Dual Infection of Hepatitis A Virus and Hepatitis E Virus— What Is Known?

Sayed, Ibrahim M.

doi:10.3390/v15020298

Cited by 13 publications

(30 citation statements)

References 132 publications

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“…An HAV/HEV double infection can also lead to complications like acalculous cystitis and hepatic neuropathy, which are the worst possible outcomes. As evidenced by liver abnormalities and liver function tests, other studies support the conclusion that HEV/HAV double infection can cause a severe disease course [ 6 , 9 - 10 ]. Similarly, Paul et al reported a higher mortality rate for HEV infections in pregnant women.…”

Section: Discussionmentioning

confidence: 75%

“…The pattern and rate of transmission are primarily influenced by socioeconomic variables. Lower infection rates are observed in areas with smaller families, better sanitation facilities, and greater access to clean water [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…This population has a greater risk of contracting HAV. Significant outbreaks can occur, particularly among high-risk populations such as homeless individuals, recreational drug users and men who have had sex with other men [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…HEV/HAV dual infection was documented in Italy in men who have sex with men (MSM). In Israel, high anti-HAV antibodies were observed in HEV seropositive haemophiliac patients, suggesting HAV/HEV dual infection [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Fulminant Hepatitis A and E Co-infection Leading to Acute Liver Failure: A Case Report

Malik¹,

Malik²,

Uderani³

et al. 2023

Cureus

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Acute liver failure (ALF) is a severe clinical condition with a high mortality rate. Although several factors can cause ALF, viral hepatitis remains one of the leading causes. Hepatitis A virus (HAV) and hepatitis E virus (HEV), which typically cause self-limiting acute disease, are rare but emerging causes of ALF, especially when both viruses infect the same individual. Both of these hepatotropic viruses share an enteric route and are most commonly transmitted through the fecal-oral route. The impact of HAV/HEV coinfection on acute hepatitis prognosis is not entirely understood, but dual infection can further exacerbate liver damage, leading to fulminant hepatic failure (FHF) with a higher mortality rate than a single virus infection.Here, we present a case of a 32-year-old male with no prior liver disease who presented to the emergency department with a two-week history of jaundice, abdominal pain, and hepatomegaly. Upon admission, he was disoriented with grade 2 encephalopathy. After a thorough investigation, co-infection with hepatitis A and E was identified as the primary cause of his ALF. The patient underwent intensive medical treatment and interventions, including dialysis. Unfortunately, the patient's survival was not possible due to the absence of availability of a transplanted organ, which is currently the only definitive treatment option. This case report underscores the significance of prompt diagnosis, timely intervention, and the accessibility of transplantation in the survival of liver failure, as it remains the sole definitive treatment for acute liver failure. Moreover, it provides a concise overview of the current literature on fulminant co-infection of HAV and HEV, including epidemiology, clinical characteristics, pathogenesis, diagnosis, treatment, and risk factors associated with co-infection of hepatitis A and E and their role in causing ALF. It also highlights the significance of identifying high-risk populations and implementing appropriate prevention and control measures such as vaccination, practising good hygiene and sanitation, and avoiding the consumption of contaminated food and water.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Fulminant Hepatitis A and E Co-infection Leading to Acute Liver Failure: A Case Report

Malik¹,

Malik²,

Uderani³

et al. 2023

Cureus

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show abstract

“…One study has indeed shown a higher presence of anti-HAV and anti-HEV in men who have sex with men [ 109 ]. These conflicting data may be due to geographical biases, risk factors and viral genotypes, so further studies are needed to evaluate the prevalence and outcomes of dual infection [ 110 ].…”

Section: Hev Infection Overviewmentioning

confidence: 99%

Treatment Options for Hepatitis A and E: A Non-Systematic Review

Gabrielli

Alberti

Russo

et al. 2023

Viruses

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Hepatitis A and hepatitis E are relatively common causes of liver disease. Both viruses are mainly transmitted through the faecal–oral route and, consequently, most outbreaks occur in countries with poor sanitation. An important role of the immune response as the driver of liver injury is also shared by the two pathogens. For both the hepatitis A (HAV) and hepatitis E (HEV) viruses, the clinical manifestations of infection mainly consist of an acute disease with mild liver injury, which results in clinical and laboratory alterations that are self-limiting in most cases. However, severe acute disease or chronic, long-lasting manifestations may occur in vulnerable patients, such as pregnant women, immunocompromised individuals or those with pre-existing liver disease. Specifically, HAV infection rarely results in fulminant hepatitis, prolonged cholestasis, relapsing hepatitis and possibly autoimmune hepatitis triggered by the viral infection. Less common manifestations of HEV include extrahepatic disease, acute liver failure and chronic HEV infection with persistent viraemia. In this paper, we conduct a non-systematic review of the available literature to provide a comprehensive understanding of the state of the art. Treatment mainly consists of supportive measures, while the available evidence for aetiological treatment and additional agents in severe disease is limited in quantity and quality. However, several therapeutic approaches have been attempted: for HAV infection, corticosteroid therapy has shown outcome improvement, and molecules, such as AZD 1480, zinc chloride and heme oxygenase-1, have demonstrated a reduction in viral replication in vitro. As for HEV infection, therapeutic options mainly rely on the use of ribavirin, and some studies utilising pegylated interferon-alpha have shown conflicting results. While a vaccine for HAV is already available and has led to a significant reduction in the prevalence of the disease, several vaccines for HEV are currently being developed, with some already available in China, showing promising results.

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Acute Hepatitis Related to Hepatitis E Virus Genotype 3f Infection in Brazil

Ribeiro,

Reche,

Nastri

et al. 2024

Journal of Medical Virology

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The hepatitis E virus (HEV) is an important causative agent of acute hepatitis (AH). Despite reports of human infection in Brazil, the investigation is not routinely conducted, even in cases of elevated liver enzymes. This study evaluated two groups: group 1—patients with acute hepatitis A (n = 44); group 2—patients with nonA‐C AH (n = 47). They were tested by enzyme immunoassay for anti‐HEV IgM/IgG and real‐time PCR for HEV RNA detection. The positive sample for HEV RNA was submitted for sequencing. The seroprevalence of anti‐HEV IgM and IgG in group 1 was 4% (2/44) and 14.5% (7/44), respectively. Viral RNA was not detected in any sample. In group 2, the anti‐HEV IgM positivity was 4.3% (2/47), and IgG 14.9% (7/47). RNA was detectable in one case, which presented a viral load of 222.4 IU/μL and positive anti‐HEV IgM/IgG. In the phylogenetic analysis, the genotype identified was HEV‐3f. These results indicate that HEV infection should be considered a possible diagnosis in cases of non‐A–C AH. The patient identified with acute hepatitis E had recently traveled to the Northeast region of Brazil (Garanhuns city in Pernambuco state), where there are reports of high HEV seroprevalence among pigs. The close phylogenetic relationship observed between the sequence characterized in this study and strains isolated from pigs in nearby cities where the patient went suggested a possible zoonotic transmission in this region. This study highlights the importance of expanding studies and improving surveillance to understand better and manage HEV infections nationwide.

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Dual Infection of Hepatitis A Virus and Hepatitis E Virus— What Is Known?

Cited by 13 publications

References 132 publications

Fulminant Hepatitis A and E Co-infection Leading to Acute Liver Failure: A Case Report

Fulminant Hepatitis A and E Co-infection Leading to Acute Liver Failure: A Case Report

Treatment Options for Hepatitis A and E: A Non-Systematic Review

Acute Hepatitis Related to Hepatitis E Virus Genotype 3f Infection in Brazil

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