1
|
Koyama M, Yamazaki T, Joshita S, Ito A, Ono K, Watanabe T, Yamashita Y, Sugiura A, Kobayashi M, Sato Y, Takahashi M, Okamoto H, Umemura T. An Autopsy Case of Primary Biliary Cholangitis with Histological Submassive Hepatic Necrosis Caused by Acute Hepatitis E Virus Infection. Intern Med 2021; 60:1863-1870. [PMID: 33518570 PMCID: PMC8263169 DOI: 10.2169/internalmedicine.6337-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old woman who had been diagnosed with cirrhotic primary biliary cholangitis (PBC) 5 years earlier was admitted for severe jaundice (total bilirubin: 30.1 mg/dL). We suspected that her cirrhotic PBC had deteriorated acutely for some reason. Her general condition deteriorated quickly, and she passed away on day 18 of admission. Hepatitis E virus (HEV)-IgA antibodies were positive, and Genotype 3b HEV involvement was confirmed from a blood sample taken on admission. Histopathological findings revealed cirrhosis and submassive loss and necrosis of hepatocytes. Clinicians should consider the possibility of acute HEV infection as a trigger for acute PBC exacerbation.
Collapse
Affiliation(s)
- Mizuki Koyama
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Tomoo Yamazaki
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Satoru Joshita
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Akihiro Ito
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Kazuyuki Ono
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Takayuki Watanabe
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Yuki Yamashita
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Ayumi Sugiura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
| | - Mikiko Kobayashi
- Department of Pathology, Shinshu University School of Medicine, Japan
| | - Yoshinori Sato
- Department of Pathology, Shinshu University School of Medicine, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Japan
- Department of Life Innovation, Institute for Biomedical Sciences, Shinshu University, Japan
| |
Collapse
|
2
|
|
3
|
Beer A, Holzmann H, Pischke S, Behrendt P, Wrba F, Schlue J, Drebber U, Neudert B, Halilbasic E, Kreipe H, Lohse A, Sterneck M, Wedemeyer H, Manns M, Dienes HP. Chronic Hepatitis E is associated with cholangitis. Liver Int 2019; 39:1876-1883. [PMID: 31102493 PMCID: PMC6790616 DOI: 10.1111/liv.14137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Sporadic hepatitis E is an emerging indigenous disease in Europe induced by genotype 3 of the virus. While the disease takes an acute self-limited course in immunocompetent individuals, under immunocompromised conditions chronic hepatitis E might develop. The histology of chronic hepatitis E has not been described in detail systematically. METHODS Liver biopsies from 19 immunosuppressed patients with chronic hepatitis E were collected: 17 were organ transplant recipients, one had a CD4-deficiency and one had received steroid therapy because of ulcerative colitis. Biopsies were processed with standard stains. Evaluation of histologic activity and fibrosis was performed according to Ishak. Additionally, immunohistochemistry with antibodies directed against open reading frame 2 and 3 of the virus was performed and liver biopsies were tested for hepatitis E virus RNA. RESULTS Biochemical data showed an increase in alanine transaminase, aspartate transaminase, gamma-glutamyl transferase and total bilirubin. Histopathology displayed typical features of chronic hepatitis with mild to moderate activity. The number of polymorphonuclear leucocytes was considerably increased and all patients had a florid cholangitis that presented as a destructive form in five of them. Hepatocytes and bile duct epithelia stained positive for hepatitis E virus by immunohistochemistry. CONCLUSIONS Chronic hepatitis E in immunocompromised individuals runs a similar course as hepatitis B and C and shows similar histopathology. However, the presence of destructive cholangitis in some cases accompanied by an increased number of polymorphonuclear leucocytes is markedly different. Immunohistochemically the virus is present in bile duct epithelia, seemingly the cause for cholangitis.
Collapse
Affiliation(s)
- Andrea Beer
- Department of PathologyMedical University of ViennaViennaAustria
| | | | | | - Patrick Behrendt
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Fritz Wrba
- Department of PathologyMedical University of ViennaViennaAustria
| | - Jerome Schlue
- Institute for PathologyMedical School of HanoverHanoverGermany
| | - Uta Drebber
- Institute of PathologyUniversity Hospital CologneCologneGermany
| | - Barbara Neudert
- Department of PathologyMedical University of ViennaViennaAustria
| | - Emina Halilbasic
- Department of GastroenterologyMedical University of ViennaViennaAustria
| | - Hans Kreipe
- Institute for PathologyMedical School of HanoverHanoverGermany
| | | | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Hans P. Dienes
- Department of PathologyMedical University of ViennaViennaAustria
| |
Collapse
|
4
|
Knegendorf L, Drave SA, Dao Thi VL, Debing Y, Brown RJP, Vondran FWR, Resner K, Friesland M, Khera T, Engelmann M, Bremer B, Wedemeyer H, Behrendt P, Neyts J, Pietschmann T, Todt D, Steinmann E. Hepatitis E virus replication and interferon responses in human placental cells. Hepatol Commun 2018; 2:173-187. [PMID: 29404525 PMCID: PMC5796324 DOI: 10.1002/hep4.1138] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/17/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV) is a member of the genus Orthohepevirus in the family Hepeviridae and the causative agent of hepatitis E in humans. HEV is a major health problem in developing countries, causing mortality rates up to 25% in pregnant women. However, these cases are mainly reported for HEV genotype (gt)1, while gt3 infections are usually associated with subclinical courses of disease. The pathogenic mechanisms of adverse maternal and fetal outcome during pregnancy in HEV-infected pregnant women remain elusive. In this study, we observed that HEV is capable of completing the full viral life cycle in placental-derived cells (JEG-3). Following transfection of JEG-3 cells, HEV replication of both HEV gts could be observed. Furthermore, determination of extracellular and intracellular viral capsid levels, infectivity, and biophysical properties revealed production of HEV infectious particles with similar characteristics as in liver-derived cells. Viral entry was analyzed by infection of target cells and detection of either viral RNA or staining for viral capsid protein by immunofluorescence. HEV gt1 and gt3 were efficiently inhibited by ribavirin in placental as well as in human hepatoma cells. In contrast, interferon-α sensitivity was lower in the placental cells compared to liver cells for gt1 but not gt3 HEV. Simultaneous determination of interferon-stimulated gene expression levels demonstrated an efficient HEV-dependent restriction in JEG-3. Conclusion: We showed differential tissue-specific host responses to HEV genotypes, adding to our understanding of the mechanisms contributing to fatal outcomes of HEV infections during pregnancy. Using this cell-culture system, new therapeutic options for HEV during pregnancy can be identified and evaluated. (Hepatology Communications 2018;2:173-187).
