Acute Hepatitis E with Elevated Creatine Phosphokinase

Kitazawa, Takatoshi; Ota, Yasuo; Suzuki, Marina Satika; Morisawa, Yuji; Shintani, Yoshizumi; Koike, Kazuhiko; Kimura, Satoshi

doi:10.2169/internalmedicine.42.899

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…Several musculoskeletal manifestations associated with the acute phase of HEV infection have been reported: (i) asymptomatic elevation of creatine phosphokinase (CK) of MM type indicating skeletal muscle damage [ 82 ], (ii) acute polyarthritis lasting for 3 months and resolving spontaneously [ 83 ], (iii) necrotizing myositis associated with GBS in a liver-transplant patient resolving after ribavirin administration [ 53 ], (iv) pyomyositis 4 weeks after recovery from acute hepatitis E in a patient with recent history of type 2 diabetes [ 84 ], (v) inflammatory polyarthralgia revealing acute hepatitis E [ 85 ], and (vi) arthralgia associated with a diffuse maculopapular rash resolving with supportive measures [ 86 ] ( Table 4 ). Further studies are needed to confirm the association of HEV infection with musculoskeletal manifestations.…”

Section: Musculoskeletal Manifestations Of Hevmentioning

confidence: 99%

Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

Bazerbachi

Haffar

Garg

et al. 2015

Gastroenterol. Rep.

102

125

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Background and aims: Hepatitis E virus (HEV) infection is a significant public health problem that afflicts almost 20 million individuals annually and causes acute liver injury in 3.5 million, with approximately 56 000 deaths. As with other viral hepatitides, extra-hepatic manifestations could represent an important aspect of this infection. The spectrum of these manifestations is still emerging. Acute pancreatitis and neurological, musculoskeletal, hematological, renal, and other immune-mediated manifestations have been described. The aim of this article is to comprehensively review the published literature of extra-hepatic manifestations associated with HEV infection.Data sources: We searched the PubMed database using the MeSH term “hepatitis E” and each of the extra-hepatic manifestations associated with HEV infection. No language or date restrictions were set in these searches. Searches retrieving articles with non-A, non-B hepatitis were excluded. Additional articles were identified through the reference lists of included articles.Results: Several extra-hepatic manifestations associated with HEV infection have been published. The temporal association between some extra-hepatic manifestations and HEV infection and the exclusion of other possible etiologies suggests that HEV infection could have caused some of them. According to the available data, HEV infection appears to be strongly associated with acute pancreatitis, neurological disorders (with primarily dominant peripheral nerve involvement, most commonly manifested as Guillain-Barré syndrome, followed by neuralgic amyotrophy), hematological diseases (hemolytic anemia due to glucose phosphate dehydrogenase deficiency, and severe thrombocytopenia), glomerulonephritis, and mixed cryoglobulinemia. More data are needed to clarify whether an association exists with musculoskeletal or other immune-mediated manifestations.Conclusions: HEV infection should be considered in patients with acute pancreatitis, Guillain-Barré syndrome, neuralgic amyotrophy, hemolytic anemia due to glucose phosphate dehydrogenase deficiency, severe thrombocytopenia, glomerulonephritis, and mixed cryoglobulinemia. Alternatively, signs and symptoms of these conditions should be sought in patients with acute or chronic HEV infection. More data are needed to confirm the role of HEV in other extra-hepatic disorders.

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Section: Musculoskeletal Manifestations Of Hevmentioning

confidence: 99%

Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

Bazerbachi

Haffar

Garg

et al. 2015

Gastroenterol. Rep.

102

125

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“…It was a well‐accepted consensus that hepatitis E is an acute self‐limiting disease; however, HEV‐associated chronic infections and cirrhosis were recently reported in immunocompromised patients, such as recipients of solid‐organ transplants, cancer patients receiving chemotherapy, and HIV/AIDS patients . This observation, along with extra‐hepatic manifestations in the context of pre‐existing HEV infection including neurological disorders, musculoskeletal, and hematological manifestations, has aroused attention globally.…”

Section: Introductionmentioning

confidence: 99%

An overview: Rabbit hepatitis E virus (HEV) and rabbit providing an animal model for HEV study

Wang

Liu

2017

Reviews in Medical Virology

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SummaryHepatitis E virus (HEV) is a single-stranded, positive-sense RNA virus and the causative agent of hepatitis E. The virus belongs to genus Orthohepevirus in the family Hepeviridae, which contains 4 major genotypes closely relating to humans. Genotypes 1 and 2 only infect humans whereas genotypes 3 and 4 HEV are harbored in a wide range of animal species worldwide and are zoonotic to humans. Recently, a novel animal strain of HEV has been isolated in farmed rabbits in China, and subsequently more strains were discovered in the rabbit populations in at least 7 other countries. Due to high sequence similarity to genotype 3 HEV, rabbit HEV (rHEV) has been assigned to genotype 3. Experimental study showed that rHEV could infect non-human primate and human, which pose a direct threat to human. Further pathogenesis studies showed laboratory rabbits infected with rHEV and genotype 4 HEV could present similar signs of acute and chronic hepatitis E along with extra-hepatic replication as observed in humans. High mortality and vertical transmission were reproduced in rHEV infected pregnant rabbits. Furthermore, rabbit model was also found suitable for evaluating HEV vaccine efficacy in order to manage zoonotic transmission. These data showed laboratory rabbits could serve as an alternative animal model for HEV study under the current circumstances that HEV propagation is limited in vitro. In general, this review aims at presenting comprehensive up-to-date information about rHEV strains and rabbit model for HEV studies.

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“…A number of common viral infections have been associated with myositis with CK elevation, including human T-cell lymphotropic virus type-1, 20 human immunodeficiency virus, 21 cytomegalovirus, 22 influenza, 23 hepatitis E, 24 hepatitis C 25 and Coxsackie B. 26 More relevant to our study, both YF 17D vaccine associated viscerotropic adverse events, 17 and natural infection with WN virus 27 have been associated with rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 54%

Exercise-Induced Serum Enzyme Elevations Confounding the Evaluation of Investigational Drug Toxicity: Report of Two Cases in a Vaccine Trial

Johnson¹,

Monath²,

Kanesa-thasan³

et al. 2005

Human Vaccines

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Two subjects developed marked elevations in creatine kinase and other serum enzymes associated with mild myalgia during a randomized, double-blind, controlled Phase 1 clinical trial of an investigational live, attenuated vaccine against West Nile virus (ChimeriVax™-WN02). One subject had received ChimeriVax™-WN02 while the other subject was enrolled in an active control group and received licensed yellow fever 17D vaccine (YF-VAX ® ). Subsequently, the clinical trial was interrupted, and an investigation was begun to evaluate the enzyme abnormalities. As daily serum samples were collected for determination of quantitative viremia, it was possible to define the enzyme elevations with precision and to relate these elevations to physical activity of the subjects, symptoms, and virological and serological measurements. Evaluation of both subjects clearly showed that skeletal muscle injury, and not cardiac or hepatic dysfunction, was responsible for the biochemical abnormalities. This investigation also implicated strenuous exercise as the cause of the apparent muscle injury rather than the study vaccines. As a result of this experience, subjects engaged in future early-stage trials of these live, attenuated viral vaccines will be advised not to engage in contact sports or new or enhanced exercise regimens for which they are not trained or conditioned. The inclusion of placebo control arm (in lieu of or addition to an active vaccine control) will also be useful in differentiating causally related serum enzyme elevations.

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Acute Hepatitis E with Elevated Creatine Phosphokinase

Cited by 7 publications

References 20 publications

Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

An overview: Rabbit hepatitis E virus (HEV) and rabbit providing an animal model for HEV study

Exercise-Induced Serum Enzyme Elevations Confounding the Evaluation of Investigational Drug Toxicity: Report of Two Cases in a Vaccine Trial

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