Hepatitis E laboratory tests: Difference between revisions

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Throughout the course of infection, serologic markers will vary according to the stage of the disease:<ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075  }} </ref>
Throughout the course of infection, serologic markers will vary according to the stage of the disease:<ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075  }} </ref>


* '''Incubation period'''
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
:*Rise of [[viremia]]
|+ '''Laboratory findings'''
:*Detection of [[HEV]] in stool
|-
 
! style="width: 75px; background: #4479BA; text-align: center;"|{{fontcolor|#FFF|Test}}
* '''Symptom onset'''
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Findings}}
:*[[IgM]] and [[IgG]] antibody detection
|-
:*Elevations on serum [[aminotransferase]] and [[symptom]] onset
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Incubation period]]'''
:*[[HEV]] detected in stool
| style="background: #DCDCDC; padding: 5px;"|
 
*Rise of [[viremia]]
* '''Recovery'''
*Detection of [[HEV]] in stool
:*[[Viral]] clearance
|-
:*Increase of [[IgG]] titers (detectable for years to life)
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Symptom onset]]'''
:*Decrease of [[IgM]] levels (detectable for 3 to 12 months)
| style="background: #DCDCDC; padding: 5px;"|
:*[[HEV]] detected in stool during the initial period of recovery
*[[IgM]] and [[IgG]] antibody detection
*Elevations on serum [[aminotransferase]] and [[symptom]] onset
*[[HEV]] detected in stool
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Recovery'''
| style="background: #DCDCDC; padding: 5px;"|
*[[Viral]] clearance
*Increase of [[IgG]] titers (detectable for years to life)
*Decrease of [[IgM]] levels (detectable for 3 to 12 months)
*[[HEV]] detected in stool during the initial period of recovery
|-
|}


The detection of increased levels of anti-HEV [[IgG]] may therefore indicate recent [[HEV]] infection.<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref>  
The detection of increased levels of anti-HEV [[IgG]] may therefore indicate recent [[HEV]] infection.<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref>  
Line 30: Line 41:
Immunocompromised patients may have a delayed immune response to HEV, and hence delayed seroconversion. Therefore, these patients should be tested for HEV RNA.<ref name="pmid19866448">{{cite journal| author=Pischke S, Suneetha PV, Baechlein C, Barg-Hock H, Heim A, Kamar N et al.| title=Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients. | journal=Liver Transpl | year= 2010 | volume= 16 | issue= 1 | pages= 74-82 | pmid=19866448 | doi=10.1002/lt.21958 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19866448  }} </ref> The RNA of the virus may be detected in blood and stool for several weeks, and quantified in order to evaluate response to treatment<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref><ref name="pmid21307208">{{cite journal| author=Baylis SA, Hanschmann KM, Blümel J, Nübling CM, HEV Collaborative Study Group| title=Standardization of hepatitis E virus (HEV) nucleic acid amplification technique-based assays: an initial study to evaluate a panel of HEV strains and investigate laboratory performance. | journal=J Clin Microbiol | year= 2011 | volume= 49 | issue= 4 | pages= 1234-9 | pmid=21307208 | doi=10.1128/JCM.02578-10 | pmc=PMC3122834 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21307208  }} </ref>
Immunocompromised patients may have a delayed immune response to HEV, and hence delayed seroconversion. Therefore, these patients should be tested for HEV RNA.<ref name="pmid19866448">{{cite journal| author=Pischke S, Suneetha PV, Baechlein C, Barg-Hock H, Heim A, Kamar N et al.| title=Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients. | journal=Liver Transpl | year= 2010 | volume= 16 | issue= 1 | pages= 74-82 | pmid=19866448 | doi=10.1002/lt.21958 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19866448  }} </ref> The RNA of the virus may be detected in blood and stool for several weeks, and quantified in order to evaluate response to treatment<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref><ref name="pmid21307208">{{cite journal| author=Baylis SA, Hanschmann KM, Blümel J, Nübling CM, HEV Collaborative Study Group| title=Standardization of hepatitis E virus (HEV) nucleic acid amplification technique-based assays: an initial study to evaluate a panel of HEV strains and investigate laboratory performance. | journal=J Clin Microbiol | year= 2011 | volume= 49 | issue= 4 | pages= 1234-9 | pmid=21307208 | doi=10.1128/JCM.02578-10 | pmc=PMC3122834 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21307208  }} </ref>


