Acute Hepatitis due to Hepatitis E Virus Genotype 1 As an Imported Infectious Disease in Japan

Miyahara, Koji; Miyake, Yasuhiro; Yasunaka, Tetsuya; Ikeda, Fusao; Takaki, Akinobu; Iwasaki, Yoshiaki; Kobashi, Haruhiko; Kang, Jong Hon; Takahashi, Kazuaki; Arai, Masahiro; Yamamoto, Kazuhide

doi:10.2169/internalmedicine.49.4221

Cited by 4 publications

(3 citation statements)

References 15 publications

(15 reference statements)

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“…However, the indication for this therapy remains controversial, with some reports suggesting no improvement in mortality in patients with advanced liver failure ( 15 ). Despite this controversy, several studies have suggested the efficacy of steroid therapy in treating liver damage in acute hepatitis E ( 2 , 16 ). In the present case, due to the patient's rapidly deteriorating liver function and coagulation capacity, we deemed aggressive treatment necessary and initiated steroid therapy at an early stage.…”

Section: Discussionmentioning

confidence: 99%

“…HEV genotype 1 is prevalent in developing regions of Asia, Africa, and South America. In contrast, acute hepatitis E is rare in developed regions, including Japan, where only sporadic cases of HEV genotypes 3 or 4 are found ( 2 ). Most people are asymptomatic or develop flu-like symptoms, such as fatigue, a fever, and nausea, in response to acute HEV infection ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Imported Hepatitis E Virus Genotype 1: A Rare Case of Acute Hepatitis Managed with Steroid Pulse Therapy

et al. 2024

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A 26-year-old Indian man who had arrived in Japan 24 days prior presented to our hospital with abdominal pain and a fever. A blood test revealed marked hepatic dysfunction, and imaging tests confirmed a diagnosis of acute hepatitis. The patient's liver function and coagulability deteriorated, and his general condition was poor. Given the possibility of fulminant hepatic failure, we initiated steroid pulse therapy. Following the initiation of steroid therapy, the patient's liver function and subjective symptoms rapidly improved. Testing revealed positive findings for IgA-hepatitis E virus, and a genetic analysis of hepatitis E identified genotype 1, which is not endemic to Japan, leading to a definitive diagnosis of imported hepatitis E infection from India. The successful response to steroid therapy highlights the potential benefit of this approach in managing severe cases of acute hepatitis E, a rare occurrence in Japan. This case underscores the importance of considering hepatitis E infection in individuals with a recent travel history to regions with high prevalence and the potential benefits of steroid therapy in managing severe cases of acute hepatitis E.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imported Hepatitis E Virus Genotype 1: A Rare Case of Acute Hepatitis Managed with Steroid Pulse Therapy

et al. 2024

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“…Among the four major genotypes infecting humans, HEV-1 and genotype 2 HEV (HEV-2) are restricted to humans and have been responsible for multiple outbreaks in developing countries where the virus is transmitted through drinking contaminated water [18]. Although HEV-1 typically affects people in developing countries, such as South Asia and most countries in sub-Saharan Africa [19], imported infections have been reported in industrialized countries, including Japan [20][21][22]. HEV-1 infection in pregnant women frequently leads to infant mortality or premature delivery.…”

Section: Introductionmentioning

confidence: 99%

Development and Characterization of Efficient Cell Culture Systems for Genotype 1 Hepatitis E Virus and Its Infectious cDNA Clone

Primadharsini

Nagashima

Tanaka

et al. 2023

Viruses

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Hepatitis E virus (HEV) is a major cause of acute viral hepatitis globally. Genotype 1 HEV (HEV-1) is responsible for multiple outbreaks in developing countries, causing high mortality rates in pregnant women. However, studies on HEV-1 have been hindered by its poor replication in cultured cells. The JE04-1601S strain recovered from a Japanese patient with fulminant hepatitis E who contracted HEV-1 while traveling to India was serially passaged 12 times in human cell lines. The cell-culture-generated viruses (passage 12; p12) grew efficiently in human cell lines, but the replication was not fully supported in porcine cells. A full-length cDNA clone was constructed using JE04-1601S_p12 as a template. It was able to produce an infectious virus, and viral protein expression was detectable in the transfected PLC/PRF/5 cells and culture supernatants. Consistently, HEV-1 growth was also not fully supported in the cell culture of cDNA-derived JE04-1601S_p12 progenies, potentially recapitulating the narrow tropism of HEV-1 observed in vivo. The availability of an efficient cell culture system for HEV-1 and its infectious cDNA clone will be useful for studying HEV species tropism and mechanisms underlying severe hepatitis in HEV-1-infected pregnant women as well as for discovering and developing safer treatment options for this condition.

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Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

Kanda,

Li,

Takahashi

et al. 2024

Hepatology Research

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Acute hepatitis E was considered rare until reports emerged affirming the existence of hepatitis E virus (HEV) genotypes 3 and 4 infections in Japan in the early 2000s. Extensive studies by Japanese researchers have highlighted the pivotal role of pigs and wild animals, such as wild boars and deer, as reservoirs for HEV, linking them to zoonotic infections in Japan. Currently, when hepatitis occurs subsequent to the consumption of undercooked or grilled pork, wild boar meat, or offal (including pig liver and intestines), HEV infection should be considered. Following the approval of anti‐HEV immunoglobulin A antibody as a diagnostic tool for hepatitis E by Japan's Health Insurance System in 2011, the annual number of diagnosed cases of HEV infection has surged. Notably, the occurrence of post‐transfusion hepatitis E promoted nationwide screening of blood products for HEV using nucleic acid amplification tests since 2020. Furthermore, chronic hepatitis E has been observed in immunosuppressed individuals. Considering the significance of hepatitis E, heightened preventive measures are essential. The Japan Agency for Medical Research and Development Hepatitis A and E viruses (HAV and HEV) Study Group, which includes special virologists and hepatologists, held a virtual meeting on February 17, 2024. Discussions encompassed pathogenesis, transmission routes, diagnosis, complications, severity factors, and ongoing and prospective vaccination or treatments for hepatitis E. Rigorous assessment of referenced studies culminated in the formulation of recommendations, which are detailed within this review. This comprehensive review presents recent advancements in HEV research and Japanese clinical practice guidelines for HEV infection.

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Acute Hepatitis due to Hepatitis E Virus Genotype 1 As an Imported Infectious Disease in Japan

Cited by 4 publications

References 15 publications

Imported Hepatitis E Virus Genotype 1: A Rare Case of Acute Hepatitis Managed with Steroid Pulse Therapy

Imported Hepatitis E Virus Genotype 1: A Rare Case of Acute Hepatitis Managed with Steroid Pulse Therapy

Development and Characterization of Efficient Cell Culture Systems for Genotype 1 Hepatitis E Virus and Its Infectious cDNA Clone

Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

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