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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 115-117

A hospital based study of Hepatitis E by serology

Department of Microbiology, St. John's Medical College, Bangalore - 560034, Karnataka, India

Correspondence Address:
Department of Microbiology, St. John's Medical College, Bangalore - 560034, Karnataka, India

 ~ Abstract 

Hepatitis E virus is recently recognised as an important cause of non-A, non-B hepatitis. A total of 569 serum samples were screened for HEV between April 1997 and March 2000, by a commercially available HEV IgM capture ELISA. The diagnosis was invariably acute viral hepatitis for differential diagnosis of jaundice. The percentage of seropositivity was found to be 18.8% in confirmed Hepatitis E cases.

How to cite this article:
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden R S. A hospital based study of Hepatitis E by serology. Indian J Med Microbiol 2003;21:115-7

How to cite this URL:
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden R S. A hospital based study of Hepatitis E by serology. Indian J Med Microbiol [serial online] 2003 [cited 2020 Sep 18];21:115-7. Available from:

Hepatitis E Virus (HEV) is now recognised as an important cause of enterically transmitted non-A non-B viral hepatitis. Several reports are available in India about well-characterised HEV cases, which are mainly about large- scale epidemics in communities.[1],[2],[3],[4] However, information about the clinical and epidemiological characteristics of HEV cases which may be either from epidemic source or sporadic in origin are scanty in India.[3],[5] The present study aims to i) determine the occurrence of specific IgM antibodies to HEV in clinical cases of hepatitis, ii) study the outcome of infection with hepatitis E in pregnant women and iii) correlate co-existing liver conditions in confirmed hepatitis E cases.

 ~ Materials and Methods Top

A total of 569 patients seen at out-patient department or hospitalised with diagnosis of hepatitis at St. John's Medical College Hospital, Bangalore were included. The study was carried out between April 1997 and March 2000. Three to five millilitre of blood was collected from the patients. IgM antibodies to HEV was detected employing a commercially available ELISA (Gene lab diagnostics, Singapore). Case records of all the HEV IgM antibody positive cases were reviewed to determine the association of HEV infection with pregnancy and co-existing clinical conditions. The serological status for other hepatitis viruses namely HBV (HBs Ag, Anti HBc IgM, HBe Ag), HCV antibodies and HAV IgM antibodies were reviewed. Liver function tests and histopathology of liver biopsies were also studied in those patients.

 ~ Results Top

Out of 569, 107 serum samples were positive for HEV IgM. The case fatality rate was 4/107 (3.75%). The clinical profile of these patients are shown in [Table - 1].
Among the seropositives, 72 were males and 35 were females (male:female ratio = 1.9: 1). Thus a male preponderance was noted. Age specific distribution of IgM serogpositivity is shown in [Table - 2]. Seropositives to HEV were noted in all age groups. But 11-20 age group had less sero-positivity than other age groups (p value <0.05).
A total of 10 cases of pregnancy with hepatitis were encountered and all of them were associated with complications. One pregnant lady expired in third trimester with intrauterine foetal death (IUD). Five women had IUD. Three women had pre-term delivery. Only one woman had normal course of pregnancy with fullterm normal delivery after symptomatic treatment. As many as 34 out of 107 (31.8%) had associated liver conditions [Table - 3]. Of these 20 were infectious and 14 were non-infectious in nature.

 ~ Discussion Top

The classic epidemiological studies by Viswanathan[4] and recent serological studies by Wong et al,[6] Khuroo,[2] Panda et al,[7] have convincingly demonstrated that HEV is an important cause of Non-A Non-B viral hepatitis. Epidemic and point source out breaks are common in rainy season when flooding leads to sewage contamination of drinking water.[8] Our data fits with the existing epidemiological features of HEV in endemic areas. Occurrence of HEV specific IgM was noted in 18.8% of serum samples [Table - 2]. Male preponderance was noted. The youngest person seropositive was aged 2 years and the oldest case was 67 years. Thus all age groups were susceptible to hepatitis E infection. However, adults (over 20 years ) recorded more sero-positives than adolescents and children [12% Vs 20.5% ; P value<0.05]. Similar findings have been recorded by Tandon.[9] Analysis of clinical profile showed that uncomplicated acute hepatitis accounted for majority of cases (75/107 cases) and acute hepatic failure was seen in 14. Sixteen cases were associated with chronic liver diseases and 7 cases had acute hepatitis with cholestasis. Cholestasis, a characteristic feature of HEV infection, has been noted by others.[8],[9] Histologically, cholestasis with glandular arrangement of hepatic parenchyma is seen in HEV hepatitis. This type of finding was noted in two of our cases. One case of anicteric hepatitis was also seen.
In our series, in pregnant women with HEV, the disease ran a virulent course. In fact, HEV was the second leading cause of jaundice in pregnant women in our hospital. Similar findings including a high case fatality rate and pregnancy wastage have been reported by others.[8],[9]
Meta-analysis of our data revealed association of HEV with many infective and non-infective conditions of the liver. The high occurrence of HBV markers in HEV cases is not clear. Literature on the other hand shows association of HCV and HEV.[9] Our results of association of HEV and HBV could be due to two reasons. The population corresponds to mesoendemic zone for HBV; second reason could be attributed to the reactivation of latent HBV due to clinical HEV. This is supported by the finding of core IgM to HBV in six cases. Further interesting feature was that three cases of HEV were associated with Hepatitis A. In addition, in two of the patients with HEV, blood cultures were positive for  Salmonella More Details typhi. These features probably suggest either food or water as a common vehicle for disease transmission.
In summary, HEV was an important cause of acute, subacute hepatitis in this part of India. The study revealed many typical epidemiological characteristics reported in the literature. Around one third of hepatitis E cases also had other infectious and non-infectious diseases as associated clinical conditions. More studies are needed to understand these associations and their impact on course of the disease. 

 ~ References Top

1.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;68:818-825.  Back to cited text no. 1    
2.Khuroo MS,Rustogi VK,Dawson GJ, et al. Spectrum of hepatitis E virus infection in India. J Med Virol 1994;43:281-286.  Back to cited text no. 2    
3.Radhakrishnan S,Raghuraman S, Abraham P, Kurian G, Chandy G, Sridharan G. Prevalence of enterically transmitted hepatitis viruses in patients attending a tertiary-care Hospital in South india. Indian J Pathol Microbiol 2000;43:433-436.  Back to cited text no. 3    
4.Viswanathan R. Infectious hepatitis in Delhi(1955-1956):a critical study with Epidemiology. Ind J Med Res, Suppl 1957;45:1.  Back to cited text no. 4    
5.Arankalle VA, Chobe LP, Jha J, et al. Etiology of acute sporadic non - A non-B viral hepatitis in India. J Med Virol 1993;40:121-125.  Back to cited text no. 5    
6.Wong Dc, Purcell RH, Srinivasan MA, et al. Epidemic and endemic hepatitis in India: Evidence for Non-A Non-B etiology. Lancet 1980;2:876.  Back to cited text no. 6    
7.Panda SK, Dutta R, Kaur J, et al. Enterically transmitted non-A, non-B hepatitis: recovery of virus like particles from an epidemic in South Delhi and transmission studies in rhesus monkey. Hepatology 1989;10:466.   Back to cited text no. 7    
8.Okuda K, Hai Y. Acute hepatitis and acute hepatic failure. In: Hepatobiliary diseases: Pathophysiology and Imaging, Ist ed. Okuda K, Mitchell DG, Itai Y, Ariyama J. Eds., (Blackwell Science, U.K) 2001:88-89.  Back to cited text no. 8    
9.Tandon BN. Viral hepatitis in tropics and its management, JAMA India - The physicians' Update 2001;4:102-106.  Back to cited text no. 9    
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2004 - Indian Journal of Medical Microbiology
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