Collapse
Affiliation(s)
- Leonard Knegendorf
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Svenja A. Drave
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Viet Loan Dao Thi
- Laboratory of Virology and Infectious DiseaseRockefeller UniversityNew YorkNY
| | - Yannick Debing
- Rega Institute for Medical Research, Department of Microbiology and ImmunologyKatholieke Universiteit LeuvenLeuvenBelgium
| | - Richard J. P. Brown
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Florian W. R. Vondran
- ReMediES, Department of General, Visceral, and Transplantation Surgery, Hannover Medical SchoolHannoverGermany
- German Center for Infection Research, partner site Hannover‐BraunschweigHannoverGermany
| | - Kathrin Resner
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Martina Friesland
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Tanvi Khera
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Michael Engelmann
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Heiner Wedemeyer
- German Center for Infection Research, partner site Hannover‐BraunschweigHannoverGermany
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Patrick Behrendt
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
- German Center for Infection Research, partner site Hannover‐BraunschweigHannoverGermany
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Johan Neyts
- Rega Institute for Medical Research, Department of Microbiology and ImmunologyKatholieke Universiteit LeuvenLeuvenBelgium
| | - Thomas Pietschmann
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
- German Center for Infection Research, partner site Hannover‐BraunschweigHannoverGermany
| | - Daniel Todt
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| | - Eike Steinmann
- Institute for Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection ResearchHannoverGermany
| |
Collapse
|
5
|
Prost S, Crossan CL, Dalton HR, De Man RA, Kamar N, Selves J, Dhaliwal C, Scobie L, Bellamy COC. Detection of viral hepatitis E in clinical liver biopsies. Histopathology 2017; 71:580-590. [DOI: 10.1111/his.13266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Sandrine Prost
- Department of Pathology; Royal Infirmary of Edinburgh; Edinburgh UK
| | - Claire L Crossan
- Department of Biological and Biomedical Sciences; Glasgow Caledonian University; Glasgow UK
| | - Harry R Dalton
- European Centre for Environment and Human Health; University of Exeter; Exeter UK
| | - Robert A De Man
- Department of Gastroenterology and Hepatology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation; Université Paul Sabatier; Toulouse France
| | - Janick Selves
- Centre de Recherche en Cancérologie de Toulouse; Department of Pathology; Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | | | - Linda Scobie
- Department of Biological and Biomedical Sciences; Glasgow Caledonian University; Glasgow UK
| | | |
Collapse
|
6
|
Xu B, Yu HB, Hui W, He JL, Wei LL, Wang Z, Guo XH. Clinical features and risk factors of acute hepatitis E with severe jaundice. World J Gastroenterol 2012; 18:7279-7284. [PMID: 23326133 PMCID: PMC3544030 DOI: 10.3748/wjg.v18.i48.7279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/24/2012] [Accepted: 11/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated.
METHODS: We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ2 analysis, Fisher’s exact test, and Student’s t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model.
RESULTS: No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol overconsumption, and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.
CONCLUSION: Acute hepatitis E patients may naturally present with severe jaundice.
Collapse
|
7
|
Acute Viral Hepatitis. SCHEUER'S LIVER BIOPSY INTERPRETATION 2010. [PMCID: PMC7315326 DOI: 10.1016/b978-0-7020-3410-7.00012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Abstract
Hepatitis E virus (HEV) is the main cause of enterically transmitted non-A hepatitis worldwide. Infection is endemic in developing countries. Disease course is benign, and severe jaundice is rarely reported. Three patients presented to our department with symptomatic acute hepatitis. Two of them had recently travelled to endemic areas. Jaundice was very marked in all patients. HEV infection was documented by HEV antibodies and by HEV-RNA detection in serum and stools. In the autochthonous case, immunoglobulin-M was absent, and diagnosis was established on HEV-RNA amplification by real-time reverse transcriptase-PCR. Comprehensive investigation for concomitant causes of liver disease was negative in all patients. Histological features showed marked cholestasis with multiple bile plugs in dilated canaliculi. In conclusion, acute hepatitis E may be autochthonous in developed countries and patients may present with severe jaundice. HEV-RNA detection by real-time reverse transcriptase-PCR is a very efficacious diagnostic tool in anti-HEV immunoglobulin-M-negative cases.
