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. 2023 Mar 1;31(1):70-78.
doi: 10.53854/liim-3101-10. eCollection 2022.

Prevalence of HEV infection in acute non-ABC hepatitis and prognostic role of extrahepatic manifestations

Giovanna Picchi  1 , Alessandra Ricciardi  2 , Lara Marola  3 , Monica Di Norcia  1 , Margherita D'alessandro  4 , Rinalda Mariani  4 , Pierluigi Cacciatore  5 , Federica Sozio  5 , Stefano Necozione  3 , Vincenza Cofini  3 , Giustino Parruti  5 , Umbertina Villano  6 , Elisabetta Madonna  6 , Cinzia Marcantonio  6 , Roberto Bruni  6 , Elida Mataj  7 , Alessandro Grimaldi  1 , Anna Rita Ciccaglione  6
Affiliations

Prevalence of HEV infection in acute non-ABC hepatitis and prognostic role of extrahepatic manifestations

Giovanna Picchi et al. Infez Med. .

Abstract

Background: HEV-3 and HEV-4 are emerging cause of zoonotic acute hepatitis in high-income countries. In Europe the disease is underdiagnosed but hyperendemic areas have been identified. We describe a population with acute non-ABC (n-ABC) hepatitis in Abruzzo, the Italian region with the highest seroprevalence reported. The study was included in the surveillance of acute hepatitis E by the Italian Institute of Public Health started in 2004 and implemented in 2015.

Methods: Patients with n-ABC hepatitis during 2004-2018 in all Abruzzo Infectious Disease Departments were tested for HEV-IgM (Wantai®) and HEV-RNA (ORF3). Positive samples were sequenced (Beckman Coulter®) and phylogenetic tree (MEGA 6.06 software) obtained. Clinical data were retrospectively collected and an alimentary risk factors-questionnaire was administered. Categorical and quantitative variables were compared (Chi square test or Fisher test and Wilcoxon test).

Results: 97 hospitalized patients were tested, most cases (91.7%) after 2015. Overall, HEV-IgM resulted positive in 36% and HEV-RNA detectable in 33.3%. All 24 sequences obtained were HEV-3, with two small groups of closely related strands. L'Aquila was the Province with higher positivity rate (44%). Retrospective clinical data were acquired in 86.5% of patients, no one having liver failure. Higher ALT-levels (1282.34 vs 893.25, p=0.0139) and extrahepatic symptoms (OR 16.69, p=0.0018) were strongly associated with HEV-IgM presence. Two small outbreaks are described.

Conclusions: More than one third of n-ABC hepatitis in all Abruzzo are HEV-related. Extrahepatic symptoms correlate with HEV aetiology. Implementing surveillance is mandatory to really understand the extent of the disease.

Keywords: Acute hepatitis; HEV hyperendemic area; extrahepatic manifestations; hepatitis E virus; viral zoonosis.

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Conflict of interest statement

Conflict of interest The authors certify that there is no conflict of interest regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
Patients classification according to serologic tests.
Figure 2
Figure 2
Map of Abruzzo region with HEV positivity rate for Provinces. Squares represent the Infectious Disease Centers.
Figure 3
Figure 3
HEV positive and negative cases by Year (A) and Infectious Diseases Center (B).
Figure 4
Figure 4
Description of 2 small outbreaks occurred in 2017–2018.
See this image and copyright information in PMC

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