head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2021, vol. 27, issue2
Subject Area: Medicine
-
DOI: 10.5272/jimab.2021272.3804
Published online: 14 June 2021

Original article

J of IMAB. 2021 Apr-Jun;27(2):3804-3811
VIRAL HEPATITIS E IN PLEVEN REGION – CLINICAL, LABORATORY AND EPIDEMIOLOGICAL CHARACTERISTICS
Galya GanchevaORCID logo Corresponding Autoremail,
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Faculty of Public Health, Medical University-Pleven, Bulgaria.

ABSTRACT:
Viral hepatitis E (VHE) is endemic in most countries nowadays. Our purpose was to analyze the characteristics of VHE in the Pleven region.
Material and Methods: We performed a retrospective analysis of clinical, laboratory, and epidemiological data of 33 consecutive serologically confirmed cases of VHE treated in Clinic of Infectious Diseases at University Hospital – Pleven (2016-2019) (18 male – 56%, mean age 59±15 years). Statistical methods – t-test and χ2 test (for parametric and non-parametric distributions, respectively; P<0.05 was considered to be significant).
Results: Totally 283 cases of hepatitis were treated in the Clinic (2016-2019) (cases of VHE- 12%). Fifty-five percent of VHE cases were older than sixty years (79% – urban residents); 39% acquired the disease during March-April. Only in two cases had contacts with pigs. The commonest symptoms were hepatomegaly (100%), fatigue (94%), darkness of urine (92%), jaundice (79%), anorexia (76%), splenomegaly (67%), nausea and vomiting (58%). The jaundice was protracted (median six days). Laboratory investigations- mild leukocytosis (21%), thrombocytopenia (18%), increased serum bilirubin with a prevalence of direct fraction (82%; mean ± sd 94±91 µmol/L; 95% CI 63÷125), increased aminotransferases in 100% (ASAT mean ± sd 812±629 IU/L; 95% CI 598÷1027; ALAT mean ± sd 1327± 790 IU/L; 95% CI 1058÷1597), mild to moderately increased alkaline phosphatase and GGT (90% and 100%, respectively). All of the patients were successfully treated with glucose infusions, hepatoprotective drugs and vitamins (mean 10 days).
Conclusions: The clinicians should consider VHE in the diagnostic process. The disease affects mainly older ages, and jaundice is protracted.

Keywords: viral hepatitis E, serum bilirubin, aminotransferases, treatment,

pdf - Download FULL TEXT /PDF 1010 KB/
Please cite this article as: Gancheva G. Viral Hepatitis E in Pleven Region – Clinical, Laboratory and Epidemiological Characteristics. J of IMAB. 2021 Apr-Jun;27(1):3804-3811.
DOI: 10.5272/jimab.2021272.3804

Corresponding AutorCorrespondence to: Galya Ivanova Gancheva, Clinic of Infectious Diseases, University Hospital; 8A “Georgi Cochev” str., Pleven 5800, Bulgaria; E-mail: galya_gancheva@abv.bg

REFERENCES:
1. EASL Clinical Practice Guidelines on hepatitis E virus infection. European Association for the Study of the Liver (EASL). J of Hepatol. 2018 June;68:1256-71. [PubMed]  
2. Dalton H, Bendall R, Ijaz S, Banks M. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis. 2008 Nov;8-11:698-709. [PubMed]
3. Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J, et al. Hepatitis E. Lancet. 2012 Jun 30;379(9835):2477-88. [PubMed]
4. Khuroo MS. Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med. 1980 Jun;68(6):818-24. [PubMed]
5. Mohammad S Khuroo, Mehnaaz S Khuroo, and Naira S Khuroo. Hepatitis E: Discovery, global impact, control and cure. World J Gastroenterol. 2016 Aug 21;22(31):7030-45. [PubMed]
6. Balayan M, Andjaparidze A, Savinskaya S, Ketiladze E, Braginsky D, Savinov A, et al. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology.1983;20(1):23-31. [PubMed]
7. Reyes G, Purdy M, Kim J, Luk K, Young L, Fry K, et al. Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis. Science. 1990 Mar 16;247(4948):1335-9. [PubMed]
8. Pishmisheva M, Baymakova M, Golkocheva-Markova E, Kundurzhiev T, Pepovich R, Popov GT, et al. First serological study of hepatitis E virus infection in pigs in Bulgaria. Comptes rendus de l'Academie bulgare des Sciences. 2018;71(7):1001-8. [Crossref]
9. Hoofnagle J, Nelson K, Purcell R. Hepatitis E. N Engl J Med. 2012 Sep 27;367(13):1237-44. [PubMed]
10. Waterborne Outbreaks of Hepatitis E: Recognition, Investigation and Control. World Health Organization. July 2014. [Internet]
11. Mansuy J, Abravanel F, Miedouge M, Mengelle C, Merviel C, Dubois M, et al. Acute hepatitis E in south-west France over a 5-year period. J of Clin Virol. 2009 Jan;44(1):74-7. [PubMed]
12. Hepatitis E in the EU/EEA, 2005-2015: Baseline assessment of testing, diagnosis, surveillance and epidemiology. Stockholm (Sweden): ECDC. Jul 11 2017. [Internet]
13. Takahashi M, Okamoto H. Features of hepatitis E virus infection in humans and animals in Japan. Hepatol Res. 2014 Jan;44(1):43-58. [PubMed]  
14. Mclean BN, Gulliver J, Dalton HR. Hepatitis E virus and neurological disorders. Pract Neurol. 2017 Aug;17(4):282-8. [PubMed]
15. Denner J. Hepatitis E virus (HEV) - The Future. Viruses. 2019 Mar 13;11(3):251. [PubMed]
16. Woolson KL, Forbes A, Vine L, Beynon L, McElhinney L, Panayi V, et al. Extra-hepatic manifestations of autochthonous hepatitis E infection. Aliment Pharmacol Ther. 2014 Dec;40(11-12):1282-91. [PubMed]
17. Pepovich R, Baymakova M, Pishmisheva M, Marutsov P, Pekova L, Tsachev I. Current knowledge on Hepatitis E virus infection. Vojnosanit Pregl. 2019; 76(7):733-9. [Crossref]  
18. Teoharov P, Tiholova M, Draganov P, Lilyanova V, Ivanova R, Varleva T, et al. First cases of hepatitis E virus infection in Bulgaria. Infectology. 1995;32:17-8. [in Bulgarian]
19. Teoharov P, Kevorkyan A, Raycheva R, Golkocheva-Markova E, Trandeva-Bankova D, Andonov A. Data on the prevalence of hepatitis E virus in Bulgaria. Comptes rendus de l'Academie bulgare des Sciences. 2014 Oct; 67(10):1427-32. [Internet]  
20. Dikov I, Popov G, Plochev K, Baymakova M. [Hepatitis E virus infection in Bulgaria.] [in Bulgarian] Bulg Hepatogastroenterology (Sofia). 2012; 14:37-40.
21. Pishmisheva M. [Clinical and epidemiological aspects of acute viral hepatitis E infection.] [dissertation] Medical University of Plovdiv. 2018. [in Bulgarian]
22. Baymakova M, Popov G, Pepovich R, Tsachev I. Hepatitis E Virus Infection in Bulgaria: A Brief Analysis of the Situation in the Country. Open Access Maced J Med Sci. 2019 Jan 25;7(3):458-60. [PubMed]
23. Petrov A, Stoycheva M, Vatev N, Boev I. [Viral hepatitis E in Plovdiv district: epidemiological, clinical and biochemical characteristics.] [in Bulgarian]  Sci Infectol Parasitol. 2015; 6(1):29-31. [Internet]
24. Baymakova M, Sakem B, Plochev K, Popov G, Mihaylova-Garnizova R, Kovaleva V, et al. Epidemiological characteristics and clinical manifestations of hepatitis E virus infection in Bulgaria: a report on 20 patients. Srp Arh Celok Lek. 2016 Jan-Feb;144(1-2):63-8. [PubMed]
25. Stoykova Z, Ivanova L, Tsaneva-Damyanova D, Kostadinova T. [Hepatitis E virus infection in Northeastern Bulgaria.] Medical Review.2017; 53(3):30-4. [in Bulgarian]
26. Bruni R, Villano U, Equestre M, Chionne P, Madonna E, Trandeva-Bankova D, et al. Hepatitis E virus genotypes and subgenotypes causing acute hepatitis, Bulgaria, 2013-2015. PLoS One. 2018 Jun 7;13(6):e0198045. [PubMed]
27. Said B, Ijaz S, Kafatos G, Booth L, Thomas HL, Walsh A, et al. Hepatitis E outbreak on cruise ship. Emerg Infect Dis. 2009 Nov;15(11):1738-44. [PubMed]
28. Anita A, Gorgan L, Anita D, Oslobanu L, Pavio N, Savuta G. Evidence of hepatitis E infection in swine and humans in the East Region of Romania. Int J Infect Dis. 2014 Dec;29:232-7. [PubMed]
29. Eker A, Tansel O, Kunduracilar H, Tokuc B, Yulugkural Z, Yuksel P. [Hepatitis E virus epidemiology in adult population in Edirne province, Turkey.] [in Turkish] Mikrobiyol Bul. 2009 Apr;43(2):251-8. [PubMed]
30. Kondili L, Chionne P, Porcaro A, Madonna E, Taffon S, Resuli B, et al. Seroprevalence of hepatitis E virus (HEV) antibody and the possible association with chronic liver disease: a case-control study in Albania. Epidemiol Infect. 2006 Feb;134(1):95-101. [PubMed]

Received: 28 August 2020
Published online: 14 June 2021

back to Online Journal