scholarly journals Hepatitis E as a cause of adult hospitalization in Bangladesh: Results from an acute jaundice surveillance study in six tertiary hospitals, 2014-2017

2019 ◽  
Author(s):  
Repon C Paul ◽  
Arifa Nazneen ◽  
Kajal C Banik ◽  
Shariful Amin Sumon ◽  
Kishor K Paul ◽  
...  
Keyword(s):  
Water Quality ◽  
Acute Hepatitis ◽  
Pregnant Women ◽  
Case Fatality ◽  
Hepatitis E ◽  
Control Measures ◽  
Hygiene Practices ◽  
Sanitation And Hygiene ◽  
Tertiary Hospitals ◽  
Acute Hepatitis E

AbstractIn the absence of reliable data on the burden of hepatitis E virus (HEV) in high endemic countries, we established a hospital-based acute jaundice surveillance program in six tertiary hospitals in Bangladesh to estimate the burden of HEV infection among hospitalized acute jaundice patients aged ≥14 years, identify seasonal and geographic patterns in the prevalence of hepatitis E, and examine factors associated with death.We collected blood specimens from enrolled acute jaundice patients, defined as new onset of either yellow eyes or skin during the past three months of hospital admission, and tested for immunoglobulin M (IgM) antibodies against HEV, HBV and HAV. The enrolled patients were followed up three months after hospital discharge to assess their survival status; pregnant women were followed up three months after their delivery to assess pregnancy outcomes.From December’2014 to September’2017, 1925 patients with acute jaundice were enrolled; 661 (34%) had acute hepatitis E, 48 (8%) had hepatitis A, and 293 (15%) had acute hepatitis B infection. Case fatality among hepatitis E patients was 5% (28/589). Most of the hepatitis E cases were males (74%; 486/661), but case fatality was higher among females—12% (8/68) among pregnant and 8% (7/91) among non-pregnant women. Half of the patients who died with acute hepatitis E had co-infection with HAV or HBV. Of the 62 HEV infected mothers who were alive until the delivery, 9 (15%) had miscarriage/stillbirth, and of those children who were born alive, 19% (10/53) died, all within one week of birth.This study confirms that hepatitis E is the leading cause of acute jaundice, leads to hospitalizations in all regions in Bangladesh, occurs throughout the year, and is associated with considerable morbidity and mortality. Effective control measures should be taken to reduce the risk of HEV infections including improvements in water quality, sanitation and hygiene practices and the introduction of HEV vaccine to high-risk groups.Author summaryIn the absence of reliable surveillance data on the burden of hepatitis E in endemic countries, we conducted a hospital-based acute jaundice surveillance study over a two and a half year period in six tertiary hospitals in Bangladesh. The study confirms that HEV infections occur throughout the year, and is a major (34%) cause of acute jaundice in tertiary hospitals in Bangladesh. Three-quarters of the acute hepatitis E cases were male, and HEV infection was higher among patients residing in urban areas than patients in rural areas (41% vs 32%). The overall case fatality rate of acute HEV infections in hospitals was 5%, but was higher among pregnant women (12%). Hepatitis E patients who died were more likely to have co-infection with HAV or HBV than the HEV infected patients who did not die. Fifteen percent of HEV infected mothers had miscarriage/stillbirth. Of the children who were born alive, 19% died, all within one week of birth. Considering the high burden of hepatitis E among hospitalized acute jaundice patients, Bangladesh could take control measures to reduce this risk including improvements in water quality, sanitation and hygiene practices and the introduction of hepatitis E vaccine in high-risk areas.

Acute hepatitis E virus in pregnant women in Israel and in other industrialized countries

2015 ◽  
Vol 73 ◽  
pp. 20-24 ◽  
Author(s):  
Tamar Lachish ◽  
Ortal Erez ◽  
Nili Daudi ◽  
Daniel Shouval ◽  
Eli Schwartz
Keyword(s):  
Acute Hepatitis ◽  
Pregnant Women ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Industrialized Countries ◽  
Acute Hepatitis E

scholarly journals Association of poor virus specific immunoglobulin G antibody responses with higher viral load is seen in Bangladeshi pregnant women having acute Hepatitis E Genotype 1 infection

2020 ◽  
Author(s):  
Rosy Sultana ◽  
Md Tarikul Islam ◽  
Golam Sarower Bhuyan ◽  
Farjana Akther Noor ◽  
Suprovath Kumar Sarker ◽  
...  
Keyword(s):  
Viral Load ◽  
Acute Hepatitis ◽  
Pregnant Women ◽  
South Asian ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Genotype 1 ◽  
Asian Countries ◽  
Igg Antibody ◽  
Acute Hepatitis E

