer H, Schmidt HHJ, Pietschmann T, Schlevogt B, Behrendt P. Enhanced monitoring and detection of recent genotype 3 hepatitis E virus infection through urine antigen testing. Emerg Microbes Infect 2023; 12:2251598. [PMID: 37649441 PMCID: PMC10512750 DOI: 10.1080/22221751.2023.2251598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis. Numerous studies have investigated the dynamics of HEV infection markers, but the most suitable marker for diagnosing ongoing or recent HEV infection remains to be determined. Recent evidence suggests that serum antigen testing is superior to serum IgM and RNA quantification. Moreover, it has been found that infected individuals excrete HEV antigen in significant quantities through urine. To address this question, we conducted a longitudinal analysis involving 16 patients with acute or chronic HEV infection in an area where genotype 3 HEV is prevalent. Our findings indicate that the diagnostic and monitoring capabilities of antigen testing for HEV infection can be further enhanced by measuring it in urine. Additionally, we were able to demonstrate that this enhancement is likely due to the presence of HEV-reactive IgG in blood plasma, which hampers efficient detection of HEV antigen through sandwich ELISA. In conclusion, urine-based antigen testing appears to be superior to measuring anti-HEV antibodies or viral RNA for diagnosing suspected HEV infection and monitoring ongoing infections.
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Affiliation(s)
- Yannick Stahl
- Institute of Experimental Virology, Twincore, Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
| | - Iyad Kabar
- Department of Medicine B, Muenster University Hospital, Muenster, Germany
- Department for Internal Medicine, Raphaelsklinik Muenster, Muenster, Germany
| | - Hauke Heinzow
- Department of Medicine B, Muenster University Hospital, Muenster, Germany
- Medical Clinic I, Klinikum Der Barmherzigen Brüder Trier, Trier, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology, Infectious Disease and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner-site Hannover-Braunschweig, Hannover, Germany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology, Infectious Disease and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Disease and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner-site Hannover-Braunschweig, Hannover, Germany
- RESIST Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Hartmut H.-J. Schmidt
- Department of Medicine B, Muenster University Hospital, Muenster, Germany
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Thomas Pietschmann
- Institute of Experimental Virology, Twincore, Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
- German Centre for Infection Research (DZIF), partner-site Hannover-Braunschweig, Hannover, Germany
| | - Bernhard Schlevogt
- Department of Medicine B, Muenster University Hospital, Muenster, Germany
- Department of Gastroenterology, Medical Center Osnabrueck, Osnabrueck, Germany
| | - Patrick Behrendt
- Institute of Experimental Virology, Twincore, Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
- Department of Gastroenterology, Hepatology, Infectious Disease and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner-site Hannover-Braunschweig, Hannover, Germany
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Kevorkyan A, Golkocheva-Markova E, Raycheva R, Rangelova V, Komitova R, Atanasova M, Tzekov V, Kostadinova T, Chardakova T. Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria. Pathogens 2023; 12:1208. [PMID: 37887724 PMCID: PMC10610113 DOI: 10.3390/pathogens12101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
Viral hepatitis B and C are widely recognized problems in hemodialysis (HD) patients. There have been increasing reports of the importance of the hepatitis E virus (HEV) in recent years, but the worldwide data on the seroprevalence of HEV among them are conflicting. The aim of the present study was to assess the seroprevalence of HEV in HD patients and to analyze the predictors of seropositivity. This study was conducted in 2020 in the central part of southern Bulgaria. A total of 225 patients were enrolled. An enzyme-linked immunosorbent assay for the determination of anti-HEV IgM/IgG was used. All patients were tested for the presence of HEV RNA. Anti-HEV IgM alone and anti-HEV IgG alone were found in 6 (2.7%) and 14 (6.2%) patients, respectively, and in 4 (1.8%) patients, they were found simultaneously. All patients were HEV RNA-negative. The overall HEV seroprevalence was 10.7% (24/225). The binominal logistic regression analysis of available predictors confirmed the role of vascular access and a duration of dialysis treatment over 5 years as predictors significantly associated with increased risk for HEV, and the consumption of bottled water with lower levels of HEV IgG seroprevalence among hemodialysis patients. The accumulated data are the basis for comparative analysis in subsequent trials in the same dialysis centers and for enhancing the range of screening markers used in this particular patient group.
