Viral hepatitis. The clinical value of HEV diagnosis for the patient

At least 20 million hepatitis E virus (HEV) infections occur annually, with more than 3 million symptomatic cases and 60,000 deaths. HEV infection mostly affects persons living in resource-limited settings with poor access to clean water and sanitation, including multiple epidemics events and can be particularly severe in pregnant women and neonates, with a reported case-fatality rates of 20–30%. Hepatitis E is mainly enterically transmitted, but also zoonotically transmitted, especially in high-income countries, and even by parenteral way, representing a risk in blood transfusion. In high-income countries, HEV represents a growing concern being currently the main cause of acute viral hepatitis. This infection is particularly severe in immunocompromised individuals in which it can evolved to chronic and in patients with previous chronic liver disease, with a fast a severe liver degeneration. HEV infection may also affect other organs causing several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, glomerulonephritis, pancreatitis and myocarditis. The lack of suspicion due to the great ignorance of this infection results in its significant diagnostic deficit, including diagnostic errors of liver pathologies such as toxic ones, which are really hepatitis E. To date, there is a limited availability and usage of diagnostic tools for the serologic and/or molecular diagnosis of hepatitis E infection, a possible factor which has contributed to the lack of knowledge of this disease. Overall, this body of evidence strongly highlights the need to implement the global efforts aimed to improve diagnostic and epidemiologic tools worldwide.

 

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