Collapse
|
9
|
Malcolm P, Dalton H, Hussaini HS, Mathew J. The histology of acute autochthonous hepatitis E virus infection. Histopathology 2007; 51:190-4. [PMID: 17650215 DOI: 10.1111/j.1365-2559.2007.02756.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To document the histological appearances of liver biopsies in autochthonous hepatitis E virus (HEV) infection. METHODS AND RESULTS Four patients were serologically positive for HEV; three had no traditional risk factors, the fourth had recently returned from China. All four consumed meat products. Liver histology of the three autochthonous (locally acquired) cases showed portal tracts expanded by a severe mixed polymorph and lymphocytic inflammatory infiltrate, with a geographical distribution of polymorphs at the interface and lymphocytes centrally. Moderate to severe interface hepatitis and cholangiolitis were present. There was a striking acinar mixed inflammatory infiltrate made up of polymorphs, lymphocytes and macrophages; frequent apoptotic hepatocytes, focal necrosis, cholestatic rosettes and zone 3 canalicular and cytoplasmic bilirubinostasis were noted. Significant steatosis, megamitochondria and Mallory bodies were not present. There was no evidence of iron, copper or alpha(1)-antitrypsin accumulation. By contrast, the histology of the imported case of HEV infection showed less intense portal and acinar inflammation, no cholangiolitis and no geographical distribution of the portal inflammatory infiltrate. CONCLUSION The histological appearances of autochthonous HEV infection are sufficiently distinctive to consider the diagnosis in an acute setting and possibly to differentiate it from the endemic form of the disease.
Collapse
Affiliation(s)
- P Malcolm
- Department of Pathology, Royal Cornwall Hospital, Truro, UK.
| | | | | | | |
Collapse
|
10
|
Tejerizo-López L, Teijelo A, Suárez P, Leiva A, Sánchez-Sánchez M, García-Robles R, Tejerizo-García A, Pérez-Escanilla J, Benavente J, Corredera F. Coma hepático posparto subsiguiente a infección por Bartonella henselae. Revisión de la respuesta inmunitaria materna a la infección. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Abstract
Travel is not generally contraindicated during pregnancy, but there are some risks. The pregnant traveler needs a careful predeparture evaluation, and her itinerary should not take her far from available medical and obstetric care. The pregnant traveler must avoid diseases (such as malaria and hepatitis E) that can have devastating effects. Travel must be curtailed when there would be potential exposure to certain infectious diseases or extreme environmental conditions.
Collapse
Affiliation(s)
- S R Rose
- Department of Emergency Medicine, Noble Hospital, Westfield, Massachusetts, USA
| |
Collapse
|
12
|
Bernal MC, Leyva A, Garcia F, Galan I, Piedrola G, Heyermann H, Maroto MC. Seroepidemiological study of hepatitis E virus in different population groups. Eur J Clin Microbiol Infect Dis 1995; 14:954-8. [PMID: 8654445 DOI: 10.1007/bf01691376] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to determine the seroprevalence of hepatitis E virus, 1,993 sera (453 from healthy pregnant women, 491 from Moroccan subjects, 492 from blood donors, 321 from children, and 236 from intravenous drug users) were studied. IgG was measured by enzyme immunoassay (EIA), and positive results were confirmed by Western blot. The EIA detected antibodies in 3.96% of the subjects (5.6% of the Moroccans and drug users and 1.8% of the children). Fifty-four percent of these results were confirmed by Western blot, 11.4% were found to be negative, and 34.2% indeterminate. The overall prevalence after confirmation by Western blot decreased to 2.15%. When studying the Western blot pattern of the positive samples, 95% showed antibodies to SG-3, 65% to 8-5, and only 9.3% to CKS fusion protein. In the indeterminate Western blots, the results for these proteins were 96.3%, 62.9%, and 37%, respectively. When the epidemiological data were analysed, no statistically significant differences between women and men or between different age groups were found.