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Affiliation(s)
- Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Elitsa Golkocheva-Markova
- National Reference Laboratory “Hepatitis Viruses”, National Center of Infectious and Parasitic Diseases, 1233 Sofia, Bulgaria;
| | - Ralitsa Raycheva
- Department of Social Medical and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Radka Komitova
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Mariya Atanasova
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Laboratory of Virology, University Multi-Profile Hospital for Active Treatment “St. George”, 4002 Plovdiv, Bulgaria
| | - Valeri Tzekov
- Section of Nephrology, Second Department of Internal Medicine, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
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Fontana S, Ripellino P, Niederhauser C, Widmer N, Gowland P, Petrini O, Aprile M, Merlani G, Bihl F. Epidemiology of HEV Infection in Blood Donors in Southern Switzerland. Microorganisms 2023; 11:2375. [PMID: 37894033 PMCID: PMC10609445 DOI: 10.3390/microorganisms11102375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
From 2014 to 2016, the number of hepatitis E virus (HEV) infections in southern Switzerland increased dramatically and suggested food as a potential infection reservoir. We evaluated the effects of food control measures introduced to limit HEV infections, assessing anti-HEV IgG and IgM rates in blood donors before and after the implementation of food control measures in 2017. From 2012 to 2013, we screened 1283, and from 2017 to 2019, we screened 1447 donors for IgG and IgM antibodies. No statistically significant differences were detected for IgG (32.8% from 2012 to 2013 vs. 31.1% from 2017 to 2019, p = 0.337) or IgM rates (2.0% from 2012 to 2013 vs. 2.8% from 2017 to 2019, p = 0.21). Rural provenience and age > 66 are predictors for positive IgG serology. A total of 5.9% of 303 donors included in both groups lost IgG positivity. We also determined nucleic acid testing (NAT) rates after the introduction of this test in 2018, comparing 49,345 donation results from southern Switzerland with those of 625,559 Swiss donor controls, and only 9 NAT-positive donors were found from 2018 to 2023. The high HEV seroprevalence in southern Switzerland may depend on different food supply chains in rural and urban areas. Local preventive measures probably have a limited impact on blood HEV risk; thus, continuous NAT testing is recommended.
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Affiliation(s)
- Stefano Fontana
- Servizio Trasfusionale CRS della Svizzera Italiana, 6900 Lugano, Switzerland;
- Blood Transfusion Unit, Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Christoph Niederhauser
- Interregional Blood Transfusion SRC, 3008 Berne, Switzerland (N.W.); (P.G.)
- Institute for Infectious Diseases, University of Berne, 3008 Berne, Switzerland
| | - Nadja Widmer
- Interregional Blood Transfusion SRC, 3008 Berne, Switzerland (N.W.); (P.G.)
| | - Peter Gowland
- Interregional Blood Transfusion SRC, 3008 Berne, Switzerland (N.W.); (P.G.)
| | - Orlando Petrini
- Institute of Microbiology, University of Applied Sciences and Arts of Southern Switzerland, 6500 Bellinzona, Switzerland;
| | - Manuela Aprile
- Servizio Trasfusionale CRS della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Giorgio Merlani
- Chief Medical Officer Office, Division of Public Health, Department for Health and Social Affairs, 6500 Bellinzona, Switzerland;
| | - Florian Bihl
- Epatocentro Ticino, Via Soldino 5, 6900 Lugano, Switzerland;
- Division of Gastroenterology and Hepatology, University Hospital Geneva, 1200 Geneva, Switzerland
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Golkocheva-Markova E, Ismailova C, Kevorkyan A, Raycheva R, Zhelyazkova S, Kotsev S, Pishmisheva M, Rangelova V, Stoyanova A, Yoncheva V, Tenev T, Gladnishka T, Trifonova I, Christova I, Dimitrov R, Bruni R, Ciccaglione AR. Age and Gender Trends in the Prevalence of Markers for Hepatitis E Virus Exposure in the Heterogeneous Bulgarian Population. Life (Basel) 2023; 13:1345. [PMID: 37374127 DOI: 10.3390/life13061345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The prevalence of hepatitis E virus (HEV) in the Bulgarian population remains underestimated. The aim of the present study was to evaluate age and gender trends in HEV prevalence in the heterogeneous Bulgarian population. Stored serum samples from blood donors and different patient sub-populations-kidney recipients (KR), patients with Guillain-Barre syndrome (GBS), Lyme disease (LD), patients with liver involvement and a clinical diagnosis other than viral hepatitis A and E (non-AE), hemodialysis (HD) and HIV-positive patients (HIV)-were retrospectively investigated for markers of past and recent/ongoing HEV infection. The estimated overall seroprevalence of past infection was 10.6%, ranging from 5.9% to 24.5% for the sub-populations evaluated, while the seroprevalence of recent/ongoing HEV infection was 7.5%, ranging from 2.1% to 20.4%. The analysis of the individual sub-populations showed a different prevalence with respect to sex. In regard to age, the cohort effect was preserved, as a multimodal pattern was observed only for the GBS sub-population. Molecular analysis revealed HEV 3f and 3e. The type of the population is one of the main factors on which the anti-HEV prevalence depends, highlighting the need for the development of guidelines related to the detection and diagnosis of HEV infection with regard to specific patient populations.
