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Hepatic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Ghassan M. Hammoud, Jamal A. Ibdah
Hepatitis E virus (HEV) is a positive-stranded RNA virus that belongs to the Hepeviridae family. The virus is transmitted via the fecal–oral route, commonly by contaminated water supplies. Vertical transmission of hepatitis E virus ranged between 33% and 50% (33,34). The virus is endemic in the Middle East, India, Southeast Asia, Central Asia, Central America, and South America. Hepatitis E is an acute disease that does not progresses to chronicity, although reports of chronic HEV have been described in liver transplant recipients (35,36). The clinical presentation is basically the same as that for HAV. HEV infection is known to cause severe hepatitis, fulminant liver failure, preterm labor, and increased mortality in pregnant women especially in their third trimester with reported maternal mortality rates as high as 20% to 31.1% (4,37). The incubation period is 3–8 weekes, with a mean of 40 days. Cholestatic hepatitis is common. Acute hepatitis E infection is diagnosed by detection of IgM anti-HEV or a rising titer of IgG anti-HEV. The treatment is supportive therapy. A proved effective vaccine against HEV is currently not available. There is no current evidence that HEV infection is transmitted in breast milk.
Hepatitis E
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
After the discovery of the hepatitis E virus as a separate entity, it has become clear that it is a significant cause of endemic hepatitis in developing countries. Because genotypes 1 and 2 of hepatitis E are transmitted via the fecal-oral route, it is endemic in places where access to hygienic cooking facilities, clean drinking water and sewage systems is poor. Depending on the location, it may comprise 25%–70% of acute hepatitis cases. More recently, however, it has become clear that in developed countries, genotypes 3 and 4 cause hepatitis through consumption of pig and wild boar meat. Possibly, other animals are a reservoir for hepatitis E too, though it is as yet unclear how many transmissions to man occur through these other animals. Screening of blood donors in Europe showed that 5%–30% are seropositive for hepatitis E IgG and that 1:600 to 1:7000 patients are viraemic. Some countries have introduced screening of blood donors for hepatitis E because of documented transmission through blood transfusion; however, screening of donated blood is not universal yet.
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Hepatitis E virus (HEV) is an RNA virus that is transmitted fecal-orally. The HEV infection is a major cause of ALF in developing countries, comprising 20%–40% of all ALF cases. In pregnancy, especially in the third trimester, the disease is more severe and has a mortality rate of 20% [9,10]. The incubation period ranges from 15–60 days, and symptoms are similar to that of other viral hepatitides. Symptoms generally coincide with an acute elevation of ALT and AST levels in the 1000s, along with elevated serum bilirubin and INR. The diagnosis is based on the detection of IgM anti-HEV antibodies, HEV RNA, or the development of IgG anti-HEV antibodies within 6–12 months in a previously seronegative individual. IgM anti-HEV appears during the early phase of an acute infection and disappears over 4–5 months, while IgG anti-HEV appears shortly after IgM and persists through the convalescent phase. The HEV RNA is not readily available and needs to be sent to specialized laboratories or to the CDC to obtain results. There is no specific therapy for HEV, and treatment includes fluids and supportive care (Table 23.1).
Acute hepatitis E in an immunocompromised patient with seropositive rheumatoid arthritis on rituximab and long-term methotrexate
Published in Modern Rheumatology Case Reports, 2021
Bryan Dalton, Gaye Cunnane, Richard Conway
Hepatitis E virus (HEV) was first detected as a nonA–nonB cause of acute hepatitis in the 1980s in developing countries, and is now the most common cause of acute hepatitis globally [1]. HEV infection is increasingly detected in western civilisation in immunosuppressed individuals, primarily post-transplant patients or those with haematological malignancies [2,3]. However, there has been increased recognition of hepatitis E in those who are immunocompromised for autoimmune conditions [4]. This is concerning particularly as there is growing evidence of autochthonous HEV infection in developed countries and new endemic areas in recent years, such as southwest France [5]. HEV3 is the most commonly recognised genotype in developed countries, with evidence of enteric zoonotic transmission from pig, wild boar, deer and mongoose [6].
Are VIDAS® anti-HEV IgM and IgG assays fit for reliable diagnosis of hepatitis E virus infections? Comparison & case story telling
Published in Acta Clinica Belgica, 2021
Lien Cattoir, Koen O.A. Vercauteren, Elizaveta Padalko, Hans De Beenhouwer, Kristien Van Vaerenbergh, An Boel
Our validation and the cases we described gave us some insight into the behavior and positioning of the new VIDAS® serological HEV assays in the diagnosis of acute HEV infections. HEV serology (IgM and IgG) can still be negative in the very beginning of an acute HEV infection, even if liver parameters are already disturbed. Thus, in case of a strong clinical suspicion and negative HEV serology, molecular detection of HEV RNA can be useful (an alternative is follow-up serology a few days later). The time interval between the moment HEV IgM becomes detectable and HEV IgG becomes detectable seems to be patient (and potentially assay-) dependent and can be very short. Therefore, an isolated HEV IgM positive result can be confirmed by either a follow up sample to detect a seroconversion of HEV IgG or by molecular detection of HEV RNA. In the herein presented acute HEV cases, liver parameters recover within weeks (ultimately within one month) after the onset of symptoms. While HEV RNA declines or becomes undetectable, HEV IgM remains positive during this time course.
Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention
Published in Expert Review of Vaccines, 2020
Carl D Kirkwood, Katherine R Dobscha, A Duncan Steele
Hepatitis E virus (HEV) is an important cause of enterically transmitted viral hepatitis and contributes to over 50% of the acute viral hepatitis cases in endemic areas [1]. A World Health Organization (WHO)-funded modeling study estimated that 20 million people were infected with HEV in 2005, with estimated 3.3 million clinical cases, up to 70,000 deaths, and 3000 stillbirths, mostly in Asia and Africa [2], causing 3.3% of all deaths from viral hepatitis worldwide [3]. HEV accounted for 1.7% of the total global healthy years of life lost (738,508 disability-adjusted life years) due to hepatitis in 2017 [4]. The most affected populations are among the world’s most vulnerable groups – pregnant women and their neonates, as well as displaced persons and those living in resource-limited settings with poor access to clean water and sanitation. HEV is a significant contributor to global maternal mortality, with reported case-fatality rates (CFRs) of 20–30% in pregnant women with the symptomatic disease [5,6]. In industrialized countries, HEV is a growing concern particularly in immunocompromised individuals and patients with chronic liver disease are also at risk for the severe disease after HEV infection [7,8]. However, given the lack of appropriate surveillance or outbreak investigations, these data are very likely significantly under-reported.