title: [Acute hepatitis, but not A, B, or C: consider E].
abstract: OBJECTIVE
  To determine the percentage of hepatitis E virus (HEV) infections in serum samples from patients with negative serology for hepatitis A, B and C and to find out what may be the harmful consequences of a missed diagnosis of acute HEV infection.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Serum samples were selected from patients with infectious hepatitis who tested negative for hepatitis A, B and C virus. Serum samples that had elevated alanine aminotransferase (ALT; > 34 U/l) were included in this study. All samples were then tested for HEV using an enzyme-linked immunosorbent assay (ELISA) and immunoblot assay. Of patients with serological evidence of acute HEV, files were checked for the originally documented diagnosis at hospital discharge.
  
  
  RESULTS
  In the period October 2007-September 2008, 139 serum samples met the inclusion criteria. In 23 serum samples the ELISA was positive (IgM positive and/or Ig total positive); in 16/23 serum samples immunoblot assay was also positive. The percentage of confirmed HEV infections was 11.5% (16/139). In only one patient was the originally documented diagnosis correct. Several patients underwent invasive diagnostic procedures and treatment as a result of an incorrect diagnosis.
  
  
  CONCLUSIONS
  Hepatitis E serology should be a standard tool in the diagnostic workup of infectious hepatitis patients in the Netherlands.
authors.affiliation: Amphia Ziekenhuis, Breda, Afd. Medische Microbiologie, the Netherlands. gunnar.andriesse@gmail.com
authors.forename: Gunnar I
authors.initials: GI
authors.lastname: Andriesse
authors.forename: Mustafa
authors.initials: M
authors.lastname: Donmez
authors.forename: Jamie
authors.initials: J
authors.lastname: Vissers
authors.forename: Peter
authors.initials: P
authors.lastname: van Wijngaarden
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000097:blood / Q000175:diagnosis*; D016752:Hepatitis E virus / Q000276:immunology*; D006801:Humans; D007223:Infant; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies