Acute, chronic and fulminant hepatitis E: Seven years of experience (2004-2011)

Objective: To study the clinical and epidemiological profiles of in 43 cases of acute hepatitis, 5 cases of fulminant hepatitis, and one of chronic hepatitis due to hepatitis E virus (HEV), detected over a 7-year period. Patients: Forty-nine individuals (33 male and 10 female) treated between 2004 and 2011 in the Hospital Ramon y Cajal (Comunidad de Madrid, Spain). The diagnosis was made by the detection of IgG and IgM anti-HEV and RNA HEV in serum samples. Acute hepatitis E was defined by the presence of IgM anti-HEV and/or RNA HEV in serum, and chronic hepatitis E if the ARN was detectable more than 6 months. Fulminant hepatitis E was diagnosed if encephalopathy was observed in addition to IgM anti-HEV and/or RNA HEV in serum. Results: The median age was 46.67 and 49.6 years in acute hepatitis E and fulminant hepatitis E, respectively. The risk factors recorded were travel to endemic areas in 13 patients, 4 were in contact with animals, 4 suffered from hepatic steatosis due to alcohol consumption, 3 consumed uncontrolled foods, and 2 drank water from streams. Discussion: HEV is the cause of acute self-limited hepatitis, although 36.73% of the studied cases had to be hospitalised. However a small number of patients, 10.2%, had fulminant hepatitis requiring liver transplant. Chronic hepatitis E is very infrequent in immunocompetent individuals. The increase in incidence of hepatitis E is due to the introduction of better diagnostic tests in recent years. (C) 2012 Elsevier Espana, S.L. All rights reserved.