Montserrat Fraga1, Christopher Doerig1, Hervé Moulin2, Florian Bihl3, Felix Brunner4, Beat Müllhaupt5, Paolo Ripellino6, David Semela7, Felix Stickel5, Benedetta Terziroli Beretta-Piccoli8, Vincent Aubert9, Amalio Telenti2, Gilbert Greub2, Roland Sahli2, Darius Moradpour1. 1. Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland. 2. Institute of Microbiology, University Hospital Lausanne, Lausanne, Switzerland. 3. Hepatology Service, Ente Ospedaliero Cantonale Ticino, Lugano and University Hospital Geneva, Geneva, Switzerland. 4. Hepatology, University Clinic for Visceral Surgery and Medicine, University Hospital Berne, Berne, Switzerland. 5. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 6. Neurocenter of Southern Switzerland, Lugano, Switzerland. 7. Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 8. Epatocentro Ticino, Lugano, Switzerland. 9. Division of Immunology and Allergy, University Hospital Lausanne, Lausanne, Switzerland.
Abstract
BACKGROUND: Autochthonous hepatitis E is increasingly recognized as zoonotic infection in western countries. Serological assays have varying sensitivity and specificity. METHODS: We implemented molecular testing to identify and characterize acute hepatitis E acquired in Switzerland. RESULTS: Ninety-three cases of mostly symptomatic acute hepatitis E acquired in Switzerland were documented by PCR between November 2011 and December 2016. Median HEV RNA was 7.5 x 104 IU/mL (range, 5.3 to 4.7 x 107 IU/mL). HEV genotyping was successful in 78 patients, revealing genotype 3 in 75 and genotype 4 in three patients. Phylogenetic analyses revealed a few limited geographical and temporal clusters. Of the 91 patients with available anti-HEV IgM serology, four were negative; three of these were also IgG-negative, likely as a result of immunosuppression, and one was IgG-positive, a constellation compatible with HEV reinfection. Median age of the patients was 58 years (range, 20-80 years); 71 (76.3%) were men and 49 of these (69.0%) were ≥ 50 years old. The clinical course was particularly severe in patients with underlying chronic liver disease, with fatal outcome in two patients. Six patients (6.5%) presented with neuralgic amyotrophy. CONCLUSIONS: Nucleic acid-based diagnosis reveals HEV as a relevant cause of acute hepatitis in Switzerland. Middle-aged and elderly men constitute the majority of symptomatic patients. Testing for HEV should be included early in the diagnostic workup of acute hepatitis and of neuralgic amyotrophy, a typical extrahepatic manifestation of HEV genotype 3 infection.
BACKGROUND: Autochthonous hepatitis E is increasingly recognized as zoonotic infection in western countries. Serological assays have varying sensitivity and specificity. METHODS: We implemented molecular testing to identify and characterize acute hepatitis E acquired in Switzerland. RESULTS: Ninety-three cases of mostly symptomatic acute hepatitis E acquired in Switzerland were documented by PCR between November 2011 and December 2016. Median HEV RNA was 7.5 x 104 IU/mL (range, 5.3 to 4.7 x 107 IU/mL). HEV genotyping was successful in 78 patients, revealing genotype 3 in 75 and genotype 4 in three patients. Phylogenetic analyses revealed a few limited geographical and temporal clusters. Of the 91 patients with available anti-HEV IgM serology, four were negative; three of these were also IgG-negative, likely as a result of immunosuppression, and one was IgG-positive, a constellation compatible with HEV reinfection. Median age of the patients was 58 years (range, 20-80 years); 71 (76.3%) were men and 49 of these (69.0%) were ≥ 50 years old. The clinical course was particularly severe in patients with underlying chronic liver disease, with fatal outcome in two patients. Six patients (6.5%) presented with neuralgic amyotrophy. CONCLUSIONS: Nucleic acid-based diagnosis reveals HEV as a relevant cause of acute hepatitis in Switzerland. Middle-aged and elderly men constitute the majority of symptomatic patients. Testing for HEV should be included early in the diagnostic workup of acute hepatitis and of neuralgic amyotrophy, a typical extrahepatic manifestation of HEV genotype 3 infection.
Authors: Debin Tian; Wen Li; C Lynn Heffron; Bo Wang; Hassan M Mahsoub; Harini Sooryanarain; Anna M Hassebroek; Sherrie Clark-Deener; Tanya LeRoith; Xiang-Jin Meng Journal: Proc Natl Acad Sci U S A Date: 2022-06-07 Impact factor: 12.779
Authors: Valeria Alfonsi; Luisa Romanò; Anna Rita Ciccaglione; Giuseppina La Rosa; Roberto Bruni; Alessandro Zanetti; Simonetta Della Libera; Marcello Iaconelli; Patrizia Bagnarelli; Maria Rosaria Capobianchi; Anna Rosa Garbuglia; Flavia Riccardo; Maria Elena Tosti Journal: Euro Surveill Date: 2018-10