Introduction Hepatitis E virus (HEV) is enterically transmitted and is endemic in some areas of the world. In the UK it was generally thought to be associated with travel but infection in those with no history of travel outside the UK has recently been recognised.[1] We reviewed data of patients with serologically proven acute HEV infection in North East of Scotland.

Methods The Regional Virology database was interrogated to identify all patients who had serological testing for acute HEV infection {anti-HEV IgM antibody [recomWell ELISA kits (Mikrogen)]} between March 2011 and November 2012. Casenote review was performed in those with positive serology. Presenting features and clinical course were recorded in addition to demographics, occupation, travel history, biochemical abnormalities, imaging and liver biopsy results.

Results There were 105 patients who had serological testing for evidence of acute HEV infection and 12 (11%) yielded positive IgM results, with HEV RNA detectable in 10/12 (83%) using an in-house real time RT-PCR assay.

Of the 12 confirmed cases, 10 (83%) were male and median age was 54.5 years. There was no history of travel outwith the UK in 7 (60%). Presentation was with flu like illness in 75% and clinically detectable jaundice was present in 66%. Hospitalisation was needed in 83%.

All patients had a significant transaminitis, median ALT 1487 IU/L (range 117–5645). The ALT to AST ratio was greater than 1. Serological screening for other causes of acute hepatitis was negative. IgA was elevated in 58% cases. Imaging was normal in 6 (50%), with fatty change in 3 (25%) and calculi confined to the gall bladder alone in 4 (33%) cases. Two patients underwent liver biopsy to exclude pre-existing liver disease. In both the features noted were consistent with viral liver injury.

All patients had spontaneous clinical and biochemical resolution with median time to normalisation of ALT of 6 (range 4–26) weeks. One patient developed both clinical and biochemical thyrotoxicosis which resolved spontaneously with resolution of HEV-associated clinical symptoms. Of interest, during the same study period 6 cases of acute Hepatitis B and 3 cases of acute Hepatitis A infection were diagnosed in our region.

Conclusion In our region, prevalence of HEV related acute hepatitis is higher than previously perceived and appears to be more common than acute Hepatitis A and B. Acquisition of HEV infection occurs in the UK often without travel history or obvious source of infection. Therefore, we suggest routine testing for HEV in patients with significant transaminitis.

Disclosure of Interest None Declared.

Reference

1. Kamar N, Bendall R, Legrand-Abravanel F, et al. Hepatitis E. The Lancet; 379(9835):2477–2488.