AbstractAlthough Hepatitis E viral illness is usually self-limiting, higher rates of morbidity and mortality are frequently observed during pregnancy in South Asian countries including Bangladesh. Of the four common variants, hepatitis E virus genotype 1 is mainly prevalent in South Asian countries. Pregnant women usually suffer from a state of immunosuppression. It is yet to be known whether virus specific immunoglobulin G (IgG) immune responses have any association with the vulnerability of pregnant women to acute hepatitis with E virus. The study aimed to compare the viral load and IgG responses of hepatitis E-infected pregnant women with that of non-pregnant women with same infection. Real Time –quantitative reverse transcription Polymerase Chain Reaction and Sanger sequencing were performed to determine the viral load and genotype, respectively, whereas Enzyme Linked Immunosorbent Assay method was used to determine hepatitis E virus specific serum IgG antibody index along with IgG avidity index. Although significant negative correlations were observed between log viral copy number and log IgG antibody index in the late acute phases of jaundice for both pregnant (r= −0.7971, p=0.0002) and non-pregnant women (r= −0.9117, p=0.0002), serum log viral copy number of pregnant women was significantly higher than that of the non-pregnant counterpart (p=0.0196) in the late acute stage of jaundice. In addition, log hepatitis E virus IgG antibody index of pregnant women was significantly lower than the non-pregnant women in the late phase of jaundice induced by hepatitis E virus (p=0.0303). Moreover, pregnant women with acute hepatitis E had higher cross-reactive IgG than in the non-pregnant women (p=0.0017). All the patients got infected with hepatitis E virus were in Genotype 1 variety. The study demonstrates that virus-specific poor IgG responses might be responsible for vulnerability of pregnant women to acute hepatitis with hepatitis E virus.Author SummaryAcute hepatitis caused by hepatitis E virus (HEV) Genotype 1 is a public health problem in Asian countries and especially it poses a potential health threat to pregnant women causing 19% to 25% mortality, particularly in South Asian countries including Bangladesh. The study aimed to explore whether HEV IgG immune responses were compromised during pregnancy, which might contribute to higher viral load and disease severity. Accordingly, pregnant and non-pregnant women with acute hepatitis (clinically presented with nausea, loss of appetite and /or jaundice) were enrolled from different tertiary care hospitals in Dhaka city. All these patients were screened and hepatitis E were differentiated from other hepatitis (caused by A, B, C) using Enzyme Linked Immunosorbent Assay (ELISA) methods. HEV IgG antibody/avidity indices and viral loads were measured using ELISA and real time quantitative polymerase chain reaction (RT-qPCR), respectively. The study showed that pregnant women with acute hepatitis E had lower IgG indices with higher viral load than their non-pregnant counterpart. Overall, the study revealed that virus-specific poor IgG responses might render pregnant women vulnerable to acute hepatitis E of varying degree of severity which might be associated with higher viral load.

scholarly journals Hepatitis E: Disease in Humans

2020 ◽  
Author(s):  
Adriana Turculeanu
Keyword(s):  
Acute Hepatitis ◽  
Pregnant Women ◽  
Organ Transplant ◽  
The Elderly ◽  
Hepatitis E ◽  
Hematologic Malignancies ◽  
Hematological Diseases ◽  
The World ◽  
Acute Hepatitis E ◽  
Immunocompetent Patients

Hepatitis E virus (HEV) is one of the 7 viruses with mainly hepatic tropism. HEV determines 20 million new infections worldwide every year, 3.4 million acute hepatitis E and 44,000 deaths in 2015 (3.3% of the mortality due to viral hepatitis). Transmitted by the digestive tract mainly (fecal- orally, particularly by water infected with feces), the virus reaches the liver where it does not have a direct cytolytic effect, but immunological phenomena, especially cellular, activated by the replication of the virus in the hepatocytes. Clinically, over 95% of cases of HEV infection are asymptomatic and sel- limiting; in immunocompetent patients in tropics HEV can cause acute hepatitis with clinical features. On rare situations the infection can result in a severe, fulminant hepatitis with acute liver failure. In immunocompromised patients (organ transplant recipients, hematologic malignancies, HIV-infected) HEV may determine chronic hepatitis. In pregnant women or the elderly people or people with underlying liver disease HEV can cause fulminant forms which can become fatal (E.g.: 30% deaths among pregnant women in some parts of the world). Acute and chronic E hepatitis may be accompanied by extrahepatic manifestations: neurological, kidney, pancreatic, hematological diseases, autoimmune diseases with a pathogenesis not fully elucidated.

