title: Role of non-hepatotropic viruses in acute sporadic viral hepatitis and acute-on-chronic liver failure in adults.
abstract: BACKGROUND
  Acute viral hepatitis (AVH) is mostly caused by hepatitis E (HEV) and hepatitis A (HAV) viruses in India. This study was undertaken to find out the incidence of various hepatotropic and non-hepatotropic viruses in AVH and acute-on-chronic liver failure (ACLF) patients.
  
  
  METHODS
  Six-hundred and seventy-three adult patients of AVH and ACLF were screened for acute serological markers of hepatotropic (A, B, C, D, and E) and the non-hepatotropic cytomegalovirus (CMV) and Epstein-Barr virus (EBV).
  
  
  RESULTS
  Viral etiology profile in 295 samples with confirmed etiology were HEV in 155 (52.5 %); HAV in 43 (14.5 %); HBV in 35 (11.8 %); HCV in 1 (0.3 %); mixed viral etiology in 30 (10.1 %); and non-hepatotropic viruses, cytomegalovirus, and Epstein-Barr virus in 31 (10.5 %). Two-hundred and six patients (69.8 %) were AVH and 89 (30.1 %) ACLF. HEV was the commonest cause of infection in both the groups AVH (n = 95, 46.1 %) and ACLF (n = 60, 67.4 %). Twenty-nine (9.8 %) patients died on follow up; mortality was higher in ACLF (25/89, 28 %) than AVH group (4/206, 1.94 %; p < 0.001). The mortality was higher when HEV was the cause of acute event (20/29, 68.9 %). In AVH, mixed infection was more common as compared to ACLF (27 vs. 3, p < 0.001). Non-hepatotropic viruses contributed significantly higher infections in AVH as compared to ACLF (29 vs. 2, p = 0.002) patients.
  
  
  CONCLUSIONS
  HEV was an important cause of symptomatic hepatitis in both AVH and ACLF patients. Non-hepatotropic viruses like CMV and EBV were identified in a significant number of patients with AVH and much less frequently in ACLF.
authors.affiliation: Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India. ektagaurisha@gmail.com.
authors.forename: Ekta
authors.initials: E
authors.lastname: Gupta
authors.affiliation: Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Ballani
authors.affiliation: Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000453:epidemiology / Q000821:virology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003587:Cytomegalovirus / Q000302:isolation & purification* / Q000472:pathogenicity; D005260:Female; D016752:Hepatitis E virus / Q000302:isolation & purification* / Q000472:pathogenicity; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D055815:Young Adult
keywords: Acute viral hepatitis; Epidemiology; Non-hepatotropic virus; Screening