Acute fulminant hepatitis E virus genotype 3e infection: Description of the first case in Europe

Abstract

Hepatitis E virus (HEV) is the most important causative agent of acute hepatitis in developing countries. The disease is usually characterized by a self-limiting, benign course. However, when particular conditions coexist (pregnancy, old age, pre-existing liver disease) it may run an unfavourable course. To date, 4 HEV genotypes have been described. Historically, in the Western world, HEV infection was considered a travel-related disease, however in the last 2 decades a great number of non-travel-related autochthonous cases have been described, more often related to genotype 3 or 4 and in the context of zoonosis. We report the case of an elderly Italian man with an acute fulminant HEV infection genotype 3e that developed in the context of pre-existing liver disease; this is the first case of an unfavourable outcome associated with subgenotype 3e. The potential pathogenicity of this subgenotype together with the influence of host-related risk factors are discussed.

Keywords::

• Hepatitis E virus
• fulminant
• phylogenetic tree
• genotype
• epidemiology
• ribavirin

Declaration of interest: The authors who took part in this study declare that they do not have anything to disclose regarding funding or a conflict of interest with respect to this manuscript.

The research leading to these results was supported by the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement number 278433-PREDEMICS, and by the Italian Ministry of Health, grants ‘Ricerca Corrente’.