Hepatitis E Virus Infection as a Possible Cause of Acute Liver Failure in Europe.
OBJECTIVE
In Western countries, infection with the hepatitis E virus (HEV) is considered to be rare and imported from endemic regions. However, the prevalence of HEV infection has increased among adults in central Europe. HEV infection can cause acute liver failure (ALF), but there have been only a few confirmed cases of HEV-associated ALF in Europe. We investigated the number of cases of indeterminate ALF associated with HEV infection.


METHODS
We performed a retrospective analysis of 80 patients diagnosed with ALF or acute hepatitis at the University Hospital Essen in Germany from November 2006 through December 2013. Clinical data were collected from the hospital databases; archived sera were tested for IgG and IgM against HEV, as well as HEV RNA.


RESULTS
Sera from 12 patients (15%) tested positive for IgG against HEV IgG; 7 of these samples did not test positive for HEV IgM or HEV RNA. Sera from 64 patients (80%) did not test positive for IgG or IgM against HEV or HEV RNA. Sera from 8 patients (10%) tested positive for HEV RNA (only 4 of these were positive for HEV IgG) and had clinical findings to support acute HEV infection.


CONCLUSIONS
In a hospital in Germany, approximately 10% to 15% of patients with ALF had evidence for HEV infection. Serologic tests for IgG against HEV are insufficient to identify or exclude HEV infection; tests for HEV RNA also should be performed on patients with ALF of ambiguous etiology.
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Paul
P
Manka
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Lars P
LP
Bechmann
Regeneration and Repair Group, Foundation for Liver Research, The Institute of Hepatology, London, United Kingdom.
Jason D
JD
Coombes
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Viktoria
V
Thodou
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Martin
M
Schlattjan
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Alisan
A
Kahraman
Regeneration and Repair Group, Foundation for Liver Research, The Institute of Hepatology, London, United Kingdom; Department of Hepatology, Barts Health NHS Trust, London, United Kingdom.
Wing-Kin
WK
Syn
Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany.
Fuat
F
Saner
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Guido
G
Gerken
Institute of Pathology and Neuropathology, University Hospital, University Duisburg-Essen, Essen, Germany.
Hideo
H
Baba
Institute of Virology, University Hospital, University Duisburg-Essen, Essen, Germany.
Jens
J
Verheyen
Institute for Virology, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
Jörg
J
Timm
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany. Electronic address: ali.canbay@uni-due.de.
Ali
A
Canbay
D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000150:complications*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies
D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral
Blood Test; Diagnosis; Hepatitis E; Liver Disease