Value of hepatitis E virus detection by cell culture compared with nested PCR and serological studies by IgM and IgG

Abstract

Hepatitis E virus (HEV) is a well-known cause of sporadic acute hepatitis. The contribution of fecal shedding of the virus to its endemic nature is not frequently studied in underdeveloped countries. The aim of the present study was to detect HEV viremia in serum and stool from patients with acute hepatitis by cell culture and by nested reverse transcriptase (RT)-PCR. A further aim was to evaluate different methods used for HEV detection, including culture by use of HPG11 cell line, PCR, immunoglobulin M (IgM) and IgG responses during the acute stage of infection. The frequency of HEV-positive cases for IgM, stool and serum cultures was 35.3%, 38.2% and 29.4%, respectively. However, only two samples (2.9%) were positive for IgG using enzyme immunoassay. The sensitivity of stool culture was 41.9%, the sensitivity of both HEV IgM and the combined laboratory tests was 37.5% for each, the sensitivity of serum culture was 30.3% and the sensitivity for HEV IgG was 2.3%. We conclude that hepatitis E viremia can be detected both in serum and in stool from patients with acute hepatitis. The shedding of virus in the stool of patients may be the responsible factor for the endemicity of HEV. In addition, the detection of HEV had high sensitivity compared with other methods. Nevertheless, it was necessary to use both stool and serum cultures to avoid missing any case with HEV infection.

The prevalence of HEV among non-A-C hepatitis in Qatar and efficiency of serological markers for the diagnosis of hepatitis E

“…In other words, HEV IgG appears shortly after the IgM response, which appears one week to two months after the onset of illness. Similar to our results, in a series of 44 children with acute HEV (con rmed with HEV viremia in serum and stool by cell culture and RT-PCR), only 35 percent of patients tested positive for HEV-IgM in serum and only 3 percent were positive for HEV-IgG [34]. In another study, HEV-RNA was detected in 23 % of patients followed by the detection of speci c HEV-IgM in 17% and HEV-IgG in 13% of patients.…”

Comparative clinical study on diagnostic detection of hepatitis E virus between nested polymerase chain reaction (PCR) and serological tests

“…Since different HEV genotypes determine the differences of their antibody response to corresponding antigens, the detection results from different ELISA kit might present discordance (Chen et al, 2005). Evidences showed that anti-HEV antibodies, developed in various laboratories using synthetic peptides or recombinant proteins derived from different genotypes and/or subtypes of HEV, showed a wide variation in sensitivity in seroprevalence studies (Zaki et al, 2009;Ma et al, 2011). Furthermore, derived from the same genotype and/or subtype of HEV but expressed in different expression system, the antigenicity and epitope displayed significance difference (Chau et al, 2006).…”

Hepatitis E: the forgotten virus

“…In the setting of outbreaks, IgM anti-HEV has been detected by enzyme immunoassay on more than 90% of patient serum samples obtained within 1–2 months after the onset of illness 17. However, in another study of patients with acute HEV (defined as acute hepatitis with a HEV viraemia in serum and stool by cell culture and PCR), only 35% of patients tested positive for IgM anti-HEV in serum 18. Therefore, beware the possibility of false negative serology results and consider PCR testing where available if clinical suspicion is high.…”