Profile of clinical characteristics and serologic markers of sporadic hepatitis E in a community cohort study

Abstract

Hepatitis E virus (HEV) is a pathogen of global significance, but the value of HEV-related markers in the diagnosis of hepatitis E remains controversial. Previous studies on hepatitis E profiles have been mainly cross-sectional and conducted among inpatients in large hospitals, and hepatitis E cases have been primarily defined by limited partial markers. In this community-based study, 4,110 active hepatitis cases from a population of nearly 600,000 were followed over 48 months and serial serum samples were collected. Both HEV pathogen (HEV RNA and antigen) and anti-HEV antibody markers were used to determine HEV infection status and the relationship between hepatitis and HEV infection. In total, 98 hepatitis E patients were identified and all available isolates from 58 patients belonged to HEV genotype 4. The mean age of the patients was 58.14 years, with an overwhelming proportion of males (70.4%). Hepatitis E accounted for 22.86% of active hepatitis cases with alanine aminotransferase levels ≥15.0-fold the upper limit of normal, suggesting the need to include HEV in routine testing for these patients. Ninety-two hepatitis E patients were positive for at least 2 of HEV antigen, anti-HEV IgM, and HEV RNA markers at presentation, and 90.22% of them were positive for HEV antigen and anti-HEV IgM. HEV antigen, HEV RNA, and anti-HEV IgM positivity were observed in 89.80%, 82.65%, and 93.88% of hepatitis E patients at presentation, respectively. However, only 57.14% of anti-HEV IgM positivity occurred in hepatitis E patients. These findings will advance our understanding of hepatitis E and improve diagnosis.

Enhanced monitoring and detection of recent genotype 3 hepatitis E virus infection through urine antigen testing

“…In congruence with the observation of Tang et al HEV Ag detection seems to be superior in the detection of ongoing or recent infection than the detection of RNA also in a region where GT3 is most prevalent [ 1 ]. The rapid decrease in HEV Ag levels observed by Tang et al .…”

“…With great interest we read the article of Tang et al . entitled “Profile of clinical characteristics and serologic markers of sporadic hepatitis E in a community cohort study” who investigated the dynamics of serological tests including hepatitis E virus (HEV) antigen (Ag), anti-HEV IgM and HEV RNA for diagnosing ongoing and recent HEV infections in a patient cohort in China, where genotype 4 (GT4) HEV is most prevalent [ 1 ]. The authors show a limited performance of current anti-HEV IgM assays.…”

“…Accordingly, and due to our limited understanding of the dynamics of HEV markers HEV RNA detection remains the gold standard for the detection of HEV infection [ 1–3 ], but other studies have indicated that HEV Ag might be a more sensitive marker for diagnosing HEV infections [ 4 , 5 ]. In their manuscript, the authors describe the superiority of HEV Ag testing over HEV RNA, IgM or IgG testing for diagnosing early HEV infection but also show a rapid decline in HEV Ag and HEV RNA after the second week after symptom onset [ 1 ]. Ag testing may be faster and more affordable than nucleic acid tests and can potentially even be used as an on-site diagnostic to test for suspected HEV infection.…”

“…In all patients but one (patient F), in which RNA was measured in both, plasma and stool, a consistent overlap of RNA positivity was found between these two body fluids. Consistent with Tang et al ., we observed a strong correlation between HEV RNA positivity in plasma and stool and Ag detection in plasma [ 1 ]. Remarkably, and in line with previous findings that were reported for HEV GT4 [ 7 ], we observed higher levels of Ag in the urine of both, individuals with acute and chronic HEV GT3 infection, compared to plasma ( Figure 1 D).…”

Redeveloping antigen detection kits for the diagnosis of rat hepatitis E virus

“…Archived sera from patients with b HEV infection in Dongtai, Jiangsu Province (China), Hong Kong (China) and blood donors in Xiamen, Fujian Province (China) were retrieved ( 21 – 26 ). Serum samples from patients with b HEV infection tested positive for b HEV RNA by RT‒PCR and tested positive with the Wantai HEV antigen kit.…”