Hepatitis E virus infection in a liver transplant recipient: delayed diagnosis due to variable performance of serologic assays

Yoo, Naomi; Bernstein, Jane; Caldwell, Cary; Dong, Chen; Drobeniuc, Jan; Kamili, Saleem; Landry, Marie L.

doi:10.1111/tid.12096

Cited by 21 publications

(14 citation statements)

References 7 publications

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“…Importantly, none of these anti-HEV-assays has been approved by the Food and Drug Administration (FDA), while in Europe and Asia, many different assays are used. In the US, testing for HEV is limited to few specialized centers, and thus diagnosis of HEV infections in the US can be delayed [51]. …”

Section: Diagnosis Of Acute Hev Infectionmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

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Section: Diagnosis Of Acute Hev Infectionmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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“…Recently, Yoo et al. reported a case in which an HEV infection was missed in an adult SOT recipient because of the poor sensitivity of a commercial HEV serologic assay.…”

Section: Discussionmentioning

confidence: 99%

“…Barriers to diagnosis include low clinical suspicion, lack of epidemiological risk factors and population prevalence estimates among North American SOT recipients, and paucity of commercially available, reliable, and accurate testing for HEV markers of infection. The lack of a US Food and Drug Administration (FDA)‐approved diagnostic test, and the variability in the performance characteristics of commercially available serologic assays, make testing for HEV infection especially challenging .…”

mentioning

confidence: 99%

Variability of hepatitis E serologic assays in a pediatric liver transplant recipient: challenges to diagnosing hepatitis E virus infection in the United States

Sue

Pisanic

Heaney

et al. 2015

Transplant Infectious Dis

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Hepatitis E virus (HEV) is an emerging cause of viral hepatitis among immunocompromised individuals in developed countries. Yet the diagnosis of HEV infection in the United States remains challenging, because of the variable sensitivity and specificity of currently available tests, and the lack of a U.S. Food and Drug Administration-approved test. We report a case of multiple discordant HEV serology results in a pediatric liver transplant recipient with idiopathic hepatitis, and review the challenges to diagnosis of HEV infection in the U.S.

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“…As these studies suggest, the limited reliability of available tests may well delay a patient's HEV diagnosis . Additionally, HEV infection can be misdiagnosed or entirely missed through a failure to consider this virus as a possibility.…”

Section: Diagnosismentioning

confidence: 99%

Hepatitis E in post‐liver transplantation: is it time to routinely consider it?

Borg

Feng

Earl

et al. 2016

Clinical Transplantation

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Hepatitis E, although commonly recognized in the Eastern Hemisphere, is less well recognized in the West. Particularly owing to this disease's grave impact on outcomes after liver transplantation, greater consideration of hepatitis E is necessary in the context of abnormal liver tests. Here, we review the most recent data on detecting and managing hepatitis E, both pre- and post-liver transplantation, discuss major detection assay limitations, consider future directions, and propose an algorithm for the diagnosis and management of pre-and post-transplantation hepatitis E.

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Hepatitis E virus infection in a liver transplant recipient: delayed diagnosis due to variable performance of serologic assays

Cited by 21 publications

References 7 publications

Acute Hepatitis E: Two Sides of the Same Coin

Acute Hepatitis E: Two Sides of the Same Coin

Variability of hepatitis E serologic assays in a pediatric liver transplant recipient: challenges to diagnosing hepatitis E virus infection in the United States

Hepatitis E in post‐liver transplantation: is it time to routinely consider it?

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