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Affiliation(s)
- Elitsa Golkocheva-Markova
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Chiydem Ismailova
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Sashka Zhelyazkova
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Medical University, 1431 Sofia, Bulgaria
| | - Stanislav Kotsev
- Department Infectious Diseases, Regional Hospital, 4400 Pazardzhik, Bulgaria
| | - Maria Pishmisheva
- Department Infectious Diseases, Regional Hospital, 4400 Pazardzhik, Bulgaria
| | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, 4002 Plovdiv, Bulgaria
| | - Asya Stoyanova
- NRL Enteroviruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Viliana Yoncheva
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Tencho Tenev
- NRL Hepatitis Viruses, Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Teodora Gladnishka
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Iva Trifonova
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Iva Christova
- NRL of Vector-Borne Infections, Listeria and Leptospires, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Roumen Dimitrov
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria
| | - Roberto Bruni
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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Yeom H, Seo S, Yoon Y, Lee J, Han MG, Lee DY, Park SW, Park SA, Jeong SH, Gwack J. The first reported hepatitis E outbreak in a food manufacturing factory: Korea, 2022. Osong Public Health Res Perspect 2023; 14:15-22. [PMID: 36944341 DOI: 10.24171/j.phrp.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES On February 16, 2022, 12 cases of hepatitis E virus (HEV) infection were reported in a food manufacturing factory in Korea. The aim of this study was to identify additional cases and to determine the source of this HEV outbreak. METHODS This study was an in-depth investigation of 12 HEV immunoglobulin M (IgM)-positive cases and their demographic, clinical, and epidemiological characteristics. On-site specimens were collected from the environment and from humans, and a follow-up investigation was conducted 2 to 3 months after the outbreak. RESULTS Among 80 production workers in the factory, 12 (15.0%) had acute HEV infection, all of whom were asymptomatic. The follow-up investigation showed that 3 cases were HEV IgMpositive, while 6 were HEV IgG-positive. HEV genes were not detected in the HEV IgM-positive specimens. HEV genes were not detected in the food products or environmental specimens collected on-site. HEV was presumed to be the causative pathogen. However, it could not be confirmed that the source of infection was common consumption inside the factory. CONCLUSIONS This was the first domestic case of an HEV infection outbreak in a food manufacturing factory in Korea. Our results provide information for the future control of outbreaks and for the preparation of measures to prevent domestic outbreaks of HEV infection.
