High Incidence of Acute Liver Failure among Patients in Egypt Coinfected with Hepatitis A and Hepatitis E Viruses

Author:

El-Mokhtar Mohamed A.12ORCID,Elkhawaga Amal A.1,Ahmed Mona Sedky Hussein3,El-Sabaa Ehsan M. W.4ORCID,Mosa Aliaa A.5,Abdelmohsen Ahmed Shawkat6,Moussa Abdelmajeed M.7,Salama Eman H.8,Aboulfotuh Sahar8,Ashmawy Ahmed M.9,Seddik Ahmed Ismail10,Sayed Ibrahim M.1ORCID,Ramadan Haidi Karam-Allah6ORCID

Affiliation:

1. Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt

2. Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 36, Lebanon

3. Molecular Biology Researches & Studies Institute (MBRSI), Assiut University, Assiut 71515, Egypt

4. Microbiology and Immunology Department, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt

5. Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut 71515, Egypt

6. Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt

7. Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan 81528, Egypt

8. Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt

9. Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Assiut University, Assiut 71515, Egypt

10. Pediatric Department, Faculty of Medicine, Aswan University, Aswan 81528, Egypt

Abstract

Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are transmitted through the fecal–oral route. HAV outbreaks and one HEV outbreak have been reported in Egypt. However, the impact of HAV–HEV co-infection is not known. In this study, we assessed HEV markers in acute HAV-infected patients (n = 57) enrolled in Assiut University hospitals. We found that 36.8% of HAV-infected patients were also positive for HEV markers (anti-HEV IgM and HEV RNA), while 63.2% of the patients were HAV mono-infected. Demographic and clinical criteria were comparable in both HAV mono-infected patients and HAV–HEV co-infected patients. Although liver enzymes were not significantly different between the two groups, liver transaminases were higher in the co-infected patients. Six patients developed acute liver failure (ALF); five of them were HAV–HEV-co-infected patients. The relative risk of ALF development was 8.5 times higher in HAV–HEV co-infection compared to mono-infection. Three cases of ALF caused by HAV–HEV co-infection were reported in children (below 18 years) and two cases were reported in adults. All patients developed jaundice, coagulopathy, and encephalopathy; all were living in rural communities. In conclusion: HAV–HEV co-infection can be complicated by ALF. The risk of ALF development in HAV-infected patients is higher when coinfection with HEV is present.

Publisher

MDPI AG

Subject

Virology,Microbiology (medical),Microbiology

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