Immunological alterations in pregnant women with acute hepatitis E

2005 ◽  
Vol 20 (7) ◽  
pp. 1094-1101 ◽  
Author(s):  
REKHA PAL ◽  
RAKESH AGGARWAL ◽  
SUBHASH R NAIK ◽  
VINEETA DAS ◽  
SIDDHARTH DAS ◽  
...  
Keyword(s):  
Acute Hepatitis ◽  
Pregnant Women ◽  
Hepatitis E ◽  
Acute Hepatitis E ◽  
Immunological Alterations

Maternal and Fetal Outcomes in Pregnant Women with Acute Hepatitis E Virus Infection

2007 ◽  
Vol 147 (1) ◽  
pp. 28 ◽  
Author(s):  
Sharda Patra ◽  
Ashish Kumar ◽  
Shubha Sagar Trivedi ◽  
Manju Puri ◽  
Shiv Kumar Sarin
Keyword(s):  
Virus Infection ◽  
Acute Hepatitis ◽  
Pregnant Women ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Fetal Outcomes ◽  
Acute Hepatitis E

scholarly journals A fatal case of acute hepatitis E among pregnant women, Central African Republic

2010 ◽  
Vol 3 (1) ◽  
Author(s):  
Charles M Goumba ◽  
Emmanuel R Yandoko-Nakouné ◽  
Narcisse P Komas
Keyword(s):  
Acute Hepatitis ◽  
Pregnant Women ◽  
Central African Republic ◽  
Fatal Case ◽  
Hepatitis E ◽  
Acute Hepatitis E

scholarly journals Lower Levels of Transaminases but Higher Levels of Serum Creatinine in Patients with Acute Hepatitis E in Comparison to Patients with Hepatitis A

Pathogens ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 60
Author(s):  
Thomas Theo Brehm ◽  
Omid Mazaheri ◽  
Thomas Horvatits ◽  
Marc Lütgehetmann ◽  
Julian Schulze zur Wiesch ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Acute Hepatitis ◽  
Hepatitis A ◽  
Medical Center ◽  
Hepatitis E ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Median Serum ◽  
Acute Hepatitis E ◽  
Hematological Manifestations

In patients with hepatitis E virus (HEV) infections, extrahepatic, particularly renal and hematological manifestations, are increasingly reported in the medical literature but have never been studied compared to a control cohort. We retrospectively analyzed medical records of consecutive patients that were diagnosed with acute hepatitis E (AHE) (n = 69) or acute hepatitis A (AHA) (n = 46) at the University Medical Center Hamburg Eppendorf from January 2009 to August 2019 for demographical, clinical, and laboratory information. Patients with AHE had significantly lower median levels of ALAT (798 U/L) and total bilirubin (1.8 mg/dL) compared to patients with AHA (2326 U/L; p < 0.001 and 5.2 mg/dL; p < 0.001), suggesting a generally less severe hepatitis. In contrast, patients with AHE had significantly higher median serum creatinine levels (0.9 mg/dL vs. 0.8 mg/dL; p = 0.002) and lower median estimated glomerular filtration rate (eGFR) (91 mL/min/1.73 m2 vs. 109 mL/min/1.73 m2; p < 0.001) than patients with AHA. Leucocyte, neutrophil and lymphocyte count, hemoglobin, platelets, red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and RDW to lymphocyte ratio (RLR) did not differ between patients with AHE and those with AHA. Our observations indicate that renal but not hematological interference presents an underrecognized extrahepatic feature of AHE, while inflammation of the liver seems to be more severe in AHA.

scholarly journals Advances in Hepatitis E Virus Biology and Pathogenesis

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 267
Author(s):  
Shaoli Lin ◽  
Yan-Jin Zhang
Keyword(s):  
Pregnant Women ◽  
Hepatitis E Virus ◽  
Case Fatality ◽  
Hepatitis E ◽  
Host Cells ◽  
High Rate ◽  
Rapid Progression ◽  
Genotype 1 ◽  
Genotype 3 ◽  
Zoonotic Infections

Hepatitis E virus (HEV) is one of the causative agents for liver inflammation across the world. HEV is a positive-sense single-stranded RNA virus. Human HEV strains mainly belong to four major genotypes in the genus Orthohepevirus A, family Hepeviridae. Among the four genotypes, genotype 1 and 2 are obligate human pathogens, and genotype 3 and 4 cause zoonotic infections. HEV infection with genotype 1 and 2 mainly presents as acute and self-limiting hepatitis in young adults. However, HEV infection of pregnant women with genotype 1 strains can be exacerbated to fulminant hepatitis, resulting in a high rate of case fatality. As pregnant women maintain the balance of maternal-fetal tolerance and effective immunity against invading pathogens, HEV infection with genotype 1 might dysregulate the balance and cause the adverse outcome. Furthermore, HEV infection with genotype 3 can be chronic in immunocompromised patients, with rapid progression, which has been a challenge since it was reported years ago. The virus has a complex interaction with the host cells in downregulating antiviral factors and recruiting elements to generate a conducive environment of replication. The virus-cell interactions at an early stage might determine the consequence of the infection. In this review, advances in HEV virology, viral life cycle, viral interference with the immune response, and the pathogenesis in pregnant women are discussed, and perspectives on these aspects are presented.

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