Fulminant liver failure from acute autochthonous hepatitis E in France: description of seven patients with acute hepatitis E and encephalopathy

Background and Aims. The involvement of cellular immunity in the development of hepatitis E virus (HEV) infection is rare. We aimed to study the roles of viral load and Th cell responses in acute hepatitis E (AHE) and HEV-related acute liver failure (HEV-ALF). Methods. We evaluated viral load and Th1/Th2 cytokine levels in 34 patients with HEV infection, including 17 each with AHE or HEV-ALF. Seventeen healthy controls (HCs) were also included who were negative for anti-HEV IgM and IgG. Results. There was no significant difference in viral load and HEV RNA in the AHE and HEV-ALF groups (both P > 0.05 ). The Th lymphocyte levels (CD3+, CD4+) in the AHE and HEV-ALF groups were significantly higher than those in the HC group (both P < 0.05 ), but there was no significant difference between the AHE and HEV-ALF groups ( P > 0.05 ). Both IFN-γ and IL-10 showed gradual upward trend from the HC group to the AHE (both P < 0.01 ), but IFN-γ showed a sharp downward trend from the AHE group to the HEV-ALF group ( P < 0.01 ) and IL-4 showed gradual upward trend from the AHE group to the HEV-ALF group ( P < 0.01 ).There was no significant difference in Th1 and Th2 cytokines between the HEV RNA(+) group and HEV RNA(-) group (all P > 0.05 ). Th2 bias was observed from the AHE ( ratio = 58.65 ) to HEV-ALF ( ratio = 1.20 ) groups. The level of IFN-γ was associated with the outcome of HEV-ALF patients. Conclusions. HEV viral load was not associated with aggravation of AHE, and the HEV-ALF patients showed significant Th2 bias, which may be involved in the aggravation of AHE.

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Acute hepatitis E virus infection in patients with acute liver failure in China: Not quite an uncommon cause

Hepatology ◽

10.1002/hep.28939 ◽

2017 ◽

Vol 65 (5) ◽

pp. 1769-1770 ◽

Cited By ~ 6

Author(s):

Lin Wang ◽

Jiabao Geng

Keyword(s):

Virus Infection ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Acute Hepatitis E

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Lethal biliary congestive acute hepatitis E without acute liver failure: A case report

Kanzo ◽

10.2957/kanzo.62.463 ◽

2021 ◽

Vol 62 (8) ◽

pp. 463-470

Author(s):

Nao Yamauchi ◽

Tetsuya Yasunaka ◽

Akinobu Takaki ◽

Yoshimune Hinami ◽

Masaru Kinomura ◽

...

Keyword(s):

Case Report ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Hepatitis E ◽

Acute Hepatitis E

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Acute Hepatitis E: A Rare Cause of Acute Liver Failure in a Patient With Acute Myeloid Leukemia

Cureus ◽

10.7759/cureus.10628 ◽

2020 ◽

Author(s):

Zachary Field ◽

Michelle Russin ◽

Rodrigo M Murillo Alvarez ◽

Mario Madruga ◽

Steve Carlan

Keyword(s):

Acute Myeloid Leukemia ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Myeloid Leukemia ◽

Hepatitis E ◽

Acute Hepatitis E ◽

Acute Myeloid

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

Pathogens ◽

10.3390/pathogens10010060 ◽

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.

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