title: Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience.
abstract: BACKGROUND
  In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world.
  
  
  OBJECTIVE
  To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics.
  
  
  METHODS
  We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed.
  
  
  RESULTS
  A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as "acute-on-chronic liver failure" (ACLF), one died and the other underwent liver transplantation.
  
  
  CONCLUSIONS
  Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis.
authors.affiliation: Aparato Digestivo, Hospital de León, España.
authors.forename: Luzdivina
authors.initials: L
authors.lastname: Monteserín Ron
authors.affiliation: Hospital de León.
authors.forename: Marcos
authors.initials: M
authors.lastname: Jiménez Palacios
authors.affiliation: Hospital de León.
authors.forename: Pedro
authors.initials: P
authors.lastname: Linares Torres
authors.affiliation: Hospital de León.
authors.forename: Aleida
authors.initials: A
authors.lastname: Miguel Peña
authors.affiliation: Aparato Digestivo, Hospital de León.
authors.forename: Begoña
authors.initials: B
authors.lastname: Álvarez Cuenllas
authors.affiliation: Hospital de León.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Fernández-Natal
authors.affiliation: Hospital de León.
authors.forename: Emilio
authors.initials: E
authors.lastname: Valverde Romero
authors.affiliation: Digestivo, Complejo hospitalario de Leon.
authors.forename: Francisco
authors.initials: F
authors.lastname: Jorquera Plaza
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome