Fulminant hepatic failure from hepatitis E in a non-pregnant female traveller: Table 1.

Chris, Robert B.; Keystone, Jay S.

doi:10.1093/jtm/taw021

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…Therefore, HEV infection does not seem to be a major problem in healthy immunocompetent travelers. However, rare fulminant liver failure in immunocompetent travelers has been reported ( 2 ), and in pregnant women and immunocompromised travelers, the risk for severe or fatal disease is much higher. Because travel has increased during the past few decades, at-risk groups also travel more ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate for fulminant hepatitis is 0.5%–4%. Pregnant women, immunosuppressed persons, and persons with preexisting liver disease are at risk for severe hepatitis E. However, fulminant liver disease in immunocompetent persons has also been reported ( 2 ). Mortality rates for hepatitis E caused by genotype 1 for pregnant women are 20%–25% ( 3 , 4 ).…”

mentioning

confidence: 99%

“…A recent case report identified a nonpregnant immunocompetent traveler who returned to Canada from India and was given a diagnosis of HEV infection, in whom fulminant liver failure developed ( 2 ). A study in Israel of 4,970 ill returning travelers during 1997–2012 reported 49 (1%) with acute hepatitis (32 cases were enterically transmitted): 19 travelers were given a diagnosis of hepatitis E, of whom 16 contracted their cases on the Indian subcontinent ( 7 ).…”

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confidence: 99%

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Hepatitis E in Long-Term Travelers from the Netherlands to Subtropical and Tropical Countries, 2008–2011

Elfrink¹,

Overbosch²,

Schinkel³

et al. 2018

Emerg. Infect. Dis.

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Hepatitis E virus (HEV) is a common cause of acute viral hepatitis. Virus genotypes 1 and 2 infect humans in developing countries by the fecal–oral route. To assess attack rates and disease incidence for travelers, we prospectively studied 604 long-term travelers to subtropical and tropical countries. Participants donated blood samples pretravel and posttravel and kept a diary. A total of 89/604 (15%) pretravel samples were positive for HEV IgG by ELISA, suggesting previous HEV infection. Seroconversion for HEV was found for 19/515 travelers (attack rate 3.7%, incidence 1.8 cases/1,000 person-weeks). We believe there is a substantial risk for acquiring HEV infection among long-term travelers. Although HEV infection does not seem to be a major problem in this healthy cohort, hygienic measures should be stressed in all pretravel health advice, particularly for pregnant women and immunocompromised travelers who are at risk for severe disease.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Hepatitis E in Long-Term Travelers from the Netherlands to Subtropical and Tropical Countries, 2008–2011

Elfrink¹,

Overbosch²,

Schinkel³

et al. 2018

Emerg. Infect. Dis.

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“…Pathologists in industrialized countries are not only confronted with liver biopsies performed on travelrelated cases of hepatitis E, but also with liver explants in the setting of liver transplantation due to rare cases of acute liver failure following imported HEV infection, in particular in young women. 28,34,39 Liver explants usually are small and lightweight due to parenchymal collapse following panlobular necrosis. Typical histopathologic features are bilirubinostasis, massive clearing by ceroid-laden macrophages, and extensive ductular reaction reflecting futile regeneration.…”

Section: Acute Epidemic Hepatitis E Virus Infectionmentioning

confidence: 99%

“…With the exception of pregnant women, acute liver failure due to acute HEV infection in immunocompetent patients may occur, but is extremely rare. 18,28 However, in patients with preexisting liver disease such as (non) alcoholic steatohepatitis, acute decompensation with fatal outcome of HEV infection is more frequently observed. 7 In immunocompromised patients, HEV infection can be easily missed.…”

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confidence: 99%

An Update on the Clinicopathologic Features and Pathologic Diagnosis of Hepatitis E in Liver Specimens

