UNASSIGNED: The hepatitis E virus (HEV) can cause acute viral hepatitis with or without neurological manifestations, and occasionally progresses to chronic infection in immunocompromised individuals. The management of chronic HEV infection in cancer patients may be challenging due to the complex immunological constellation. Furthermore, the diagnostic workflow and the impact on quality of life of neurological HEV manifestations in immunocompromised patients have not been sufficiently delineated previously.
UNASSIGNED: A 61-year-old male with systemically treated chronic lymphocytic leukemia (CLL) experienced a slowly progressive atrophy of the spinal cord due to a chronic HEV infection. Despite continuous antiviral treatment with ribavirin, the patient\'s neurological condition continued to deteriorate, particularly following subsequent attempts to treat CLL. Treatment with obinutuzumab resulted in acute bowel and urinary retention and a further deterioration of motor skills, prompting the discontinuation of obinutuzumab. The patient\'s neurological status improved after the administration of intravenous immunoglobulins.
UNASSIGNED: This case study provides a comprehensive long-term follow-up of a cancer patient with chronic HEV infection and associated CNS involvement, which resulted in progressive neurological disability over several years. The challenges faced in diagnosing new neurological symptoms in patients undergoing immunosuppressive cancer treatment underscore the need for an interdisciplinary diagnostic approach that includes HEV testing. We propose a diagnostic pathway for future validation in immunocompromised cohorts presenting with neurological symptoms, emphasizing its potential to enhance clinical outcomes.

Hepatitis E virus (HEV) is a major cause of acute viral hepatitis. Since the coronavirus disease 2019 (COVID-19) pandemic, immunocompromised individuals face an increased risk of HEV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection, posing a threat of liver failure and prolonged illness. A 69-year-old male, with a history of chronic lymphocytic leukemia, was co-infected with HEV and SARS-CoV-2. Given the progressive decline in liver function post-admission, steroid therapy was initiated, which led to treatment-related complications. Additionally, the patient experienced an aggravation of COVID-19 symptoms due to persistent SARS-CoV-2 infection, effectively managed through a combination of antiviral medications and corticosteroids. This case describes the intricate clinical trajectory and therapeutic approach for managing HEV and SARS-CoV-2 co-infection, underscoring the potential efficacy of short-term corticosteroid intervention alongside comprehensive antiviral treatment.

UNASSIGNED: Hepatitis E (HE), caused by the Hepatitis E virus (HEV), is a significant cause of acute viral hepatitis globally and a major public health concern, particularly in specific high-prevalence areas in China, which have diverse transmission routes and regional differences. Identifying the primary risk factors for HE transmission is essential to develop targeted interventions for vulnerable populations.
UNASSIGNED: This study employed a 1:1 matched case-control methodology, using a standardized questionnaire complemented by medical records for data validation.
UNASSIGNED: Among the 442 HE cases and 428 healthy controls, the case group had a higher prevalence of fatigue (46.21%) and loss of appetite (43.84%) compared to the control group. Furthermore, liver function indicators were significantly higher in the case group, with an average alanine aminotransferase (ALT) level of 621.94 U/L and aspartate aminotransferase (AST) level of 411.53 U/L. Severe HE patients were predominantly male, with significantly increased ALT and AST levels reaching 1443.81 U/L and 862.31 U/L respectively, along with a higher incidence of fatigue (90%) and loss of appetite (75%). Multifactorial analysis indicated that frequent dining out (OR = 2.553, 95%CI:1.686-3.868), poor hygiene conditions (OR = 3.889, 95%CI:1.399-10.807), and comorbid chronic illnesses (OR = 2.275, 95%CI:1.616-3.202) were risk factors for HE infection; conversely, good hygiene practices were protective factors against HE infection (OR = 0.698, 95%CI:0.521-0.934).
UNASSIGNED: In conclusion, HE infection in Zhejiang Province is closely associated with dietary habits and environmental hygiene, and individuals with chronic diseases or co-infections are at increased risk. This highlights the need for targeted health education to reduce the incidence of HE among these populations.

BACKGROUND: Hepatitis E is a potentially serious infection in organ recipients, with an estimated two-thirds of cases becoming chronic, and with a subsequent risk of cirrhosis and death. In Europe, transmission occurs most often through the consumption of raw or undercooked pork, more rarely through blood transfusion, but also after solid organ transplantation. Here we describe a case of Hepatitis E virus (HEV) infection transmitted following kidney transplantation and review the literature describing cases of HEV infection transmitted by solid organ transplantation.
METHODS: Three weeks after kidney transplantation, the patient presented with an isolated minimal increase in GGT and hepatic cytolysis 6 months later, leading to the diagnosis of genotype 3c hepatitis E, with a plasma viral load of 6.5 log10IU/mL. In retrospect, HEV RNA was detected in the patient\'s serum from the onset of hepatitis, and in the donor\'s serum on the day of donation, with 100% identity between the viral sequences, confirming donor-derived HEV infection. Hepatitis E had a chronic course, was treated by ribavirin, and relapsed 10 months after the end of treatment.
CONCLUSIONS: Seven cases of transmission of HEV by solid organ transplantation have been described since 2012 without systematic screening for donors, all diagnosed at the chronic infection stage; two patients died. HEV organ donor transmission may be underestimated and there is insufficient focus on immunocompromised patients in whom mild liver function test impairment is potentially related to hepatitis E. However, since HEV infection is potentially severe in these patients, and as evidence accumulates, we believe that systematic screening of organ donors should be implemented for deceased and living donors regardless of liver function abnormalities, as is already the case in the UK and Spain. In January 2024, the French regulatory agency of transplantation has implemented mandatory screening of organ donors for HEV RNA.

BACKGROUND: The causes of diaphragmatic paresis are manifold. An association between neuralgic amyotrophy (NA) and hepatitis E virus (HEV) infection has been reported. We wondered about the prevalence of diaphragmatic disfunction and hepatitis E infection in our clinic.
METHODS: From July 1st, 2020 to August 31st, 2023, patients presenting with diaphragmatic dysfunction and simultaneous clinical symptoms of an acute NA, or a history of NA, as well as patients with previously unexplained diaphragmatic dysfunction were examined for HEV infection.
RESULTS: By August 31st, 2023, 13 patients with diaphragmatic dysfunction and HEV infection were diagnosed (4 women, 9 men). Mean age was 59 ± 10 years. Liver values were normal in all patients. The median latency to diagnosis was five months (range: 1-48 months); nine patients, 4 of them with typical symptoms of NA, presented with acute onset three patients showed bilateral diaphragmatic dysfunction. All patients had a positive IgG immunoblot. Seven patients, three with NA, had an elevated hepatitis E IgM titer and six of them also a positive IgM immunoblot. In all cases, O2C hepatitis genotype 3 was identified. In eight cases, all those with a high IgG titer >125, the O2 genotype 1 was also detected.
CONCLUSIONS: NA that shows involvement of the phrenic nerve resulting in diaphragmatic dysfunction and dyspnoea, may be associated with HEV infection. The observation of 13 patients with diaphragmatic dysfunctions and HEV infection within a period of three years indicates a high number of undetected HEV-associated diaphragmatic dysfunction in the population, especially in the absence of NA symptoms. Therefore, even in diaphragmatic dysfunction without NA symptoms and causative damaging event, HEV infection should be considered, as it may represent a subform of NA with only phrenic nerve involvement. Therapy of HEV-associated diaphragmatic dysfunction in the acute phase is an open question. In view of the poor prognosis for recovery, antiviral therapy should be discussed. However, no relevant data are currently available.
UNASSIGNED: Die Ursachen einer Zwerchfellparese sind vielfältig. Mittlerweile wird über einen Zusammenhang zwischen Neuralgischen Amyotrophie (NA) und einer Infektion durch Hepatitis-E-Virus(HEV) berichtet, sodass sich die Frage nach der Prävalenz von Zwerchfellstörungen und HEV-Infektionen in unserer Klinik ergab.
METHODS: Vom 1. Juli 2020 bis zum 31. August 2023 wurden Patienten mit einer Zwerchfellfunktionsstörung und gleichzeitigen klinischen Symptomen einer akuten NA oder einer NA in der Vorgeschichte sowie einer bislang ungeklärten Zwerchfellfunktionsstörung auf eine HEV-Infektion hin untersucht.
UNASSIGNED: Bis zum 31. August 2023 wurden bei 13 Patienten eine Zwerchfellfunktionsstörung und eine Hepatitis-E-Infektion diagnostiziert (4 Frauen, 9 Männer). Das Durchschnittsalter betrug 59 ± 10 Jahre. Die Leberwerte waren bei allen Patienten normal. Die mittlere Latenzzeit bis zur Diagnose betrug 5 Monate (Bereich: 1–48 Monate). 9 Patienten – 4 davon mit typischen NA-Symptomen – stellten sich mit einem akuten Krankheitsverlauf vor. 3 Patienten zeigten eine beidseitige Zwerchfelldysfunktion. Alle Patienten hatten einen positiven IgG-Immunoblot. 7 Patienten, davon 3 mit NA, hatten einen erhöhten Hepatitis-E-IgM-Titer und 6 von ihnen auch einen positiven IgM-Immunoblot. In allen Fällen fand sich der O2C-Genotyp 3. Bei 8 Patienten – allesamt mit einem hohen IgG-Titer >125 – wurde auch der O2-Genotyp 1 nachgewiesen.
UNASSIGNED: Eine NA, die eine Beteiligung des Nervus phrenicus mit Zwerchfelldysfunktion und Dyspnoe zeigt, kann mit einer HEV-Infektion verbunden sein. Die Beobachtung von 13 Patienten mit Zwerchfellfunktionsstörungen und HEV-Infektion innerhalb eines Zeitraums von 3 Jahren lässt eine hohe Anzahl unentdeckter HEV-assoziierter Zwerchfellfunktionsstörungen in der Bevölkerung vermuten, insbesondere wenn keine NA-Symptome vorliegen. So sollte auch bei Zwerchfellfunktionsstörungen ohne NA-Symptome und ursächliches Schädigungsereignis eine HEV-Infektion in Betracht gezogen werden, da es sich möglicherweise um eine Unterform der neuralgischen Amyotrophie handelt, bei der nur der Nervus phrenicus betroffen ist. Die Therapie der HEV-assoziierten Zwerchfelldysfunktion in der Akutphase ist eine offene Frage. Angesichts der schlechten Prognose der Genesung sollte eine antivirale Therapie diskutiert werden. Allerdings liegen hierzu bisher keine Daten vor.

BACKGROUND: There are abundant studies on COVID-19 but few on its impact on hepatitis E. We aimed to assess the effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence and explore the application of time series models in analyzing this pattern.
METHODS: Our pivotal idea was to fit a pre-COVID-19 model with data from before the COVID-19 outbreak and use the deviation between forecast values and actual values to reflect the effect of COVID-19 countermeasures. We analyzed the pattern of hepatitis E incidence in China from 2013 to 2018. We evaluated the fitting and forecasting capability of 3 methods before the COVID-19 outbreak. Furthermore, we employed these methods to construct pre-COVID-19 incidence models and compare post-COVID-19 forecasts with reality.
RESULTS: Before the COVID-19 outbreak, the Chinese hepatitis E incidence pattern was overall stationary and seasonal, with a peak in March, a trough in October, and higher levels in winter and spring than in summer and autumn, annually. Nevertheless, post-COVID-19 forecasts from pre-COVID-19 models were extremely different from reality in sectional periods but congruous in others.
CONCLUSIONS: Since the COVID-19 pandemic, the Chinese hepatitis E incidence pattern has altered substantially, and the incidence has greatly decreased. The effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence was temporary. The incidence of hepatitis E was anticipated to gradually revert to its pre-COVID-19 pattern.

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The main differences in cases of sudden elevation of hepatic enzyme levels during immunochemotherapy are the reactivation of the hepatitis B virus or drug-induced liver injury. Here, we report a case of acute liver injury caused by the hepatitis E virus (HEV) during chemotherapy for malignant lymphoma, wherein the patient was successfully treated for the hepatitis and resumed chemotherapy to completion.
A 57-year-old woman visited her local doctor because she felt lightweight and tired. The patient underwent lower gastrointestinal endoscopy and was diagnosed with a malignant lymphoma of the small intestine (diffuse large B-cell lymphoma). The patient had a history of oral consumption of undercooked pork liver to improve anemia and was diagnosed with acute hepatitis E.
This report highlights the successful treatment of HEV infection in a patient undergoing immunosuppressive therapy for malignant lymphomas. A novel aspect of this study is the safe and effective use of ribavirin, an antiviral medication, along with continued chemotherapy, which resulted in sustained virological response (SVR) and the completion of the planned chemotherapy regimen. This report also provides new insights into the management of HEV infections in immunosuppressed patients undergoing chemotherapy and emphasizes the importance of considering HEV as a potential cause of acute liver injury in such cases. The successful use of ribavirin along with continued chemotherapy offers a promising treatment strategy for clinicians to consider in similar scenarios.

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