Institut hospitalo-universitaire (IHU) Méditerranée Infection, pôle des maladies infectieuses et tropicales clinique et biologique, fédération de bactériologie-hygiène-virologie, Assistance publique-Hôpitaux de Marseille, centre hospitalo-universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Service d'hépatogastroentérologie, centre hospitalo-universitaire Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France.
Clin Res Hepatol Gastroenterol. 2014 Feb;38(1):24-31. doi: 10.1016/j.clinre.2013.05.013. Epub 2014 Jan 23.
Hepatitis E virus of genotype 3 (HEV-3) is an emerging cause of sporadic autochthonous acute hepatitis in Europe. Although spontaneous outcome of hepatitis E is usually favorable, fulminant liver failure has been described worldwide. In Europe, autochthonous hepatitis E associated with fulminant hepatic failure and leading to liver transplantation has been exceptionally reported. We report here four cases of fulminant and sub-fulminant hepatitis E proposed for liver transplantation in Marseille University hospitals between July 2006 and March 2010. HEV diagnosis relied on detection of anti-HEV IgM antibodies and HEV RNA in serum samples. All cases were men, with no travel history in hyperendemic areas. HEV sequence analyses revealed genotype 3 HEV in the four patients. Liver histology indicated severe acute hepatitis in all of them, pre-existing fibrosis being found in two cases. Two patients underwent liver transplantation, and the two other patients could not be transplanted due to septic complications and died. HEV testing should be performed for the initial evaluation of every acute liver failure regardless of the epidemiological and clinical context. With respect to the potentially fulminant evolution of HEV genotype 3 infections, treatment with ribavirin of severe acute hepatitis E should be considered.
基因型 3 型戊型肝炎病毒（HEV-3）是在欧洲散发性地方性急性肝炎的一个新兴病因。虽然戊型肝炎的自发结局通常良好，但全世界均有暴发性肝衰竭的描述。在欧洲，与暴发性肝衰竭相关并导致肝移植的自发性戊型肝炎曾有例外报道。我们在此报告马赛大学附属医院 2006 年 7 月至 2010 年 3 月间提出的 4 例拟行肝移植的暴发性和亚暴发性 HEV 病例。HEV 诊断依赖于血清样本中抗-HEV IgM 抗体和 HEV RNA 的检测。所有病例均为男性，无流行地区旅行史。4 例患者的 HEV 序列分析均显示为基因型 3 型 HEV。肝组织学检查显示所有患者均为急性重型肝炎，其中 2 例存在先前的纤维化。2 例患者接受了肝移植，另外 2 例由于感染性并发症而无法移植并死亡。无论流行病学和临床背景如何，对于每例急性肝衰竭，均应进行 HEV 检测以作初始评估。鉴于 HEV 基因型 3 感染具有潜在的暴发性病程，应考虑利巴韦林治疗严重急性戊型肝炎。
