Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland.
Institute of Microbiology, University Hospital Lausanne, Lausanne, Switzerland.
Liver Int. 2018 Apr;38(4):619-626. doi: 10.1111/liv.13557. Epub 2017 Sep 7.
Autochthonous hepatitis E is increasingly recognized as zoonotic infection in western countries. Serological assays have varying sensitivity and specificity.
We implemented molecular testing to identify and characterize acute hepatitis E acquired in Switzerland.
Ninety-three cases of mostly symptomatic acute hepatitis E acquired in Switzerland were documented by PCR between November 2011 and December 2016. Median HEV RNA was 7.5 x 10 IU/mL (range, 5.3 to 4.7 x 10 IU/mL). HEV genotyping was successful in 78 patients, revealing genotype 3 in 75 and genotype 4 in three patients. Phylogenetic analyses revealed a few limited geographical and temporal clusters. Of the 91 patients with available anti-HEV IgM serology, four were negative; three of these were also IgG-negative, likely as a result of immunosuppression, and one was IgG-positive, a constellation compatible with HEV reinfection. Median age of the patients was 58 years (range, 20-80 years); 71 (76.3%) were men and 49 of these (69.0%) were ≥ 50 years old. The clinical course was particularly severe in patients with underlying chronic liver disease, with fatal outcome in two patients. Six patients (6.5%) presented with neuralgic amyotrophy.
Nucleic acid-based diagnosis reveals HEV as a relevant cause of acute hepatitis in Switzerland. Middle-aged and elderly men constitute the majority of symptomatic patients. Testing for HEV should be included early in the diagnostic workup of acute hepatitis and of neuralgic amyotrophy, a typical extrahepatic manifestation of HEV genotype 3 infection.
在西方国家，自生型戊型肝炎越来越被认为是一种人畜共患感染。血清学检测方法的敏感性和特异性存在差异。
我们实施了分子检测，以鉴定和描述在瑞士获得的急性戊型肝炎。
2011 年 11 月至 2016 年 12 月期间，通过 PCR 共记录了 93 例在瑞士获得的主要表现为症状性急性戊型肝炎病例。中位 HEV RNA 为 7.5×10 IU/mL（范围为 5.3 至 4.7×10 IU/mL）。78 例患者的 HEV 基因分型成功，其中 75 例为基因型 3，3 例为基因型 4。系统进化分析显示存在少数有限的地理和时间聚类。在 91 例具有可用抗-HEV IgM 血清学的患者中，有 4 例为阴性；其中 3 例也是 IgG 阴性，可能是由于免疫抑制所致，1 例是 IgG 阳性，这一组合与 HEV 再感染相符。患者的中位年龄为 58 岁（范围为 20-80 岁）；71 例（76.3%）为男性，其中 49 例（69.0%）≥50 岁。患有基础慢性肝病的患者的临床病程特别严重，有 2 例患者死亡。6 例（6.5%）患者出现神经痛性肌萎缩。
基于核酸的诊断显示 HEV 是瑞士急性肝炎的一个重要原因。中年和老年男性构成了大多数有症状患者的主体。在急性肝炎和神经痛性肌萎缩的诊断中，应尽早进行 HEV 检测，神经痛性肌萎缩是 HEV 基因型 3 感染的一种典型肝外表现。
