Hepatitis E in Qatar imported by expatriate workers from Nepal: Epidemiological characteristics and clinical manifestations

Abstract

Prompted by cases of acute hepatitis in expatriate workers presenting at Alkhor Hospital, Qatar, a limited prospective observational study was conducted from July 2005 to June 2006 to determine the epidemiological and clinical features of patients (predominantly Nepalese) presenting with acute hepatitis. Countrywide during that period samples from 86 Nepalese presenting at different centers were found to be anti-HEV IgG positive and 50 of these were also positive for anti-HEV IgM. Fifty-eight of those Nepalese were seen and treated at Alkhor Hospital and of them 43 were confirmed as cases of acute HEV, being positive for both anti-HEV IgM and IgG. The remaining 15 were diagnosed as probable cases of acute HEV on the basis of clinical and epidemiological similarity. It seems likely that transit in Kathmandu in reportedly unsanitary conditions was the focus of infection. In some of those examined at Alkhor, ultrasound detected a thickened gallbladder wall in 30 of 39 (76.9%) with two cases having clinical acalcular cholecystitis. Higher levels of alanine aminotransferase and aspartate aminotransferase were associated with severe disease and derangement in coagulation. On the available evidence hepatitis E was imported by expatriate workers and it is clear that medical screening of these workers pre- and post-arrival must be improved to prevent further outbreaks. It is also essential that health care workers in Qatar are made aware of this ongoing problem of imported HEV and understand the variable presentation of the condition.

Virus Host Protein Interaction Network Analysis Reveals That the HEV ORF3 Protein May Interrupt the Blood Coagulation Process

“…In the acute phase of hepatitis E, higher levels of alanine aminotransferase and aspartate aminotransferase are associated with severe disease and derangement of coagulation [44]. HEV is a major cause of fulminant hepatitis in endemic regions [4], [45].…”

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

“…The peak incidence of acute hepatitis due to genotype 1 occurs in 15 to 35-year-old patients (7)(8)(9), and the mortality rate is about 1% (1). On the other hand, most patients with the disease due to genotype 3 or 4, which is the major genotype in Japan, are reported to be aged 60 years or older and the mortality rate is relatively high, ranging from 6% to 10% (8,10,11).…”

Positive hepatitis E and Epstein Barr virus serology in a patient with jaundice after travel

“…Splenomegaly is invariably found in acute EBV infection, but was also seen in one third of patients suffering from acute "classical" viral hepatitis. 5 Abdominal pain was reported in 81% of 43 patients with acute HEV infection, 6 but absent in our patient. During the follow-up period, a maculopapular exanthema developed 1 day after the patient had taken diphenhydramine to relieve nausea (Fig.…”

“…7 However, leukocytosis was not a feature in a study with 43 HEV infected patients, but relative lymphocytosis and monocytosis. 6 EBV shedding occurs in saliva intermittendly and to a lesser extent in genital secretions, 8 and the patient could thus have been infected by his heterosexual partner even after some years. HEV infection is thought to be a zoonosis involving pigs, deer, and rodents.…”