Acute, Chronic and Fulminant Hepatitis E: Ten Years of Experience (2004-2013)

Abstract

The hepatitis E virus (HEV) is the main cause of acute epidemic hepatitis in developing countries and it is estimated that approximately one third of the world's population has been infected with this virus. The aim of this study is to describe the most important clinical manifestations and epidemiological aspects in 62 hepatitis E cases treated in Madrid (Spain) during a 10-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013).Fifty-five patients, six patients and one patient with acute, fulminant and chronic hepatitis E, respectively, have been studied over a period of 10 years. Sixty-two individuals (33 male and 10 female) were treated between 2004 and 2013 in the Hospital Ramón y Cajal (Madrid, Spain). The diagnosis was performed by the detection of IgG and IgM anti-HEV and HEV RNA in serum samples. Acute hepatitis E was defined by the presence of IgM anti-HEV and/or HEV RNA in serum and chronic hepatitis E if the RNA was detectable more than 6 months. Fulminant hepatitis E was diagnosed if encephalopathy was observed in addition to IgM anti-HEV and/or RNA HEV in serum. The median age was 46.67 and 49.6 years in acute hepatitis E and fulminant hepatitis E, respectively. The risk factors recorded were travel to endemic areas in 14 patients, 4 were in contact with animals, 5 suffered from hepatic steatosis due to alcohol consumption, 3 consumed uncontrolled foods and 2 used to drink water from streams. HEV is the cause of acute self-limited hepatitis although 50% of the studied cases had to be hospitalized. However a small number of patients, 4.8% had fulminant hepatitis requiring hepatic transplant. Chronic hepatitis E is very infrequent in immunocompetent individuals. The increase in incidence of hepatitis E is due to better diagnostic tests in these recent years.