- Page navigation anchor for Chronic Hepatitis E—An Important Entity for Clinicians to be Aware OfChronic Hepatitis E—An Important Entity for Clinicians to be Aware Of
We read with interest the recent article by Miller et al(1) highlighting a case of bilateral neuralgic amyotrophy in a patient who acquired hepatitis E from livestock which provides a concise review of the epidemiology of hepatitis E and its acute clinical manifestations.
One important concept that we would like to highlight is that although generally hepatitis E is predominately an acute, self-limited infection with rare cases of liver failure as reported by the authors, chronic hepatitis E infection can occur in the immunosuppressed population with significant morbidity(2).
Chronic hepatitis E was first reported in 2008 in transplant recipients with most cases being reported in Europe although a few have been reported in North America(3). Although most common in transplant recipients, chronic hepatitis E has also been reported in patients requiring immunosuppression for rheumatological conditions(2) and in hematological conditions(3).
Diagnosis of chronic hepatitis E (assessed by the simultaneous assessment for anti-hepatitis E antibodies AND hepatitis E RNA) is often under-recognized given many patients are asymptomatic and may manifest only after the development of abnormal liver tests. Chronic hepatitis E though can lead to rapid progression of liver disease with the possibility of developing cirrhosis within 2 years(4). Furthermore, history of direct farm exposure may be lacking as this is predominately acquired through ingestion of undercooked...
Show MoreCompeting Interests: None declared.References
- Miller NJ, Hooper DR, Sharma A. Bilateral neuralgic amyotrophy in a patient with livestock-associated hepatitis E virus infection. CMAJ. 2022 Apr 4;194(13):E495–9.
- Horvatits T, Schulze zur Wiesch J, Lütgehetmann M, Lohse AW, Pischke S. The Clinical Perspective on Hepatitis E. Viruses. 2019 Jul 5;11(7):617.
- Ma Z, de Man RA, Kamar N, Pan Q. Chronic hepatitis E: Advancing research and patient care. J Hepatol. 2022 May;S0168827822003191.
- Zhou X, de Man RA, de Knegt RJ, Metselaar HJ, Peppelenbosch MP, Pan Q. Epidemiology and management of chronic hepatitis E infection in solid organ transplantation: a comprehensive literature review. Rev Med Virol. 2013 Sep;23(5):295–304.
- Kar P, Karna R. A Review of the Diagnosis and Management of Hepatitis E. Curr Treat Options Infect Dis. 2020;12(3):310–20.
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