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Affiliation(s)
- Hansol Yeom
- Division of Infectious Disease Response, Capital Regional Center for Disease Control and Prevention, Seoul, Korea
| | - Soonryu Seo
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Youngsil Yoon
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jaeeun Lee
- Division of Immunization, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Myung-Guk Han
- Division of Viral Disease, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Deog-Yong Lee
- Division of Viral Disease, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sun-Whan Park
- Division of Viral Disease, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Song A Park
- Division of Viral Disease, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Gwack
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Korea
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Zhou YH, Zhao H. Immunobiology and Host Response to HEV. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1417:93-118. [PMID: 37223861 DOI: 10.1007/978-981-99-1304-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Hepatitis E virus (HEV) usually causes acute self-limiting hepatitis but sometimes leads to chronic infection in immunocompromised persons. HEV is not directly cytopathic. Immunologically mediated events after HEV infection are believed to play important roles in the pathogenesis and clearance of infection. The anti-HEV antibody responses have been largely clarified since the determination of major antigenic determinant of HEV, which is located in the C-terminal portion of ORF2. This major antigenic determinant also forms the conformational neutralization epitopes. Robust anti-HEV immunoglobulin M (IgM) and IgG responses usually develop 3-4 weeks after infection in experimentally infected nonhuman primates. In humans, potent specific IgM and IgG responses occur in the very early phase of the disease and are critical in eliminating the virus, in concert with the innate and adaptive T-cell immune responses. Testing anti-HEV IgM is valuable in the diagnosis of acute hepatitis E. The long-term persistence and protection of anti-HEV IgG provide the basis for estimating the prevalence of HEV infection and for the development of a hepatitis E vaccine. Although human HEV has four genotypes, all the viral strains are considered to belong to a single serotype. It is becoming increasingly clear that the innate and adaptive T-cell immune responses play critical roles in the clearance of the virus. Potent and multispecific CD4+ and CD8+ T cell responses to the ORF2 protein occur in patients with acute hepatitis E, and weaker HEV-specific CD4+ and CD8+ T cell responses appear to be associated with chronic hepatitis E in immunocompromised individuals.
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Affiliation(s)
- Yi-Hua Zhou
- Departments of Experimental Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Hong Zhao
- Department of Infectious Diseases, Second Hospital of Nanjing, Southeast University School of Medicine, Nanjing, China
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López‐López P, Frias M, Camacho A, Machuca I, Caballero‐Gómez J, Risalde MA, García‐Bocanegra I, Pérez‐Valero I, Gomez‐Villamandos JC, Rivero‐Juárez A, Rivero A. Seroreversion of IgG anti-HEV in HIV cirrhotic patients: A long-term multi-sampling longitudinal study. Transbound Emerg Dis 2022; 69:e1541-e1548. [PMID: 35184415 PMCID: PMC9790577 DOI: 10.1111/tbed.14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/02/2022] [Accepted: 02/17/2022] [Indexed: 12/30/2022]
Abstract
The aim of our study was to evaluate HEV antibody kinetics in HIV/HCV-coinfected patients with cirrhosis. A longitudinal retrospective study was designed. Patients were followed up every 6 months; anti-HEV IgG and IgM antibodies levels and HEV-RNA by qPCR were analysed. The prevalence and incidence of every HEV infection marker were calculated. The kinetics of anti-HEV IgG and IgM during the follow-up were evaluated. Seventy-five patients comprised the study population. The seroprevalence observed was 17.3%. None showed IgM antibodies or HEV-RNA at baseline. None showed detectable HEV viral load during the study period. After a median follow-up of 5.1 years, two of 62 seronegative patients (3.2%) seroconverted to IgG antibody. The incidence for IgM was 2.7%. Of the 13 patients with IgG seropositivity at baseline, five (38.5%) seroreverted. Meanwhile, of the two patients who exhibited IgM positivity during the study, one (50%) showed intermittent positivity. We found that HEV seropositivity is common in HIV/HCV-coinfected cirrhotic patients. A remarkable rate of IgG seroreversions and IgM intermittence was found, limiting the use of antibodies for the diagnosis of HEV infection in this population.
