Characteristics of Autochthonous Hepatitis E Virus Infection in Solid‐Organ Transplant Recipients in France

Abravanel, Florence; Kamar, Nassim; Sandres-Sauné, Karine; Garrouste, Cyril; Dubois, Martine; Mansuy, Jean‐Michel; Muscari, Fabrice; Sallusto, Fédérico; Rostaing, Lionel; Izopet, Jacques

doi:10.1086/655899

Cited by 179 publications

(148 citation statements)

References 48 publications

(72 reference statements)

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“…A case-control study among transplant recipients in MP found a significant association between HEV infection and the consumption of game meat [20]. The virus was detected in the livers of wild boar from the forests of the Ariège and Aude; these virus strains were very similar, genomically, to those isolated from patients suffering from hepatitis E (data not shown).…”

Section: Discussionmentioning

confidence: 95%

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Mansuy¹,

Sauné

Rech³

et al. 2015

Eurosurveillance

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The apparent seroprevalence of hepatitis E Virus (HEV) varies greatly among developed countries depending on the geographical area and the sensitivity of immunoassays. We used a validated assay to determine the prevalence of HEV IgG and IgM antibodies among 3,353 blood donors living in southern France, who gave blood during the two first weeks of October 2011 and participated in the study. Demographic and epidemiological information was collected using a specific questionnaire. We also screened 591 samples for HEV RNA. Overall IgG seroprevalence was 39.1% and varied from 20% to 71.3% depending on the geographical area (p < 0.001) while IgM seroprevalence was 3.31%. Anti-HEV IgG was significantly correlated with increasing age (p < 0.001), eating uncooked pork liver sausages (p < 0.001), offal (p = 0.003), or mussels (p = 0.02). Anti-HEV IgM was associated with being male (p = 0.01) and eating uncooked pork liver sausages (p = 0.02). HEV RNA was detected in one of the 99 anti-HEV IgM-positive samples, but in none of the 492 anti-HEV IgM-negative samples. HEV is hyperendemic in southern France. Dietary and culinary habits alone cannot explain the epidemiology of HEV in this region, indicating that other modes of contamination should be investigated.

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Section: Discussionmentioning

confidence: 95%

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Mansuy¹,

Sauné

Rech³

et al. 2015

Eurosurveillance

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“…Also levels of IgM, IgG anti-HEV antibodies and HEV RNA during acute infection phase were not predictive of whether or not the infection will become chronic. In acute phase itself, only 24% had abnormal bilirubin levels [25] . This further emphasizes that an acute HEV infection can be easily missed unless clinician had a high index of suspicion.…”

Section: High Index Of Suspicionmentioning

confidence: 96%

Hepatitis E virus infection in the liver transplant recipients: Clinical presentation and management

Aggarwal

Perumpail

Tummala

et al. 2016

WJH

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Hepatitis E virus (HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy. Current suggested approach to manage acute HEV involves modifying immunosuppression, especially discontinuing calcineurin inhibitors which are the preferred immunosuppressive agents post-orthotopic liver transplantation. The addition of ribavirin monotherapy has shown promising success rates in clearing HEV infection and is used commonly in reported cases. Core tip: Hepatitis E virus (HEV) is an emerging pathogen in developed countries and an important cause of graft hepatitis in the post-orthotopic liver transplantation population that is often misdiagnosed either due to low index of suspicion or due to poor diagnostic assays. We recommend mandatory HEV testing in such cases, and careful treatment with modification of immunosuppression, especially switching from calcineurin inhibitors to a different class. Ribavirin has shown to be increasingly successful in treating HEV infection and preventing graft failure from acute HEV infection, if diagnosed early.Aggarwal A, Perumpail RB, Tummala S, Ahmed A. Hepatitis E virus infection in the liver transplant recipients: Clinical presentation and management.

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“…However, 4 y ago a case of chronic hepatitis E was identified in Europe, and since then chronicity has been documented in immunocompromised solid-organ transplant recipients and HIVinfected individuals (4)(5)(6)(7). Although hepatitis E infection generally causes mild to moderate disease, it occasionally has caused fulminant liver failure in acute cases, in chronically infected patients, and especially in those with underlying chronic liver disease or pregnancy (1,2,(4)(5)(6)(7)(8). Additionally, hepatitis E has been misdiagnosed as drug-induced liver injury, thus complicating drug trials or treatment regimens (9).…”

mentioning

confidence: 99%

Cross-species infections of cultured cells by hepatitis E virus and discovery of an infectious virus–host recombinant

Shukla

Nguyen

Torian

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

286

335

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The RNA virus, hepatitis E virus (HEV) is the most or second-most important cause of acute clinical hepatitis in adults throughout much of Asia, the Middle East, and Africa. In these regions it is an important cause of acute liver failure, especially in pregnant women who have a mortality rate of 20–30%. Until recently, hepatitis E was rarely identified in industrialized countries, but Hepatitis E now is reported increasingly throughout Western Europe, some Eastern European countries, and Japan. Most of these cases are caused by genotype 3, which is endemic in swine, and these cases are thought to be zoonotically acquired. However, transmission routes are not well understood. HEV that infect humans are divided into nonzoonotic (types 1, 2) and zoonotic (types 3, 4) genotypes. HEV cell culture is inefficient and limited, and thus far HEV has been cultured only in human cell lines. The HEV strain Kernow-C1 (genotype 3) isolated from a chronically infected patient was used to identify human, pig, and deer cell lines permissive for infection. Cross-species infections by genotypes 1 and 3 were studied with this set of cultures. Adaptation of the Kernow-C1 strain to growth in human hepatoma cells selected for a rare virus recombinant that contained an insertion of 174 ribonucleotides (58 amino acids) of a human ribosomal protein gene.

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Characteristics of Autochthonous Hepatitis E Virus Infection in Solid‐Organ Transplant Recipients in France

Abstract: Immunocompromised patients should avoid eating insufficiently cooked game meat or pork products so as to reduce the risk of HEV infection and chronic liver disease.

Cited by 179 publications

References 48 publications

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Seroprevalence in blood donors reveals widespread, multi-source exposure to hepatitis E virus, southern France, October 2011

Hepatitis E virus infection in the liver transplant recipients: Clinical presentation and management

Cross-species infections of cultured cells by hepatitis E virus and discovery of an infectious virus–host recombinant

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