Hepatitis E is an autochthonous disease in industrialized countries. Analysis of 23 patients in South-West France over a 13-month period and comparison with hepatitis A.
OBJECTIVE
Hepatitis E virus (HEV) is responsible for acute hepatitis predominantly in developing countries. In Western Europe and in the US, cases of acute HEV infection are uncommon and occur primarily in travelers returning from endemic countries. The aim of this study was to describe patients with acute hepatitis E in South West France and compare them with patients with acute hepatitis A.


METHODS
23 consecutive patients over 13 months were analysed. Acute hepatitis E was diagnosed on the presence of specific serum antibodies or viral RNA detection in serum or stools. Real time PCR products from viraemic patients were sequenced.


RESULTS
All the HEV sequences belonged to genotype 3. Two patients (8%) died during their hospital stay, both suffered from severe underlying disease. Only 3 patients (13%) had travelled outside of Europe, within 3 months of the onset of disease. When compared to 23 patients with acute hepatitis A at the same hospital and during the same time frame, HEV-infected patients were older (54.4 +/- 16.6 vs 24.5 +/- 16.6, P<0.05), had lower ALT levels (55.4 X upper normal limit +/- 48.6 vs 107.8 X upper normal limit +/- 82.8, P<0.05) and had lower incidence of recent travel outside of Europe (13% in the hepatitis E group vs 60% in the hepatitis A group, P<0.05).


CONCLUSIONS
Hepatitis E can be considered an autochthonous infection in South West France. All strains sequenced were related to genotype III. When compared to hepatitis A, HEV-infected patients were older, had lower ALT levels and had a lower incidence of travel outside of Europe.
Péron
Jean-Marie
JM
Service d'Hépato-Gastro-Entérologie, Fédération Digestive Fédération Digestive, CHU Toulouse, Hôpital Purpan, Toulouse. peron.jm@chu-toulouse.fr
Mansuy
Jean-Michel
JM
Poirson
Hélène
H
Bureau
Christophe
C
Dupuis
Emmanuel
E
Alric
Laurent
L
Izopet
Jacques
J
Vinel
Jean-Pierre
JP
D000328:Adult; D017677:Age Distribution; D000410:Alanine Transaminase / Q000032:analysis; D004279:DNA, Viral / Q000302:isolation & purification; D019049:Developed Countries; D005260:Female; D005602:France / Q000453:epidemiology; D006506:Hepatitis A / Q000175:diagnosis*; D016751:Hepatitis E / Q000175:diagnosis*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D014195:Travel
D004279:DNA, Viral; D000410:Alanine Transaminase