title: Acute fulminant hepatitis E virus genotype 3e infection: description of the first case in Europe.
abstract: Hepatitis E virus (HEV) is the most important causative agent of acute hepatitis in developing countries. The disease is usually characterized by a self-limiting, benign course. However, when particular conditions coexist (pregnancy, old age, pre-existing liver disease) it may run an unfavourable course. To date, 4 HEV genotypes have been described. Historically, in the Western world, HEV infection was considered a travel-related disease, however in the last 2 decades a great number of non-travel-related autochthonous cases have been described, more often related to genotype 3 or 4 and in the context of zoonosis. We report the case of an elderly Italian man with an acute fulminant HEV infection genotype 3e that developed in the context of pre-existing liver disease; this is the first case of an unfavourable outcome associated with subgenotype 3e. The potential pathogenicity of this subgenotype together with the influence of host-related risk factors are discussed.
authors.affiliation: From the Digestive and Liver Disease Unit, School of Medicine and Psychology, Sapienza University of Rome , Sant'Andrea Hospital.
authors.forename: Stefano
authors.initials: S
authors.lastname: Festa
authors.forename: Anna Rosa
authors.initials: AR
authors.lastname: Garbuglia
authors.forename: Flavia
authors.initials: F
authors.lastname: Baccini
authors.forename: Francesco
authors.initials: F
authors.lastname: Panzuto
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Capobianchi
authors.forename: Iolanda
authors.initials: I
authors.lastname: Santino
authors.forename: Flaminia
authors.initials: F
authors.lastname: Purchiaroni
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Orgera
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
authors.forename: Massimo
authors.initials: M
authors.lastname: Marignani
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis* / Q000821:virology*; D016752:Hepatitis E virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007558:Italy; D008297:Male; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics*; D017422:Sequence Analysis, DNA
chemical_list: D012367:RNA, Viral
keywords: Hepatitis E virus; epidemiology; fulminant; genotype; phylogenetic tree; ribavirin