1
|
Rojc B, Šarabon N. A patient with bilateral neuralgic amyotrophy and hepatitis E virus infection: an educational communication. Eur J Transl Myol 2024; 34:12143. [PMID: 38226557 PMCID: PMC11017166 DOI: 10.4081/ejtm.2024.12143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024] Open
Abstract
Neuralgic Amyotrophy, a peripheral nervous system disorder, is characterized by severe pain and muscle weakness, which can have a significant impact on patients' quality of life. The exact cause of neuralgic amyotrophy is unknown, but it may be linked to immunopathological mechanisms. Recent research has found an association between neuralgic amyotrophy and hepatitis E virus infection. This communication aims to expand knowledge on the clinical phenotype of patients with neuralgic amyotrophy and hepatitis E virus infection, presenting the case of a 55-year-old man diagnosed with bilateral neuralgic amyotrophy and hepatitis E virus infection.
Collapse
Affiliation(s)
- Bojan Rojc
- General Hospital Izola, Neurology Service, Izola, Slovenia; University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper.
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Department of Physiotherapy, Izola.
| |
Collapse
|
2
|
Gupta HB, Deshpande T, Choraria N, Patel P, Sethia SG, Sethia S. Clinico-Serological Profile of Infective Causes of Acute Hepatitis in Children Admitted to a Tertiary Care Centre. Cureus 2023; 15:e38237. [PMID: 37252557 PMCID: PMC10225067 DOI: 10.7759/cureus.38237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Hepatitis is a major cause of healthcare burden in India. Hepatitis A is the most common cause of acute viral hepatitis in the pediatric population whereas hepatitis E virus (HEV) is the most important cause of epidemic hepatitis. Various other causes of acute infective hepatitis in children are dengue, malaria, and enteric fever. The aim of the present study is to understand the clinico-serological profile in cases of acute infective hepatitis in children. Methodology: The present study is a cross-sectional study that was carried out from 1 September 2017 to 31 March 2019. A total of 89 children in the age group 1-18 years with clinically suspected acute infective hepatitis and subsequent confirmation on laboratory tests were included in the study. RESULTS Hepatitis A (48.3%) was found to be the most common aetiology followed by dengue (22.5%) and hepatitis E (12.4%). No cases of hepatitis B or hepatitis C were found. The most common presenting complaint was fever (90%) and the most common clinical finding was icterus (69.7%). The sensitivity of icterus for the diagnosis of hepatitis was found to be 70%. Lab investigations showed a significant association between different etiologies of infective hepatitis with packed cell volume (PCV), white blood cell (WBC) count, and platelet count. Levels of aspartate aminotransferase (AST) and alanine transaminase (ALT) were raised in samples of patients with hepatitis A, hepatitis E, and combined hepatitis A and E infection as compared to other causes. All cases of hepatitis A and E were diagnosed with positive IgM antibody tests to the respective viral antigens. The most common complication was hepatic encephalopathy which was seen in patients with hepatitis A, dengue, and septicemia. Around 99% of patients recovered well and were discharged. One death occurred in a case of septicemia with septic shock with multiple organ dysfunction syndrome (MODS). CONCLUSION The most common cause of infective hepatitis in children is hepatitis A. Other causes like dengue, malaria, and typhoid should also be kept in mind. The absence of icterus does not rule out hepatitis. Lab investigations including serology are important to confirm the diagnosis of various causes of hepatitis. Timely immunization against hepatitis is strongly recommended.
