ABSTRACT
Background: Hepatitis E is being increasingly recognized as an emerging infection in developed countries. Data on histological findings and nature of inflammatory cell infiltrate in liver in this disease are quite sparse. Aims: This study was planned to study the histological features and the type of inflammatory infiltrate in liver biopsies of patients with acute fulminant hepatitis E. Materials and Methods: We retrieved postmortem liver biopsies of 11 Indian patients with fulminant hepatitis E, and compared these with biopsies from seven patients with fulminant hepatitis B. Results : Biopsies from acute fulminant hepatitis E showed varying degrees of hepatocyte necrosis, mixed portal and lobular inflammation, accompanied by bile ductular proliferation, lymphocytic cholangitis, Kupffer cell prominence, cholestasis, apoptotic bodies, pseudo-rosette formation, steatosis, and presence of plasma cells in portal tracts. Interface hepatitis was more frequent in acute hepatitis B than in acute hepatitis E (100% vs 20%; P<0.05). These findings differ from those reported in cases with autochthonous hepatitis E in Europe. On immunohistochemistry, lymphocyte infiltrate consisted predominantly of CD3 + T cells in both hepatitis E and hepatitis B; these cells contained a predominant cytotoxic (CD8 + ) cell subpopulation in 81.8% of cases with hepatitis E and in 50% of cases with hepatitis B. Conclusion: Our findings suggest that histological changes in HEV infection may vary with geographical location because of prevalent HEV genotypes, and that CD8 + lymphocytes play a role in HEV-induced liver injury.
Subject(s)
Adolescent , Adult , CD3 Complex/analysis , Biopsy , CD8-Positive T-Lymphocytes/immunology , Child , Female , Hepatitis B/pathology , Hepatitis E/pathology , Histocytochemistry , Humans , Immunohistochemistry , Liver/pathology , Male , Microscopy , Middle Aged , Young AdultABSTRACT
India is endemic for both Leptospira and hepatitis E virus (HEV). The clinical presentations of these diseases have overlapping features. We report a case of superinfection of HEV in a patient with resolving leptospirosis with underlying Hodgkin lymphoma. The diagnosis of HEV in our case was established by HEV-RNA PCR as our patient was immunosuppressed. The present study highlights the need for molecular diagnosis in the case of HEV infection with strong clinical suspicion and negative serological results.
Subject(s)
Adult , Female , Hepatitis E/diagnosis , Hepatitis E/pathology , Hepatitis E virus/genetics , Hepatitis E virus/isolation & purification , Hodgkin Disease/complications , Humans , India , Jaundice/diagnosis , Jaundice/etiology , Leptospirosis/complications , Leptospirosis/pathology , Polymerase Chain Reaction , RNA, Viral/genetics , RNA, Viral/isolation & purification , Superinfection/diagnosisABSTRACT
La hepatitis E, conocida previamente como hepatitis no A, no B, de transmisión enteral, es una infección causada por el virus de la hepatitis E (VHE), cuyas características clínicas y epidemiológicas son las de una hepatitis aguda. Pertenece a la familia Hepaviridae. El VHE setransmite principalmente por la vía fecal-oral, la mayoría de las epidemias se pueden asociar conbrotes que tienen su origen en el agua, alta densidad de población y deficientes condiciones sanitarias. El cuadro clínico es el de una hepatitis aguda típica, sin embargo, tiene un amplio espectro de presentación clínica. Es común encontrar marcadores serológicos para VHE positivos en niños con hepatitis viral aguda por otros virus hepatótropos, especialmente el virus B y C. El diagnóstico de infección por VHE se puede hacer por detección serológica y/o molecular. La teórica viabilidad de una vacuna frente alVHEestá basada en diversas evidencias.
Hepatitis E, formerly known as hepatitis non A, non B, enteral transmission, is an infection causedby the hepatitis E virus (HEV), clinical and epidemiological characteristics are those of acute hepatitis. Hepaviridae belongs to the family. HEV is transmitted primarily through fecal-oral route,most outbreaks have been associated with outbreaks that have their origin in water, high population density and poor sanitation. The clinical picture is that of a typical acute hepatitis, however, has a broad spectrum of clinical presentation. Commonly found positive for HEV serological markers in children with acute viral hepatitis other hepatotropic viruses, especially viruses B and C. The diagnosis of HEV infectionan be done by serological detection and/or molecular. The theoretical feasibility of a vaccineagainstHEVis based on different evidence.