Lenggenhager

Weber

2018

Advances in Anatomic Pathology

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Infection with the hepatitis E virus (HEV) is globally seen a leading cause of hepatitis. Now increasingly recognized also in industrialized countries, hepatitis E constitutes a significant health problem worldwide. The patient's immune status determines the clinical course and histopathology of hepatitis E. In immunocompetent patients, hepatitis E usually follows an asymptomatic or subclinical course, but may also present with acute hepatitis. In contrast, immunocompromised patients may develop chronic hepatitis, and patients with preexisting liver diseases are at risk for liver decompensation with potentially fatal outcome. Whereas pathologists only occasionally encounter liver biopsies from immunocompetent individuals with hepatitis E, they are more likely exposed to biopsies from patients with preexisting liver disease or immunocompromised individuals. Histopathologic hallmarks of hepatitis E in immunocompetent patients comprise lobular disarray, lobular, and portal inflammation, as well as hepatocyte necrosis of varying extend and regeneration. Thus, it is similar to acute non-E viral hepatitis, yet further differential diagnoses include autoimmune hepatitis and drug-induced liver injury. Histopathologic findings of hepatitis E in preexisting liver disease are determined by the underlying pathology, but may be more severe. Histopathologic presentation of hepatitis E in immunocompromised patients is highly variable, ranging from minimal active hepatitis to chronic hepatitis with severe activity and progressive fibrosis. Taken together, the variability of the histologic features depending on the clinical context and the overlap with other liver diseases make the histopathologic diagnosis of hepatitis E challenging. Immunohistochemistry for HEV open reading frame 2 protein and molecular testing for HEV RNA are useful tissue-based ancillary tools.

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Travel-related hepatitis E: a two-decade GeoSentinel analysis

Nicolini

Stoney

Vecchia

et al. 2020

Journal of Travel Medicine

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Background Hepatitis E virus (HEV) is widely distributed worldwide and is endemic in developing countries. Travel-related HEV infection has been reported at national levels, but global data are missing. Moreover, the global availability of HEV diagnostic testing has not been explored so far. The aim of this study is to describe the epidemiology of hepatitis E virus (HEV) infections in returning travelers and availability of HEV diagnostic testing in the GeoSentinel surveillance network. Methods This was a multicenter retrospective cross-sectional study. All confirmed and probable HEV travel-related infections reported in the GeoSentinel Network between 1999 and 2018 were evaluated. GeoSentinel sites were asked to complete a survey in 2018 to assess the availability and accessibility of HEV diagnostic procedures (i.e. serology and molecular tests) throughout the study period. Results Overall, 165 travel related HEV infections were reported, mainly since 2010 (60%) and in tourists (50%). Travelers were exposed to hepatitis E in 27 countries; most travellers (62%) were exposed to HEV in South Asia. One patient was pregnant at the time of HEV infection and 14 had a concomitant gastrointestinal infection. No deaths were reported. In the 51% of patients with information available, there was no pre-travel consultation. Among 44 GeoSentinel sites that responded to the survey, 73% have access to HEV serology at a local level, while 55% could perform (at a local or central level) molecular diagnostics. Conclusion Reported access to HEV diagnostic testing is suboptimal among sites that responded to the survey; this could negatively affect diagnosing HEV. Pre-travel consultations before travel to South Asia and other low income and high prevalence areas with a focus on food and water precautions could be helpful in preventing hepatitis E infection. Improved HEV diagnostic capacity should be implemented to prevent and correctly diagnose travel-related HEV infection.

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Fulminant hepatic failure from hepatitis E in a non-pregnant female traveller: Table 1.

Cited by 4 publications

References 11 publications

Hepatitis E in Long-Term Travelers from the Netherlands to Subtropical and Tropical Countries, 2008–2011

Hepatitis E in Long-Term Travelers from the Netherlands to Subtropical and Tropical Countries, 2008–2011

An Update on the Clinicopathologic Features and Pathologic Diagnosis of Hepatitis E in Liver Specimens

Travel-related hepatitis E: a two-decade GeoSentinel analysis

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