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Clin Gastroenterol Hepatol. 2015 Oct;13(10):1836-1842.e2; quiz e157-8. doi: 10.1016/j.cgh.2015.04.014. Epub 2015 Apr 23.

Hepatitis E Virus Infection as a Possible Cause of Acute Liver Failure in Europe.

Author information

1
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
2
Regeneration and Repair Group, Foundation for Liver Research, The Institute of Hepatology, London, United Kingdom.
3
Regeneration and Repair Group, Foundation for Liver Research, The Institute of Hepatology, London, United Kingdom; Department of Hepatology, Barts Health NHS Trust, London, United Kingdom.
4
Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany.
5
Institute of Pathology and Neuropathology, University Hospital, University Duisburg-Essen, Essen, Germany.
6
Institute of Virology, University Hospital, University Duisburg-Essen, Essen, Germany.
7
Institute for Virology, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
8
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany. Electronic address: ali.canbay@uni-due.de.

Abstract

BACKGROUND & AIMS:

In Western countries, infection with the hepatitis E virus (HEV) is considered to be rare and imported from endemic regions. However, the prevalence of HEV infection has increased among adults in central Europe. HEV infection can cause acute liver failure (ALF), but there have been only a few confirmed cases of HEV-associated ALF in Europe. We investigated the number of cases of indeterminate ALF associated with HEV infection.

METHODS:

We performed a retrospective analysis of 80 patients diagnosed with ALF or acute hepatitis at the University Hospital Essen in Germany from November 2006 through December 2013. Clinical data were collected from the hospital databases; archived sera were tested for IgG and IgM against HEV, as well as HEV RNA.

RESULTS:

Sera from 12 patients (15%) tested positive for IgG against HEV IgG; 7 of these samples did not test positive for HEV IgM or HEV RNA. Sera from 64 patients (80%) did not test positive for IgG or IgM against HEV or HEV RNA. Sera from 8 patients (10%) tested positive for HEV RNA (only 4 of these were positive for HEV IgG) and had clinical findings to support acute HEV infection.

CONCLUSIONS:

In a hospital in Germany, approximately 10% to 15% of patients with ALF had evidence for HEV infection. Serologic tests for IgG against HEV are insufficient to identify or exclude HEV infection; tests for HEV RNA also should be performed on patients with ALF of ambiguous etiology.

KEYWORDS:

Blood Test; Diagnosis; Hepatitis E; Liver Disease

Comment in

PMID:
25912835
DOI:
10.1016/j.cgh.2015.04.014
[Indexed for MEDLINE]

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