The table below displays nonspecific laboratory abnormalities associated with Hepatitis E, including:<ref name=NCBI>{{cite web | title = Diarrhoea and Vomiting Caused by Gastroenteritis
The table below displays nonspecific laboratory abnormalities associated with Hepatitis E, including:
| url = http://www.ncbi.nlm.nih.gov/books/NBK63841/ }}</ref><ref name="pmid8039632">{{cite journal| author=Agarwal R, Afzalpurkar R, Fordtran JS| title=Pathophysiology of potassium absorption and secretion by the human intestine. | journal=Gastroenterology | year= 1994 | volume= 107 | issue= 2 | pages= 548-71 | pmid=8039632 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8039632  }} </ref><ref name="pmid3785323">{{cite journal| author=Wang F, Butler T, Rabbani GH, Jones PK| title=The acidosis of cholera. Contributions of hyperproteinemia, lactic acidemia, and hyperphosphatemia to an increased serum anion gap. | journal=N Engl J Med | year= 1986 | volume= 315 | issue= 25 | pages= 1591-5 | pmid=3785323 | doi=10.1056/NEJM198612183152506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3785323  }} </ref><ref name="pmid4555786">{{cite journal| author=Welbourne T, Weber M, Bank N| title=The effect of glutamine administration on urinary ammonium excretion in normal subjects and patients with renal disease. | journal=J Clin Invest | year= 1972 | volume= 51 | issue= 7 | pages= 1852-60 | pmid=4555786 | doi=10.1172/JCI106987 | pmc=PMC292333 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4555786  }} </ref><ref name="pmid3796685">{{cite journal| author=Batlle DC, von Riotte A, Schlueter W| title=Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 3 | pages= 140-4 | pmid=3796685 | doi=10.1056/NEJM198701153160305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3796685  }} </ref>
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
|+ '''Laboratory findings'''
|+ '''Laboratory findings'''

Revision as of 13:31, 26 August 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2] João André Alves Silva, M.D. [3]

Overview

Laboratory Findings

Every patient with acute or chronic hepatitis, which cannot be explained by other causes, should be tested for hepatitis E.[1] Unfortunately, the different available assays show different specificity and sensitivity, and are only available at certain centers.[2]

Throughout the course of infection, serologic markers will vary according to the stage of the disease:[2]

Laboratory findings
Test Findings
Incubation period
Symptom onset
Recovery
  • Viral clearance
  • Increase of IgG titers (detectable for years to life)
  • Decrease of IgM levels (detectable for 3 to 12 months)
  • HEV detected in stool during the initial period of recovery

The detection of increased levels of anti-HEV IgG may therefore indicate recent HEV infection.[1] Several assays are based on the HEV genotype, therefore, even though the specificity may be high, sensitivity of different tests for the remaining genotypes may be lower.[1]

Immunocompromised patients may have a delayed immune response to HEV, and hence delayed seroconversion. Therefore, these patients should be tested for HEV RNA.[3] The RNA of the virus may be detected in blood and stool for several weeks, and quantified in order to evaluate response to treatment[1][4]

The table below displays nonspecific laboratory abnormalities associated with Hepatitis E, including:

Laboratory findings
Test Findings
Complete Blood Count
Electrolytes
Inflammatory Markers
Blood cultures
Urinalysis

The following tests are done to identify and monitor liver damage from hepatitis B:

  • Albumin level
  • Liver function tests
  • Prothrombin time
  • Antibody test

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available.

Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.

References

  1. ↑ 1.0 1.1 1.2 1.3 Wedemeyer H, Pischke S, Manns MP (2012). "Pathogenesis and treatment of hepatitis e virus infection". Gastroenterology. 142 (6): 1388–1397.e1. doi:10.1053/j.gastro.2012.02.014. PMID 22537448.
  2. ↑ 2.0 2.1 Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
  3. ↑ Pischke S, Suneetha PV, Baechlein C, Barg-Hock H, Heim A, Kamar N; et al. (2010). "Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients". Liver Transpl. 16 (1): 74–82. doi:10.1002/lt.21958. PMID 19866448.
  4. ↑ Baylis SA, Hanschmann KM, Blümel J, Nübling CM, HEV Collaborative Study Group (2011). "Standardization of hepatitis E virus (HEV) nucleic acid amplification technique-based assays: an initial study to evaluate a panel of HEV strains and investigate laboratory performance". J Clin Microbiol. 49 (4): 1234–9. doi:10.1128/JCM.02578-10. PMC 3122834. PMID 21307208.

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