Collapse
Affiliation(s)
- Harsh Bal Gupta
- Department of Paediatric Medicine, Cloud Nine Hospital, Panchkhula, IND
| | - Trupti Deshpande
- Department of Paediatric Medicine, Gujarat Medical Education and Research Society (GMERS) Gotri, Vadodara, IND
| | - Nirmal Choraria
- Department of Paediatric Medicine, Nirmal Hospital Pvt. Ltd., Surat, IND
| | - Putun Patel
- Department of Paediatric Medicine, Gujarat Medical Education and Research Society (GMERS) Gotri, Vadodara, IND
| | - Shruti G Sethia
- Department of Paediatric Medicine, Nandkumar Singh Chouhan Government Medical College, Khandwa, IND
| | - Soumitra Sethia
- Department of Community Medicine, Nandkumar Singh Chouhan Government Medical College, Khandwa, IND
| |
Collapse
|
3
|
Malik H, Malik H, Uderani M, Berhanu M, Soto CJ, Saleem F. Fulminant Hepatitis A and E Co-infection Leading to Acute Liver Failure: A Case Report. Cureus 2023; 15:e38101. [PMID: 37252544 PMCID: PMC10210521 DOI: 10.7759/cureus.38101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Acute liver failure (ALF) is a severe clinical condition with a high mortality rate. Although several factors can cause ALF, viral hepatitis remains one of the leading causes. Hepatitis A virus (HAV) and hepatitis E virus (HEV), which typically cause self-limiting acute disease, are rare but emerging causes of ALF, especially when both viruses infect the same individual. Both of these hepatotropic viruses share an enteric route and are most commonly transmitted through the fecal-oral route. The impact of HAV/HEV co-infection on acute hepatitis prognosis is not entirely understood, but dual infection can further exacerbate liver damage, leading to fulminant hepatic failure (FHF) with a higher mortality rate than a single virus infection. Here, we present a case of a 32-year-old male with no prior liver disease who presented to the emergency department with a two-week history of jaundice, abdominal pain, and hepatomegaly. Upon admission, he was disoriented with grade 2 encephalopathy. After a thorough investigation, co-infection with hepatitis A and E was identified as the primary cause of his ALF. The patient underwent intensive medical treatment and interventions, including dialysis. Unfortunately, the patient's survival was not possible due to the absence of availability of a transplanted organ, which is currently the only definitive treatment option. This case report underscores the significance of prompt diagnosis, timely intervention, and the accessibility of transplantation in the survival of liver failure, as it remains the sole definitive treatment for acute liver failure. Moreover, it provides a concise overview of the current literature on fulminant co-infection of HAV and HEV, including epidemiology, clinical characteristics, pathogenesis, diagnosis, treatment, and risk factors associated with co-infection of hepatitis A and E and their role in causing ALF. It also highlights the significance of identifying high-risk populations and implementing appropriate prevention and control measures such as vaccination, practising good hygiene and sanitation, and avoiding the consumption of contaminated food and water.
Collapse
Affiliation(s)
- Haider Malik
- Medical School, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Hamza Malik
- Medical School, Foundation University Medical College, Rawalpindi, PAK
| | - Muskan Uderani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Mefthe Berhanu
- Health Science, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Faraz Saleem
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK
| |
Collapse
|
4
|
Laurence Gérard, Margaux Garzaro, Venicia Ferrer, Marion Malphettes, Claire Fieschi, Jean-Luc Garnier, Nicolas Just, Agathe Masseau, Constance Delaugerre, Jacques Izopet, Eric Oksenhendler, Florence Abravanel. Hepatitis E infection in adults with primary immunodeficiency with or without immunoglobulin replacement therapy. Blood Transfus 2022; 20. [PMID: 35175187 DOI: 10.2450/2022.0258-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In a context of secondary immunodeficiency, hepatitis E virus (HEV) infection can be responsible for chronic liver disease. MATERIALS AND METHODS We investigated HEV infection in patients with primary immunodeficiency treated (or not) with immunoglobulin (Ig) replacement therapy (IgRT) in France, a country with a high seroprevalence of HEV. In a nationwide study of individuals with primary immunodeficiency, 533 patients (349 and 184 receiving IgRT or not, respectively) were tested for HEV RNA and anti-HEV antibodies. In addition, 23 batches of five different commercially available immunoglobulin preparations were screened for anti-HEV IgG. RESULTS Three of the 533 patients displayed markers of a recent HEV infection (HEV RNA in one case, and anti-HEV IgG and IgM in two) but no evidence of chronic liver disease. The overall seroprevalence of HEV was 50% (266 out of 533), with values of 68% and 16% in patients receiving IgRT or not, respectively (p<0.001). Anti-HEV IgG were detected in all batches of immunoglobulin preparations, although the titer varied from 3 to 127 IU/g IgG. Seroconversion was observed in 15 of the 22 (68%) patients tested before and after IgRT. DISCUSSION No cases of chronic HEV-related disease were detected among patients with primary immunodeficiency and hypogammaglobulinemia, whether they received IgRT or not. This confirms that patients with primary immunodeficiency have a low risk of chronic infection despite a seroprevalence close to that observed in the French general population and that IgRT, which confers a high HEV seroprevalence, might play a key role in protection against chronic infection.
Collapse
|
5
|
Fontana RJ, Engle RE, Hayashi PH, Gu J, Kleiner DE, Nguyen H, Barnhart H, Hoofnagle JH, Farci P. Incidence of Hepatitis E Infection in American Patients With Suspected Drug-Induced Liver Injury Is Low and Declining: The DILIN Prospective Study. Am J Gastroenterol 2022; 117:1462-1470. [PMID: 35973149 PMCID: PMC9437122 DOI: 10.14309/ajg.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hepatitis E virus (HEV) infection rarely causes icteric hepatitis, yet 10%-40% of adult Americans have serological evidence of previous infection. The aim of this study was to investigate the incidence, presentation, and outcome of acute and previous HEV infection in a large cohort of patients with suspected drug-induced liver injury (DILI). METHODS Serum samples from 2012 patients enrolled in the DILI Network were tested for anti-HEV immunoglobulin G (IgG). Those with detectable anti-HEV IgG underwent testing for anti-HEV IgM; those with detectable anti-HEV immunoglobulin m (IgM) were tested for HEV RNA. RESULTS Anti-HEV IgG was detected in 407 (20%) patients and associated with increasing subject age and earlier year of enrollment. The median age of seropositive subjects was more than a decade higher than seronegative subjects (59.8 vs 48.7 years). The overall prevalence of anti-HEV declined from 22% (2004-2011) to 18% (2012-2019), suggestive of a cohort effect. The frequency of acute hepatitis E (median ALT = 1231 IU/L) also decreased from 3% (2004-2008) to 1.2% (2009-2013) to 0.6% (2014-2019). These results suggest that acute HEV infection is usually subclinical and was much more frequent in this cohort before 2004. DISCUSSION Acute HEV infection accounts for less than 1% of suspected American DILI cases and is more frequent in older men. Previous HEV infection is also most commonly seen in older individuals. Clinicians should consider testing for unsuspected acute HEV infection in older adult patients with acute hepatocellular DILI and jaundice.
Collapse
Affiliation(s)
- Robert John Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald E Engle
- Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, NIAID, Bethesda, Maryland, USA
| | - Paul H Hayashi
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hahn Nguyen
- Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, NIAID, Bethesda, Maryland, USA
| | - Huiman Barnhart
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jay H Hoofnagle
- Department of Medicine, Ohio State University, Columbus, Ohio, USA
- National Institute of Diabetes and Digestive and Kidney-Diseases, Bethesda, Maryland, USA
| | - Patrizia Farci
- Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, NIAID, Bethesda, Maryland, USA
| |
Collapse
|
6
|
Zitelli PMY, Gomes-Gouvêa M, Mazo DF, Singer JDM, Oliveira CP, Farias AQ, Pinho JR, Tanigawa RY, Alves VAF, Carrilho FJ, Pessoa MG. Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection. Clinics (Sao Paulo) 2021; 76:e3270. [PMID: 34852140 PMCID: PMC8595601 DOI: 10.6061/clinics/2021/e3270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis ≥3 versus ≤2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of ≥1.45 (p=0.003), and Fibrosis-4 score of ≥3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.