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Affiliation(s)
- Pedro López‐López
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Mario Frias
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Angela Camacho
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Isabel Machuca
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Javier Caballero‐Gómez
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC,Animal Health and Zoonoses Research Group (GISAZ), Animal Health DepartmentUniversity of CordobaCordobaSpain
| | - María A. Risalde
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC,Animal Health and Zoonoses Research Group (GISAZ), Animal Pathology and Toxicology DepartmentUniversity of CordobaCordobaSpain
| | - Ignacio García‐Bocanegra
- CIBERINFEC,Animal Health and Zoonoses Research Group (GISAZ), Animal Health DepartmentUniversity of CordobaCordobaSpain
| | - Ignacio Pérez‐Valero
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Jose C. Gomez‐Villamandos
- CIBERINFEC,Animal Health and Zoonoses Research Group (GISAZ), Animal Pathology and Toxicology DepartmentUniversity of CordobaCordobaSpain
| | - Antonio Rivero‐Juárez
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
| | - Antonio Rivero
- Infectious Diseases Unit and Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia HospitalUniversity of CordobaCordobaSpain,CIBERINFEC
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10
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A novel model based on qAnti-HBc and conventional biomarkers for identifying significant liver injury among CHB patients with ALT ≤ ULN. Antiviral Res 2022; 202:105315. [DOI: 10.1016/j.antiviral.2022.105315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2022]
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11
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Fang L, Zhang J, Chen H, Lv F, Yu Y, Du X. Epidemiological Characteristics and Clinical Manifestations of Hepatitis E in a Tertiary Hospital in China: A Retrospective Study. Front Microbiol 2022; 12:831968. [PMID: 35310389 PMCID: PMC8928388 DOI: 10.3389/fmicb.2021.831968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 01/12/2023] Open
Abstract
Background Hepatitis E virus (HEV) infection is the most common cause of acute viral hepatitis worldwide and one of the main causes of death in the last decade, causing chronic hepatitis and liver failure in some populations. The aging population and obesity are two major factors threatening human health. Therefore, we want to understand the relationship between these two groups and HEV infection. Objectives The study aimed to analyze the epidemiological, clinical, and laboratory features of HEV infection and evaluate probable high-risk factors for disease progression and the current diagnostic strategies of hepatitis E infection. Study Design Patients diagnosed with acute hepatitis E with symptoms and liver dysfunction were enrolled. For statistical analysis, clinical features and laboratory findings were collected between the elderly and non-elderly and HEV+ fatty liver disease (FLD) groups. Statistical analysis was performed using Excel and the platform VassarStats, and statistical significance was taken as P < 0.05. Results Jaundice and the bilirubin peak were significantly deeper, the duration of hospitalization was significantly longer, and the proportion of ascites and liver failure was significantly higher in the elderly group. The aging population is one of the risk factors of severe hepatitis E. Hepatitis E becomes more serious in the HEV + FLD group, although the results did not reach statistical significance. Conclusion The aging and FLD were suggested to aggravate HEV infection. However, the diagnosis of HEV infection remains a challenge. A prospective study with sufficient sample size is needed to confirm this conclusion.
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Affiliation(s)
- Li Fang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junli Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huiying Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangfang Lv
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoxing Du
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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12
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Fritz-Weltin M, Frommherz E, Isenmann N, Niedermeier L, Csernalabics B, Boettler T, Neumann-Haefelin C, Endres D, Panning M, Berger B. Hepatitis E virus as a trigger for Guillain-Barré syndrome. BMC Neurol 2021; 21:304. [PMID: 34362318 PMCID: PMC8343920 DOI: 10.1186/s12883-021-02334-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. An association with neuralgic amyotrophy and Guillain-Barré syndrome (GBS) was previously described. Concerning GBS, studies from other countries found an acute HEV infection in 5–11% of cases. However, HEV prevalence shows considerable regional variations. Therefore, we retrospectively analyzed the frequency of HEV infections in association with GBS in a monocentric cohort in Southwestern Germany. Methods Overall, 163 patients with GBS treated in our clinic between 2008 and 2018 of whom serum and/or cerebrospinal fluid (CSF) samples were available, were identified. Serum samples were analyzed for anti-HEV immunoglobulin (Ig)M and IgG antibodies by ELISA. Additionally, both serum and cerebrospinal fluid (CSF) samples were tested for HEV RNA by PCR if IgM was positive or patients presented within the first 7 days from GBS symptom onset. A group of 167 healthy volunteers and 96 healthy blood donors served as controls. Results An acute HEV infection was found in two GBS patients (1.2%) with anti-HEV IgM and IgG antibodies. HEV PCR in serum and CSF was negative in these two patients as well as in all other tested cases. Seroprevalences indicated that acute infection did not differ significantly from controls (0.8%). Anti-HEV IgG seroprevalence indicating previous infection was unexpectedly high (41%) and revealed an age-dependent increase to more than 50% in patients older than 60 years. Conclusion In this study, serological evidence of an acute HEV infection in patients with GBS was rare and not different from controls. Comparing our data with previous studies, incidence rates show considerable regional variations.
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Affiliation(s)
- Miriam Fritz-Weltin
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Estelle Frommherz
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Nora Isenmann
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Lisa Niedermeier
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Benedikt Csernalabics
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Berger
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
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