title: Coexistence of IgM antihepatitis A virus and IgM antihepatitis E virus in acute viral hepatitis: a prospective, multicentre study in Korea.
abstract: This study investigated the clinical, serological and molecular characteristics of coexistence of both immunoglobulin M (IgM) antihepatitis A virus (HAV) and IgM antihepatitis E virus (HEV) in acute viral hepatitis using a prospective, multicentre design. Among a total of 771 symptomatic cases with acute viral hepatitis enrolled in a Korean city from September 2006 to August 2008, coexistence of IgM anti-HAV and IgM anti-HEV was found in 43 patients (A+E group; 6%), while the existence of IgM anti-HAV alone was found in 595 patients (A group; 77%) and that of IgM anti-HEV alone in 14 patients (E group; 2%). Clinical data analysis and measurement of IgM and IgG anti-HEV were performed using two different commercial kits, and HAV RNA and HEV RNA were detected in available serum or stool samples. The clinical features of the A+E group were similar to those of the A group. HAV RNA detection rates in the A+E and A group were similar, while HEV RNA was detected only in the stool samples of the E group, not in the A+E group. Comparative testing of anti-HEV using two different ELISA kits showed markedly discordant results for IgM anti-HEV positivity and consistently low positivity for IgG anti-HEV in the A+E group. Coexistence of IgM anti-HEV measured by the Genelabs ELISA kit in the setting of hepatitis A appears to yield false-positive results in nonendemic areas of HEV infection. Diagnosis of hepatitis E using IgM anti-HEV should be made with caution.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Seoul, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Jang
authors.forename: Y M
authors.initials: YM
authors.lastname: Jung
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: J-W
authors.initials: JW
authors.lastname: Kim
authors.forename: S G
authors.initials: SG
authors.lastname: Hwang
authors.forename: K S
authors.initials: KS
authors.lastname: Rim
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: Y M
authors.initials: YM
authors.lastname: Park
authors.forename: S-K
authors.initials: SK
authors.lastname: Kang
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Yun
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Jeong
mesh_terms: D000293:Adolescent; D000328:Adult; D001769:Blood / Q000821:virology; D015897:Comorbidity; D005243:Feces / Q000821:virology; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology* / Q000276:immunology*; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood*; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral