A Study of Viral Hepatitis E Infection in a Tertiary Care Hospital in Mysore, South India

Abstract

Background. In this study, we aimed to explore the clinical and epidemiological profile of all patients with hepatitis E virus (HEV) who were admitted to a tertiary care hospital in Mysore, India and to further assess various factors that influence the prognosis of these patients.Methods. Two hundred ninety patients with HEV infection were included in the study and interviewed. They were subjected to clinical examination and laboratory investigations, including complete hemogram, renal, and liver function tests. Viral markers for HBV, HAV, HCV, and HEV by hepatitis B surface antigen, anti-HAV, anti-HCV, and anti-HEV antibodies, respectively, were done using the enzyme-linked immunosorbent assay method. Final outcome was recorded in the form of discharge or death.Results. Males had higher (82.8%) incidence of HEV infection. Yellowish discoloration of urine was the most common symptom, and icterus was the most common sign at presentation. Hepatomegaly was most common finding on abdominal examination. Mean duration of hospital stay was higher among diabetics (10 days vs 7.11 ± 3.52 days). Overall, mortality observed was 3.45%. A higher mean age (P = .000) and duration of hospital stay (P = .000) were associated with higher mortality. Mortality was significantly higher among patients with alcohol abuse (25% vs 0%) (P = .004). Higher mean prothrombin time-international normalised ratio (PT-INR) (1.6 ± 0.13 vs 1.21 ± 0.32), total bilirubin (20.3 ± 5.08 vs 11.33 ± 7.26 mg/dL), and direct bilirubin (15.05 ± 3.64 vs 6.35 ± 3.71 mg/dL) were associated with higher mortality, whereas lower mean serum albumin (2.6 ± 0.11 vs 3.41 ± 0.40 gm/dL) was associated with higher mortality. Increase in renal parameters (ie, urea [97 ± 33.48 vs 32.43 ± 18.41 mg/dL] and creatinine [2.9 ± 1.38 vs 1.12 ± 0.64 mg/dL]) and electrolyte imbalances (ie, hyperkalemia [5.95 ± 1.21 vs 4.29 ± 0.51 mmol/L] and hyponatremia [123 ± 3.56 vs 136.04 ± 2.97 mmol/L]) were associated with higher mortality. There were 20-fold increases in mean serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) values (SGPT: SGOT = 1.148) and a 1-fold increase in mean alkaline phosphatase.Conclusions. Higher mean age, duration of hospital stay, PT-INR, total bilirubin, direct bilirubin, blood urea, serum creatinine, potassium values, alcohol abuse, presence of ascites, and fulminant hepatitis were associated with higher mortality, whereas lower mean serum albumin and sodium values were associated with higher mortality. Diabetics had a higher mean duration of hospital stay.

Detection of Genotype 1a and 1f of Hepatitis E Virus in Patients Treated at Tertiary Care Hospitals in Central India

“…Our findings are similar to other documented studies [2, 3, 5, 15, 21]. It is well known that the symptoms of HEV infection are more common and apparent in adults, whereas children have asymptomatic infections [3, 22].…”

“…This is the first study from central India that documents a prevalence of 24.9% of HEV infection in the suspected cases, indicating that HEV is a leading aetiological agent among hepatotropic viruses. Several other studies have also reported similar observations from other parts of India [2, 5]. During the study period of 3 years, samples from villages, towns, and cities of 20 districts were found to be positive, indicating widespread cases of HEV in the region.…”

“…In Asian countries, a case fatality rate (CFR) of 1–2% is reported in the general population, whilst a case fatality rate of about 20% is reported in pregnant women, especially during the third trimester [5, 6]. …”

“…HEV, a member of the family Hepeviridae within the genus Hepevirus [3], is a non-enveloped, spherical virus of about 27–34 nm in size with positive-sense RNA and a length of 7.2 kb [5, 7-9]. Its RNA genome possesses short untranslated regions at either end and 3 open reading frames (ORF).…”

Feto-Maternal Outcomes of Hepatitis E Virus Infection in Pregnancy of Bangladeshi women.

“…High level of liver enzyme indicates on going hepatocytes injury. Similar findings were also observed in other study in India, where significant relationship between higher level of total and direct bilirubin and mortality rate among HEV infected person was observed (21) . The higher proportion of IUDs and preterm babies observed in present study among HEV-infected women was reported before by others also9.…”