Collapse
Affiliation(s)
- M C Bernal
- University Hospital, Department of Microbiology
| | | | | | | | | | | | | |
Collapse
|
13
|
Lau JY, Sallie R, Fang JW, Yarbough PO, Reyes GR, Portmann BC, Mieli-Vergani G, Williams R. Detection of hepatitis E virus genome and gene products in two patients with fulminant hepatitis E. J Hepatol 1995; 22:605-10. [PMID: 7560853 DOI: 10.1016/0168-8278(95)80215-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Non-isotopic in situ hybridization (digoxigenin-labeled probe directed towards hepatitis E virus ORF1) and immunohistochemistry (against hepatitis E virus ORF2 and ORF3) were applied to detect hepatitis E virus genome and gene product in the liver tissue of two patients with fulminant hepatitis E seropositive for hepatitis E virus RNA. Both hepatitis E virus RNA and hepatitis E virus antigens were detected exclusively in the cytoplasm of hepatocytes and not detected in other cell types. In both patients, more than 50% of the hepatocytes were positive for both hepatitis E virus RNA and hepatitis E virus antigens, most of which showed degenerative changes. This is consistent with the histological appearance of marked loss of hepatocytes with acinar collapse. Interestingly, denaturation of the RNA before in situ hybridization was found to enhance hepatitis E virus RNA detection. We conclude that: (1) hepatitis E virus RNA and hepatitis E virus antigens can be demonstrated in the liver in hepatitis E virus-related fulminant hepatitic failure, (2) hepatitis E virus is hepatocyte-tropic within the liver, (3) cytoplasmic localization of hepatitis E virus RNA and hepatitis E virus antigens is consistent with cytoplasmic replication, and (4) the presence of degenerative changes in hepatitis E virus positive cells, together with the histological appearance of hepatocyte loss in the absence of significant inflammatory infiltrate, suggests that hepatitis E virus-related fulminant hepatitic failure is mediated by a cytopathic mechanism.
Collapse
Affiliation(s)
- J Y Lau
- Department of Medicine, University of Florida, Gainesville 32610, USA
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Fulminant hepatic failure is characterized by severe metabolic derangements, neurologic complications and, ultimately, multiorgan failure. In the past three decades, improved intensive care has increased mean survival from 15% to 50% in certain patient groups by providing metabolic support and management of specific, frequent, and potentially fatal complications. However, outcome remains highly dependent on etiology. While intensive care is sufficient therapy in some patients (Group I), those with irreparable hepatic damage (Group III) can only survive if transplanted. In intermediate cases (Group II), the liver retains the potential to regenerate if the patient receives hepatic functional support. Major areas of current research in this field include development of hepatic support devices, strategies to accelerate and maximize hepatic regeneration, and criteria for accurate prognostic classification of patients.
Collapse
Affiliation(s)
- E Atillasoy
- Department of Medicine (Division of Liver Diseases), Mount Sinai School of Medicine, New York, New York 10029, USA
| | | |
Collapse
|
15
|
Köksal I, Aydin K, Kardes B, Turgut H, Murt F. The role of hepatitis E virus in acute sporadic non-A, non-B hepatitis. Infection 1994; 22:407-10. [PMID: 7698838 DOI: 10.1007/bf01715498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-B (NANB) hepatitis. Water-borne epidemics have been reported in many developing countries primarily affecting young and middle-aged adults. To determine the role of HEV in acute sporadic NANB hepatitis, we have studied the profiles of anti-HEV IgG in the sera of patients previously diagnosed for NANB hepatitis. We tested the sera of 53 patients with acute NANB hepatitis and 100 healthy people as a control group for anti-HEV IgG. Thirty-nine of the 53 patients (73.3%) and none of the control group were positive for HEV infection, according to results shown by ELISA. This result suggests that HEV is a common cause of acute sporadic NANB hepatitis in Turkey. Further studies are needed in the other regions to determine the true prevalence of HEV infection in Turkey.