Collapse
Affiliation(s)
- Patricia Momoyo Yoshimura Zitelli
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Michele Gomes-Gouvêa
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Daniel F. Mazo
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Gastroenterologia (Gastrocentro), Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Julio da Motta Singer
- Departamento de Estatistica, Instituto de Matematica e Estatistica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia P.M.S. Oliveira
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alberto Queiroz Farias
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - João Renato Pinho
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ryan Yukimatsu Tanigawa
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Flair José Carrilho
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mário Guimarães Pessoa
- Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
7
|
Meyyur Aravamudan V, Khan SR, Dosala S, Hussain I. Beyond the Liver, Hepatitis E Can Affect the Nerves, Pancreas, and Blood Vessels. Extrahepatic Manifestations of Hepatitis E: A Comprehensive Literature Review. Cureus 2019; 11:e5499. [PMID: 31667034 PMCID: PMC6816525 DOI: 10.7759/cureus.5499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Extrahepatic manifestations of Hepatitis E, though rare, are being increasingly reported in the medical literature. In this review article, we will discuss the extrahepatic manifestations of hepatitis E, such as Guillain-Barre syndrome, pancreatitis, and cryoglobulinemia, their clinical association with hepatitis E, and their management.
Collapse
Affiliation(s)
| | - Shahab R Khan
- Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, USA
| | - Sushanth Dosala
- Internal Medicine, University of Illinois at Chicago, Illinois, USA
| | - Ikram Hussain
- Internal Medicine: Gastroenterology, Woodlands Health Campus, Singapore, SGP
| |
Collapse
|
8
|
Malghani WS, Jan W, Tameez Ud Din A, Raza A, Chaudhary FMD. Acute Hepatitis E in a Young Male. Cureus 2019; 11:e5414. [PMID: 31632867 PMCID: PMC6795373 DOI: 10.7759/cureus.5414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 11/23/2022] Open
Abstract
Hepatitis E (Hep E) is a type of liver disease caused by hepatitis E virus (HEV), which is a single-stranded 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.
Collapse
Affiliation(s)
| | - Waseem Jan
- Gastroenterlogy, Nishtar Medical University & Hospital, Multan, PAK
| | | | - Ali Raza
- Gastroenterology, Nishtar Medical University & Hospital, Multan, PAK
| | | |
Collapse
|
9
|
Abstract
Foodborne pathogens cause acute and chronic health outcomes of very different durations, severity and mortality, resulting in high costs and burdens to society. The issues of food safety and food poisoning are being increasingly emphasised, particularly in developed countries. Infection/contamination with many agents i.e., bacterial, parasitic and viral entities can result in foodborne illness. This article will focus mainly on viral agents of infection. A range of different viruses can cause food poisoning/foodborne infection, and infection can result in a myriad of symptoms, ranging from mild, acute disease to chronic, debilitating disease and even death. Due to the inherent differences between bacteria and viruses, namely the fact that viruses do not replicate in food, while bacteria do, viruses are frequently difficult to detect. This is compounded by the fact that many of the viruses associated with enteric disease do not replicate in cell culture. These factors can lead to a lag between reporting, detection and analysis of foodborne viruses versus bacterial agents. Despite these constraints, it is now evident that there are both well-established and emerging viruses implicated in foodborne infections, and the role of molecular detection and characterisation is becoming increasingly important.
