Premium
Hepatitis E virus as a cause of acute hepatitis acquired in Switzerland
Author(s) -
Fraga Montserrat,
Doerig Christopher,
Moulin Hervé,
Bihl Florian,
Brunner Felix,
Müllhaupt Beat,
Ripellino Paolo,
Semela David,
Stickel Felix,
Terziroli BerettaPiccoli Benedetta,
Aubert Vincent,
Telenti Amalio,
Greub Gilbert,
Sahli Roland,
Moradpour Darius
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13557
Subject(s) - medicine , hepatitis e virus , hepatitis e , serology , genotype , acute hepatitis , genotyping , hepatitis , hepatitis c , virology , immunosuppression , immunology , antibody , biology , biochemistry , gene
Background Autochthonous hepatitis E is increasingly recognized as zoonotic infection in western countries. Serological assays have varying sensitivity and specificity. Methods We implemented molecular testing to identify and characterize acute hepatitis E acquired in Switzerland. Results Ninety‐three cases of mostly symptomatic acute hepatitis E acquired in Switzerland were documented by PCR between November 2011 and December 2016. Median HEV RNA was 7.5 x 10 4 IU /mL (range, 5.3 to 4.7 x 10 7 IU /mL). HEV genotyping was successful in 78 patients, revealing genotype 3 in 75 and genotype 4 in three patients. Phylogenetic analyses revealed a few limited geographical and temporal clusters. Of the 91 patients with available anti‐ HEV IgM serology, four were negative; three of these were also IgG‐negative, likely as a result of immunosuppression, and one was IgG‐positive, a constellation compatible with HEV reinfection. Median age of the patients was 58 years (range, 20‐80 years); 71 (76.3%) were men and 49 of these (69.0%) were ≥ 50 years old. The clinical course was particularly severe in patients with underlying chronic liver disease, with fatal outcome in two patients. Six patients (6.5%) presented with neuralgic amyotrophy. Conclusions Nucleic acid‐based diagnosis reveals HEV as a relevant cause of acute hepatitis in Switzerland. Middle‐aged and elderly men constitute the majority of symptomatic patients. Testing for HEV should be included early in the diagnostic workup of acute hepatitis and of neuralgic amyotrophy, a typical extrahepatic manifestation of HEV genotype 3 infection.