Hepatitis E virus excretion can be prolonged in patients with hematological malignancies.
BACKGROUND
Hepatitis E virus (HEV) is transmitted via the fecal-oral route and locally acquired sporadic hepatitis E can occur in Western countries. Chronic hepatitis E virus infections have been recently described in solid organ transplant recipients. There is little data on the evolution of hepatitis E in patients immunocompromised for other reasons.


OBJECTIVE
The aim of this study was to evaluate the clinical course of hepatitis E in patients immunocompromised because of hematological malignancies.


METHODS
Starting on November 2003, all patients in the Toulouse University Hospital Hematology Department with unexplained elevated transaminases were tested for hepatitis E using viral RNA detection in serum or stools and serology.


RESULTS
Acute hepatitis E was diagnosed in six middle-aged hematology patients. All cases were autochthonous. HEV strains were genotype 3. All patients had a significant increase of transaminases (6-95 upper limit normal) and only two had HEV IgG. Five patients were asymptomatic and one had jaundice. Transmission of HEV occurred between two patients who had overlapping stays in the hematology ward. All five evaluable patients ultimately cleared their HEV but viremia was prolonged over 6 months in three patients and specific treatment had to be postponed in two patients.


CONCLUSIONS
Screening for HEV should be carried out routinely in hematology patients with elevated transaminases, and patient-to-patient transmission is a concern. Further studies are required to determine whether management of malignancy, particularly stem-cell transplantation should be adapted to HEV status.
Tavitian
Suzanne
S
Service d'Hématologie, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse cedex, France.
Péron
Jean-Marie
JM
Huynh
Anne
A
Mansuy
Jean-Michel
JM
Ysebaert
Loic
L
Huguet
Françoise
F
Vinel
Jean-Pierre
JP
Attal
Michel
M
Izopet
Jacques
J
Récher
Christian
C
D000328:Adult; D000368:Aged; D005243:Feces / Q000821:virology; D005260:Female; D005602:France; D005838:Genotype; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D017422:Sequence Analysis, DNA; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D017201:Virus Shedding
D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D012367:RNA, Viral; D000637:Transaminases