Collapse
|
10
|
Grierson S, Rabie A, Lambert M, Choudhury B, Smith RP. HEV infection not evident in rodents on English pig farms. Vet Rec 2017; 182:81. [PMID: 29196489 DOI: 10.1136/vr.104417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/16/2017] [Accepted: 11/05/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Sylvia Grierson
- Department of Virology, Animal and Plant Health Agency, Addlestone, UK
| | - Andre Rabie
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, UK
| | - Mark Lambert
- National Wildlife Management Centre, Animal and Plant Health Agency, Sand Hutton, UK
| | - Bhudipa Choudhury
- Department of Virology, Animal and Plant Health Agency, Addlestone, UK
| | - Richard P Smith
- Department of Epidemiological Sciences, Animal and Plant Health Agency, Addlestone, UK
| |
Collapse
|
11
|
Luetkemeyer AF, Wyles DL. CROI 2016: Viral Hepatitis and Liver Fibrosis. Top Antivir Med 2016; 24:47-58. [PMID: 27398862 PMCID: PMC6148925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 06/06/2023]
Abstract
At the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, Massachusetts, hepatitis C virus (HCV) infection remained a major theme in the context of HIV-associated liver disease, although other causes of liver disease garnered increased attention, including fatty liver disease, hepatitis B, and the impact of HIV disease itself on the liver. Although no data from phase III studies of HCV direct-acting antiviral (DAA) drugs for the treatment of HIV/HCV coinfection were presented at CROI 2016, a broad range of HCV DAA-related topics were presented, including accumulating experience with real-world performance of DAA-based regimens outside of clinical trials, drug interactions between DAA and antiretroviral drugs, treatment of acute HCV infection, and retreatment of individuals whose DAA-based regimens failed and those in whom resistance to DAA drugs emerged. A summary of select abstracts from CROI 2016 is presented, including discussion of clinical relevance where appropriate and areas for future research.
Collapse
Affiliation(s)
- Anne F Luetkemeyer
- University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - David L Wyles
- University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
12
|
Kim JH, Nelson KE, Panzner U, Kasture Y, Labrique AB, Wierzba TF. A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infect Dis 2014; 14:308. [PMID: 24902967 PMCID: PMC4055251 DOI: 10.1186/1471-2334-14-308] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 05/28/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis E Virus (HEV) infection is a newly recognized serious threat to global public health and Africa is suspected to be among the most severely affected regions in the world. Understanding HEV epidemiology in Africa will expedite the implementation of evidence-based control policies aimed at preventing the spread of HEV including policies for the use of available resources such as HEV vaccines. METHODS Here we present a comprehensive review of HEV epidemiology in Africa based on published data. We searched for articles on HEV epidemiology in Africa from online databases such as PubMed, Scopus, and ISI Web of Science and critically reviewed appropriate publications to extract consistent findings, identify knowledge gaps, and suggest future studies. RESULTS Taking a particularly high toll in pregnant women and their fetuses, HEV has infected human populations in 28 of 56 African countries. Since 1979, 17 HEV outbreaks have been reported about once every other year from Africa causing a reported 35,300 cases with 650 deaths. CONCLUSIONS In Africa, HEV infection is not new, is widespread, and the number of reported outbreaks are likely a significant underestimate. The authors suggest that this is a continent-wide public health problem that deserves the attention of local, regional and international agencies to implement control policies that can save numerous lives, especially those of pregnant women and their fetuses.
Collapse
Affiliation(s)
- Jong-Hoon Kim
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul 151-919, South Korea
| | - Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Ursula Panzner
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul 151-919, South Korea
| | - Yogita Kasture
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul 151-919, South Korea
| | - Alain B Labrique
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Thomas F Wierzba
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul 151-919, South Korea
| |
Collapse
|
13
|
Zhao Q, Zhang J, Wu T, Li SW, Ng MH, Xia NS, Shih JWK. Antigenic determinants of hepatitis E virus and vaccine-induced immunogenicity and efficacy. J Gastroenterol 2013; 48:159-68. [PMID: 23149436 PMCID: PMC3698418 DOI: 10.1007/s00535-012-0701-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/08/2012] [Indexed: 02/07/2023]
Abstract
There is emerging evidence for an under-recognized hepatitis E virus (HEV) as a human pathogen. Among different reasons for this neglect are the unsatisfactory performance and under-utilization of commercial HEV diagnostic kits; for instance, the number of anti-HEV IgM kits marketed in China is about one-fifth of that of hepatitis A kits. Over the last two decades, substantial progress has been achieved in furthering our knowledge on the HEV-specific immune responses, antigenic features of HEV virions, and development of serological assays and more recently prophylactic vaccines. This review will focus on presenting the evidence of the importance of HEV infection for certain cohorts such as pregnant women, the key antigenic determinants of the virus, and immunogenicity and clinical efficacy conferred by a newly developed prophylactic vaccine. Robust immunogenicity, greater than 195-fold and approximately 50-fold increase of anti-HEV IgG level in seronegative and seropositive vaccinees, respectively, as well as impressive clinical efficacy of this vaccine was demonstrated. The protection rate against the hepatitis E disease and the virus infection was shown to be 100% (95% CI 75-100) and 78% (95% CI 66-86), respectively.
