title: Clinical and virological profiling of sporadic hepatitis E virus infection in China.
abstract: Recently, genotype 4 HEV (HEV-4) associated hepatitis E has overtaken HEV-1 infections in China, but few studies reported the clinical and virological features of HEV-4 infection.
  
  
  
  Sixty-two patients with acute hepatitis E (AHE) were enrolled from three hospitals in China. Clinical profiles and epidemiological records were analyzed. Patients' serum samples were tested for anti-HEV IgM/IgG and fecal samples were screened for HEV RNA. Representative HEV isolates were partially sequenced and analyzed phylogenetically.
  
  
  
  A high median age (57.5 years) and an overwhelming proportion of males (51/62, 82%) were found. Most patients presented with symptoms of jaundice (56/62, 90%), malaise (44/62, 71%), anorexia (44/62, 71%) and nausea (41/62, 66%). Elevated mean values of total bilirubin (186 μmol/L), direct bilirubin (109 μmol/L), ALT (997 IU/L), AST (583 IU/L), ALP (159 IU/L) and GGT (170 IU/L) and reduced albumin level (32 g/L) were observed. The positive rate for anti-HEV IgM/IgG was 100% (62/62)/76% (47/62), for HEV RNA was 58% (25/43). Twelve HEV-4 isolates were obtained.
  
  
  
  All HEV isolates belonged to HEV-4 and showed high sequence similarity to swine HEV-4. Most of the sporadic cases had typical clinical symptoms, signs of AHE, and elevated levels of serum bilirubin and liver enzymes.
authors.affiliation: Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Linyi People's Hospital, Shandong Province, China.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Infectious Diseases, Taiyuan No.3 Hospital, Shanxi Province, China.
authors.forename: Qianhui
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Linyi People's Hospital, Shandong Province, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Tian
authors.affiliation: Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China. Electronic address: lingwang@bjmu.edu.cn.
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhuang
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007565:Jaundice / Q000453:epidemiology / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D013552:Swine; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral; D000410:Alanine Transaminase
keywords: Clinical features; Hepatitis E; Hepatitis E virus; Molecular epidemiology; Zoonotic transmission