Hepatitis E virus-associated aplastic anaemia: The first case of its kind

Shah, Shahida Amjad Riaz; Lal, Amreek; Idrees, Muhammad; Hussain, Abrar; Jeet, Charan; Malik, Fayyaz Ahmed; Iqbal, Zafar; Rehman, Habib ur

doi:10.1016/j.jcv.2012.02.002

Cited by 48 publications

(29 citation statements)

References 9 publications

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“…A range of extrahepatic manifestations have been described in association with HEV infection in European and Asian countries. These complications include neurological disorders (Kamar et al 2011;Cheung et al 2012;Santos et al 2013;van den Berg et al 2014;Woolson et al 2014), myasthenia gravis (Belbezier et al 2014), thrombocytopenia (Fourquet et al 2010), aplastic anemia (Shah et al 2012) glomerulonephritis (Kamar et al 2012) and acute pancreatitis (Deniel et al 2011). Among them, neurological complications are more frequently reported, including Guillain-Barré syndrome, brachial neuritis, transverse myelitis, cranial nerve palsy and peripheral neuropathy (Kamar et al 2011;Cheung et al 2012;van den Berg et al 2014;Woolson et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Yazaki

Sugawara²,

Honda

et al. 2015

Tohoku J. Exp. Med.

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Autochthonous hepatitis E is increasingly being recognized in industrialized countries, including Japan. Although neurological abnormalities have been sporadically reported as an extrahepatic manifestation of hepatitis E virus (HEV) infection, it is rare and has not been reported in Japan. The present study aimed to characterize a total of 20 patients consecutively diagnosed with sporadic acute hepatitis E at a city hospital in Hokkaido, Japan, during 2001-2014, focusing on a patient complicated with neuropathy. Seventeen patients were infected with genotype 4 HEV, while the remaining three patients were with genotype 3 HEV. Although a 67-year-old male with severe hepatitis did not have predisposing factors associated with the development of neurological disorders, such as diabetes mellitus and the use of immunosuppressive agents, he developed bilateral peripheral facial palsy six days after admission. A neurological examination revealed the inability to smile, frown, close his eyes completely or puff out his cheeks. MRI brain scans were considered to be normal. Although it took 83 days after admission for the total bilirubin levels to normalize, his neurological symptoms resolved gradually within three weeks without any sequelae following conservative therapy. A full-length genomic analysis of the HEV strain (HE-JA30) isolated from the patient belonged to genotype 4 and was closest to that currently circulating in Hokkaido, Japan. This is the first report of HEV-associated neuropathy in Japan. While all of previous reports on HEV-related neuropathy involve genotype 3 HEV, the present report is unique in that genotype 4 HEV is responsible for the neuropathy.

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Section: Introductionmentioning

confidence: 99%

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Yazaki

Sugawara²,

Honda

et al. 2015

Tohoku J. Exp. Med.

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“…Extrahepatic manifestations such as hematological manifestations (8)(9)(10), acute pancreatitis (11), kidney injuries (12), or neurological manifestations can also occur (13)(14)(15).…”

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confidence: 99%

Mutation in the Hepatitis E Virus Polymerase and Outcome of Ribavirin Therapy

Lhomme

Kamar

Nicot³

et al. 2016

Antimicrob Agents Chemother

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m Hepatitis E virus (HEV) can lead to chronic infection in solid-organ transplant patients. Ribavirin is efficient for treatment of chronically infected patients. Recently, the1634R mutation in the HEV polymerase has been associated with treatment failure. However, it is unclear if this mutation can be used as a prognostic marker of treatment outcome. We studied the prevalence of the 1634R mutation in the HEV polymerase of patients starting ribavirin therapy, the influence of the 1634R variants on the viral response, the frequency of the 1634R mutation in patients whose treatment failed, and its impact on ribavirin retreatment. We analyzed pretreatment samples from 63 solid-organ transplant patients with chronic hepatitis E using deep sequencing; 42 patients had a sustained virologic response (SVR), and 21 were non-SVR patients. We detected the 1634R variant by deep sequencing in 36.5% (23/63) of the patients (proportions, 1.3 to 100%). The 1634R variant was detected in 31.0% (13/42) of baseline plasma samples from patients with SVR and in 47.6% (10/21) in the other patients (P ‫؍‬ 0.2). The presence of this mutation did not influence the initial decrease in viral RNA. Lastly, a second prolonged ribavirin treatment led to SVR in 70% of the patients who initially did not have SVR, despite the presence of the 1634R variant. We conclude that the presence of the 1634R variant at ribavirin initiation does not lead to absolute ribavirin resistance. Although its proportion increased in patients whose treatment failed, the presence of the 1634R variant did not compromise the response to a second ribavirin treatment.

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“…Such type of marrow failure may be severe and is typically fatal if untreated. Shah et al (2012) reported a case of 32-year-old male who developed severe aplastic anemia after an acute attack of hepatitis by hepatitis E virus in Pakistan. 18 In the present study, no patient presented with either pancytopenia or clinical features of pancytopenia.…”

Section: Discussionmentioning

confidence: 99%

Hematological changes associated with hepatitis by hepatitis E virus

Rahman¹,

Giti

Kabir

et al. 2018

Bangabandhu Sheikh Mujib Medical Univ J

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The purpose of the study was to find out the changes in the common hematological parameters in patients (n=998) of acute viral hepatitis caused by hepatitis E virus from April to May, 2018. The mean hemoglobin level was 13.5 g/dL. However, seven patients were found to have hemoglobin level <11.0 g/dL. The mean red cell count was 4.5 x 1012/L. The mean packed cell volume was 40.6%. The mean white blood cell count was 7.1 x 109/L. However, leucopenia was found in 8 cases. The mean platelet count was 186.2 x 109/L. Among the hematological changes associated with hepatitis E virus infection, thrombocytopenia is a notable finding.

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Hepatitis E virus-associated aplastic anaemia: The first case of its kind

Cited by 48 publications

References 9 publications

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Mutation in the Hepatitis E Virus Polymerase and Outcome of Ribavirin Therapy

Hematological changes associated with hepatitis by hepatitis E virus

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