Collapse
Affiliation(s)
- Qinjian Zhao
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - Jun Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - Ting Wu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - Shao-Wei Li
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - Mun-Hon Ng
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - Ning-Shao Xia
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| | - James Wai-Kuo Shih
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, 422 Siming South Road, Xiamen, 361005 People’s Republic of China
| |
Collapse
|
14
|
|
15
|
Ippagunta SK, Naik S, Jameel S, KN SR, Aggarwal R. Viral RNA but no evidence of replication can be detected in the peripheral blood mononuclear cells of hepatitis E virus-infected patients. J Viral Hepat 2011; 18:668-72. [PMID: 20659304 PMCID: PMC3075346 DOI: 10.1111/j.1365-2893.2010.01351.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hepatitis E virus (HEV) infection is an important cause of acute viral hepatitis in several developing countries but has recently been shown to cause chronic hepatitis in immunosuppressed persons. Other hepatotropic viruses that cause chronic infection have been shown to infect peripheral blood mononuclear cells (PBMCs) and to persist in those cells. We therefore decided to look for evidence of replication of HEV in PBMCs obtained from patients with acute hepatitis E, using strand-specific assays for positive and negative HEV RNA. Of the 44 patients with acute hepatitis E during an outbreak in India, including 27 with detectable IgM anti-HEV and 19 with detectable serum HEV RNA, 11 had detectable HEV RNA in their PBMCs. However, of the six PBMC specimens with strong HEV RNA signal, none had detectable negative-strand HEV RNA, a marker of viral replication. These findings indicate the presence of HEV RNA but the absence of its replication in PBMCs from patients with acute hepatitis E.
Collapse
Affiliation(s)
- Sirish Kumar Ippagunta
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sita Naik
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Shahid Jameel
- Virology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Sudha Ramana KN
- Sir Ronald Ross Institute of Tropical and Communicable Diseases, Government Fever Hospital, Hyderabad 530 044, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| |
Collapse
|
16
|
Abstract
BACKGROUND Hepatitis E virus (HEV) is an enterically transmitted cause of viral hepatitis rarely noted without international travel. OBJECTIVE To report the first case of an HIV-infected man with acute hepatitis due to HEV infection who had not traveled outside the United States.
Collapse
|
17
|
Abstract
Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, particularly from certain geographical areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (oestrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include downregulation of the p65 component of nuclear factor (NF-kappaB) with a predominant T-helper type 2 (Th2) bias in the T-cell response along with host susceptibility factors, mediated by human leucocyte antigen expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review the possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.