Collapse
Affiliation(s)
- I Köksal
- Dept. of Infectious Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | | |
Collapse
|
16
|
Sallie R, Chiyende J, Tan KC, Bradley D, Portmann B, Williams R, Mowat AP, Mieli-Vergani G. Fulminant hepatic failure resulting from coexistent Wilson's disease and hepatitis E. Gut 1994; 35:849-53. [PMID: 8020819 PMCID: PMC1374894 DOI: 10.1136/gut.35.6.849] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fulminant hepatic failure resulting from hepatitis E and coexistent Wilson's disease was diagnosed in a six year old girl six weeks after returning from a holiday in India. Wilson's disease was diagnosed on the basis of histological evidence of hepatocellular copper deposition, confirmed by biochemical estimation of liver copper concentration. Although severely damaged, the liver was non-cirrhotic. Hepatitis E virus (HEV) was diagnosed by nested polymerase chain reaction, the specificity of which was confirmed by direct sequencing of amplified DNA. Replication of HEV within the liver at the time of diagnosis was confirmed by selective amplification of the antigenomic strand of the virus obtained from total liver RNA. The patient had an orthotopic liver transplantation without recurrence of hepatitis and remains well at 19 months. Viral excretion, recorded by serial amplification of HEV RNA extracted from stool samples, persisted for 30 days after liver grafting. Severe vitiligo, present preoperatively, dramatically improved after liver grafting and institution of immunosuppressive treatment. This case suggests that viral infection may play a part in the acute decompensation seen in some cases of Wilson's disease.
Collapse
Affiliation(s)
- R Sallie
- Institute of Liver Studies, King's College Hospital, London
| | | | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Sallie R, Silva AE, Purdy M, Smith H, McCaustland K, Tibbs C, Portmann B, Eddleston A, Bradley D, Williams R. Hepatitis C and E in non-A non-B fulminant hepatic failure: a polymerase chain reaction and serological study. J Hepatol 1994; 20:580-8. [PMID: 8071532 DOI: 10.1016/s0168-8278(05)80343-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A significant proportion of patients with fulminant hepatic failure have clinical, biochemical and histological features suggestive of acute viral hepatitis, without serological evidence of either hepatitis A or B. The contribution of hepatitis C to such cases of non-A non-B fulminant hepatic failure is presently uncertain while hepatitis E is well recognized as a cause of fulminant hepatic failure in endemic areas. Nested polymerase chain reaction for detection of both hepatitis C and E virus as well as two serological assays for anti-hepatitis C virus and anti-hepatitis E virus western blotting (both IgG and IgM) were performed on acute sera of 42 consecutive cases of non A, non B-fulminant hepatic failure and on convalescent sera of 17 of 20 patients who underwent orthotopic liver transplantation. Fresh liver tissue, obtained at the time of transplantation, was also studied by polymerase chain reaction in eight cases. Evidence of an acute hepatitis E virus infection (hepatitis E virus RNA amplified from serum by polymerase chain reaction or serum IgM positive to western blot) was found in eight patients. One patient had anti-HCV at presentation but assays on later sera proved negative. Convalescent sera and sera obtained after orthotopic liver transplantation were all negative to both anti-HCV assay systems, but HCV RNA was not found in either serum or liver tissue in any case.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- R Sallie
- Institute of Liver Studies, King's College School of Medicine and Dentistry, London, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Coursaget P, Depril N, Buisson Y, Molinié C, Roué R. Hepatitis type E in a French population: detection of anti-HEV by a synthetic peptide-based enzyme-linked immunosorbent assay. RESEARCH IN VIROLOGY 1994; 145:51-7. [PMID: 8023016 DOI: 10.1016/s0923-2516(07)80007-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Four synthetic peptides were used to develop an ELISA for detecting hepatitis type E infections. Antibodies to HEV were detected in 54 of 64 patients present during two outbreaks previously recognized as being due to hepatitis E virus. Those patients included French soldiers stationed in Chad at the time, and Algerian civilians residing in Algeria and considered as positive controls. Anti-HEV were also detected in 3 out of 74 cases of sporadic non-A, non-B, non-C hepatitis in France, and in 2 out of 150 anti-HAV-IgM-positive sporadic cases, also in France, but in none of 278 healthy adults from the general French population. Among a total of 34 anti-HEV-positive cases in French subjects, 32 were shown to be associated with travel outside of western Europe; in two cases, however, HEV transmission appeared to have taken place in Europe. Using this ELISA, a rapid drop in anti-HEV antibodies to undetectable levels following the acute phase of the disease was observed in a high proportion of the infected subjects. Thus, the present test would appear to be more suitable for diagnostic purposes than for epidemiological investigations.
Collapse
Affiliation(s)
- P Coursaget
- Institut de Virologie de Tours, Faculté de Pharmacie, Tours, France
| | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- W M Lee
- Liver Unit, University of Texas Southwestern Medical School, Dallas 75235-8887
| |
Collapse
|
21
|
Fagan EA, Ellis DS, Tovey GM, Lloyd G, Smith HM, Portmann B, Tan KC, Zuckerman AJ, Williams R. Toga virus-like particles in acute liver failure attributed to sporadic non-A, non-B hepatitis and recurrence after liver transplantation. J Med Virol 1992; 38:71-7. [PMID: 1328513 DOI: 10.1002/jmv.1890380115] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Toga virus-like particles (typically 60-70 nm: enveloped with small surface spikes) were detected in the native hepatectomy specimens in 7 of 18 patients grafted for acute liver failure attributed to sporadic non-A, non-B hepatitis and in 2 patients grafted for fulminant hepatitis attributed to anti-epileptic drug hepatotoxicity. These particles were not detected in the hepatectomies from 12 other patients grafted for other causes of acute liver failure, 12 for various chronic liver diseases, and 2 histologically normal livers. Acute hepatic failure, characterized histologically by severe haemorrhagic necrosis, developed 7 days after grafting in 5 patients, all in the non-A, non-B group with toga virus-like particles in native liver. Similar virus-like particles were detected in all grafts and were in greater abundance than in the native livers. The agent may be novel because pre- and post-grafting sera were negative for antibodies against representative panels of arboviruses and in first and second generation antibody tests for hepatitis C virus.
Collapse
Affiliation(s)
- E A Fagan
- Institute of Liver Studies, King's College Hospital, London, England, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Ticehurst J, Popkin TJ, Bryan JP, Innis BL, Duncan JF, Ahmed A, Iqbal M, Malik I, Kapikian AZ, Legters LJ. Association of hepatitis E virus with an outbreak of hepatitis in Pakistan: serologic responses and pattern of virus excretion. J Med Virol 1992; 36:84-92. [PMID: 1583470 DOI: 10.1002/jmv.1890360205] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hepatitis E virus (HEV), a positive-strand RNA agent, has been associated with enterically transmitted non-A, non-B hepatitis in Asia, Africa, and Mexico. To evaluate the role of HEV in an outbreak of hepatitis in Pakistan, we used immune electron microscopy to detect 1) antibody to HEV, for evidence of infection, and 2) virus, to determine the pattern of HEV excretion. Paired sera from 2 patients were assayed for antibody by using reference HEV: one seroconverted, an atypical finding for HEV infections; the other had high levels of anti-HEV in both sera. Virus particles with the size (29 x 31 nm) and morphology of HEV were detected in feces from 10 of 85 patients and serologically identified as HEV by using reference antibodies from an HEV-infected chimpanzee. One of these HEV-containing specimens was collected 9 days before the onset of jaundice; it was among feces from 38 outpatients with nonspecific symptoms and biochemical hepatitis, 12 of whom subsequently developed jaundice. The other 9 feces with HEV were among 36 collected within 7 days of the onset of acute icteric hepatitis; all 11 feces from days 8 to 15 were negative for HEV. Fecal concentrations of HEV appeared to be lower than those of many enteric viruses: only one specimen contained as many as 5 particles per EM grid square. It is concluded that HEV was etiologically associated with the epidemic and was predominantly excreted at very low levels during the first week of jaundice.
Collapse
Affiliation(s)
- J Ticehurst
- Department of Viral Diseases, Walter Reed Army Institute of Research, Washington, DC 20307-5100
| | | | | | | | | | | | | | | | | | | |
Collapse
|