title: Hepatitis E autochthonous infection in chronic liver disease.
abstract: Hepatitis E virus is endemic in many parts of the developing world and causes a self-limiting hepatitis in young adults, except in pregnant women and patients with chronic liver disease, where the mortality is high. Locally acquired hepatitis E is increasingly recognized in the developed world. It is caused by hepatitis E virus genotype 3, affects the middle-aged and the elderly, and may be a zoonotic infection from pigs. We present a case of locally acquired hepatitis E infection in a patient with previously undiagnosed cirrhosis, which resulted in subacute liver failure and death. We describe our attempt to trace this infection to a free-range pig farm adjacent to the patient's place of employment. Hepatitis E infection should be considered in the differential diagnosis in patients with decompensated chronic liver disease whatever their age or travel history. When found, the prognosis may be poor.
authors.affiliation: Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, Cornwall, UK.
authors.forename: Gabrielle L
authors.initials: GL
authors.lastname: Lockwood
authors.forename: Salceda
authors.initials: S
authors.lastname: Fernandez-Barredo
authors.forename: Richard
authors.initials: R
authors.lastname: Bendall
authors.forename: Malcolm
authors.initials: M
authors.lastname: Banks
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000818:Animals; D002908:Chronic Disease; D017809:Fatal Outcome; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis* / Q000635:transmission / Q000821:virology; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D034421:Sus scrofa; D015047:Zoonoses / Q000635:transmission