Collapse
Affiliation(s)
- Udayakumar Navaneethan
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Mayar Al Mohajer
- Department of Internal Medicine, University of Cincinnati Medical Center, Ohio, USA
| | - Mohamed T Shata
- Associate Research Prof. of Medicine, Division of Digestive diseases University of Cincinnati College of Medicine, Ohio, USA
| |
Collapse
|
18
|
Shata MT, Barrett A, Shire NJ, Abdelwahab SF, Sobhy M, Daef E, El-Kamary SS, Hashem M, Engle RE, Purcell RH, Emerson SU, Strickland GT, Sherman KE. Characterization of hepatitis E-specific cell-mediated immune response using IFN-gamma ELISPOT assay. J Immunol Methods 2007; 328:152-61. [PMID: 17905301 PMCID: PMC2094100 DOI: 10.1016/j.jim.2007.08.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 08/09/2007] [Accepted: 08/29/2007] [Indexed: 02/08/2023]
Abstract
In developing countries, hepatitis E (HEV) and hepatitis A (HAV) are the major causes of acute viral hepatitis with similar feco-oral modes of transmission. In contrast to the high seroprevalence of hepatitis A infection, a low seroprevalence of HEV among children in endemic areas has been reported. These data suggest the possibility that silent HEV infection is undiagnosed by the current available methods. Many of the serological tests used for HEV diagnosis have poor specificity and are unable to differentiate among different genotypes of HEV. Moreover, the RT-PCR used for HEV isolation is only valid for a brief period during the acute stage of infection. Cell-mediated immune (CMI) responses are highly sensitive, and long lasting after sub-clinical infections as shown in HCV and HIV. Our objective was to develop a quantitative assay for cell-mediated immune (CMI) responses in HEV infection as a surrogate marker for HEV exposure in silent infection. Quantitative assessment of the CMI responses in HEV will also help us to evaluate the role of CMI in HEV morbidity. In this study, an HEV-specific interferon-gamma (IFN-gamma) ELISPOT assay was optimized to analyze HEV-specific CMI responses. We used peripheral blood mononuclear cells (PBMC) and sera from experimentally infected chimpanzees and from seroconverted and control human subjects to validate the assay. The HEV-specific IFN-gamma ELISPOT responses correlated strongly and significantly with anti-HEV ELISA positive/negative results (rho=0.73, p=0.02). Moreover, fine specificities of HEV-specific T cell responses could be identified using overlapping HEV ORF2 peptides.
Collapse
Affiliation(s)
- M T Shata
- Internal Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45267-0595, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Joshi M, Walimbe A, Arankalle V, Chadha M, Chitambar S. Hepatitis E antibody profiles in serum and urine. J Clin Lab Anal 2002; 16:137-42. [PMID: 11968050 PMCID: PMC6807706 DOI: 10.1002/jcla.10027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2001] [Accepted: 12/19/2001] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to evaluate anti-HEV antibody profiles in urine specimens in comparison to corresponding serum samples to assess the utility of urine as a clinical specimen. Paired serum and urine specimens from 71 hepatitis E patients, 33 non-E hepatitis patients, 63 patients with nonhepatic diseases, and 26 healthy individuals were tested by recombinant HEV protein (55 kD)-based indirect enzyme-linked immunosorbent assay (ELISA). Uronegativity for anti-HEV IgM was noted in 71 (100%) serologically confirmed patients with hepatitis E. Hepatitis E patients (10/10) showed urinary absence or very low levels of total IgM by capture ELISA, suggesting absence or low levels of filtration, and/or local synthesis, and/or transudation of IgM in urine during infection. When these patients were tested for total IgG and IgA, microquantities of immunoglobulins were noted in all urine samples (10/10 for each). However, the proportions of uropositivity for anti-HEV IgG and IgA in hepatitis E patients were low and indicated only 21.42% and 49.33% concordance with seropositivity, respectively. Control groups also showed low and variable uropositivity for anti-HEV IgG and IgA. Overall, HEV-specific antibodies exhibited by serum in recent and past infections were not found in urine. The study demonstrated the inadequacy of urine specimens for detection of hepatitis E antibodies.
Collapse
Affiliation(s)
- M.S. Joshi
- Hepatitis Division, National Institute of Virology, Pune, India
| | - A.M. Walimbe
- Hepatitis Division, National Institute of Virology, Pune, India
| | - V.A. Arankalle
- Hepatitis Division, National Institute of Virology, Pune, India
| | - M.S. Chadha
- Hepatitis Division, National Institute of Virology, Pune, India
| | - S.D. Chitambar
- Hepatitis Division, National Institute of Virology, Pune, India
| |
Collapse
|