Thrombotic thrombocytopenic purpura relapse induced by acute hepatitis E transmitted by cryosupernatant plasma and successfully controlled with ribavirin

Riveiro‐Barciela, Mar; Bes, Marta; Quer, Josep; Valcárcel, David; Piriz, Sofia; Gregori, Josep; Llorens-Revull, Meritxell; Salcedo, Maite; Pirón, María; Esteban, Rafael; Buti, Marı́a; Sauleda, Sílvia

doi:10.1111/trf.14831

Cited by 18 publications

(19 citation statements)

References 17 publications

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“…Transfusion of blood products (red blood cells) containing HEV RNA can cause acute hepatitis E in an immunocompetent patients as recently reported [19]. Interestingly, Riveiro-Barciela et al recently reported a case of HEV associated exacerbation of thrombotic thrombocytopenic purpura transmitted by cryosupernatant plasma [20].…”

Section: Introductionmentioning

confidence: 98%

The Clinical Perspective on Hepatitis E

Horvatits

Wiesch

Lütgehetmann

et al. 2019

Viruses

102

117

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Every year, there are an estimated 20 million hepatitis E virus (HEV) infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. HEV is largely circulating in the west and is associated with several hepatic and extrahepatic diseases. HEV Genotype 1 and 2 infections are waterborne and causative for epidemics in the tropics, while genotype 3 and 4 infections are zoonotic diseases and are mainly transmitted by ingestion of undercooked pork in industrialized nations. The clinical course of these infections differs: genotype 1 and 2 infection can cause acute illness and can lead to acute liver failure (ALF) or acute on chronic liver failure (ACLF) with a high mortality rate of 20% in pregnant women. In contrast, the majority of HEV GT-3 and -4 infections have a clinically asymptomatic course and only rarely lead to acute on chronic liver failure in elderly or patients with underlying liver disease. Immunosuppressed individuals infected with genotype 3 or 4 may develop chronic hepatitis E, which then can lead to life-threatening cirrhosis. Furthermore, several extra-hepatic manifestations affecting various organs have been associated with ongoing or previous HEV infections but the causal link for many of them still needs to be proven. There is no approved specific therapy for the treatment of acute or chronic HEV GT-3 or -4 infections but off-label use of ribavirin has been demonstrated to be safe and effective in the majority of patients. However, in approximately 15% of chronically HEV infected patients, cure is not possible.

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Section: Introductionmentioning

confidence: 98%

The Clinical Perspective on Hepatitis E

Horvatits

Wiesch

Lütgehetmann

et al. 2019

Viruses

102

117

View full text Add to dashboard Cite

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“…HEV infection treated with ribavirin and thrombotic thrombocytopenic purpura remitted with remission of HEV infection. 74…”

Section: Thrombocytopeniamentioning

confidence: 99%

Extrahepatic manifestations of hepatitis E virus: An overview

2020

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Hepatitis E virus (HEV) is a significant health problem with approximately 20 million individuals infected annually. HEV infection has been associated with a wide spectrum of extrahepatic manifestations, including neurological, hematological and renal disorders. Guillain-Barré syndrome and neuralgic amyotrophy are the most frequent neurological manifestations. In addition, HEV infection has been observed with other neurological diseases, such as encephalitis, myelitis and Bell's palsy. Hematologic manifestations include anemia due to glucose-6-phospate dehydrogonase deficiency, autoimmune hemolytic anemia and severe thrombocytopenia. Membranoproliferative glomerulonephritis and relapse IgA nephropathy with or without coexisting cryoglobulinemia appear to be the most common renal injuries related with HEV infection. Also, HEV infection has been associated with acute pancreatitis and other immune-mediated manifestations, such as arthritis and myocarditis. However, the pathophysiologic mechanisms of HEV-related extrahepatic manifestations are still largely unclear.

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“…People at risk are not only immunosuppressed patients such as transplant recipients or patients with HIV infection but also include cancer patients under chemotherapy or patients with rheumatic diseases. (ii) Clinical effects of an HEV infections had also been observed in immunocompetent individuals with different underlying diseases such as thrombotic thrombocytopenic purpura [59] or systemic lupus erythematosus [60]. (iii) The handling of two different types of donations may be difficult and expensive, and (iv) It is nearly impossible for a physician to assign a patient to an HEV risk in event of an emergency that requires blood transfusion [58].…”

Section: Measures To Prevent Hev Transmissionmentioning

confidence: 99%

Hepatitis E virus (HEV)—The Future

Denner

2019

Viruses

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Hepatitis (HEV) is widely distributed in pigs and is transmitted with increasing numbers to humans by contact with pigs, contaminated food and blood transfusion. The virus is mostly apathogenic in pigs but may enhance the pathogenicity of other pig viruses. In humans, infection can lead to acute and chronic hepatitis and extrahepatic manifestations. In order to stop the emerging infection, effective counter-measures are required. First of all, transmission by blood products can be prevented by screening all blood donations. Meat and sausages should be appropriately cooked. Elimination of the virus from the entire pork production can be achieved by sensitive testing and elimination programs including early weaning, colostrum deprivation, Caesarean delivery, embryo transfer, treatment with antivirals, protection from de novo infection, and possibly vaccination. In addition, contaminated water, shellfish, vegetables, and fruits by HEV-contaminated manure should be avoided. A special situation is given in xenotransplantation using pig cells, tissues or organs in order to alleviate the lack of human transplants. The elimination of HEV from pigs, other animals and humans is consistent with the One Health concept, preventing subclinical infections in the animals as well as preventing transmission to humans and disease.

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Thrombotic thrombocytopenic purpura relapse induced by acute hepatitis E transmitted by cryosupernatant plasma and successfully controlled with ribavirin

Cited by 18 publications

References 17 publications

The Clinical Perspective on Hepatitis E

The Clinical Perspective on Hepatitis E

Extrahepatic manifestations of hepatitis E virus: An overview

Hepatitis E virus (HEV)—The Future

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