ID = 191109042

Disease Place Number of Cases

show the keywords found by daniel

Document language : en

Unknown title

Published Date: 2017-06-24 17:56:16
Subject: PRO/EDR> Hepatitis E - Nepal: (DO, KT)
Archive Number: 20170624.5128824

HEPATITIS E - NEPAL: (DOLKHA, KATHMANDU)
****************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1]
Date: Tue 20 Jun 2017
From: Dr Sher Bahadur Pun <drsherbdr@yahoo.com> [edited]

On [Sun 18 Jun 2017], a 28-year-old pregnant woman with hepatitis E virus (HEV), visited Sukraraj Tropical and Infectious Disease Hospital, for a follow up consultation. Her liver enzymes were remarkably elevated (ALT-1972 IU/L, AST-988 IU/L). She had visited Makaibari-11, Dolkha district [Province Three] a month ago, where she joined a religious ceremony attended by 80 to 90 local people. They used tap water in the ceremony. She was diagnosed with HEV after her return from Dolkha district. It was not immediately known whether other people who joined the same ceremony became sick due to HEV.

HEV remains one of the public health problems in Nepal, though data reporting is suboptimal and surveillance system is inadequate.

--
Communicated by:
Dr Sher Bahadur Pun, MD,PhD
Clinical Research Unit,
Sukraraj Tropical and Infectious Disease Hospital,
Kathmandu, Nepal.
<drsherbdr@yahoo.com>

******
[2]
Date: Fri 23 Jun 2017
From: Dr Anup Bastola <docanup11@gmail.com> [edited]

A 17-year-old male, student from Bhadrabas-16, Sundarijal, Kathmandu (province 3) was admited on [Wed 21 Jun 2017] with history of yellow discoloration of sclera, epigastric pain and vomiting. He had fever before appearance of jaundice. There was no history of travel. Clinically he had jaundice with epigastric pain. He had increased level of bilirubin, marked increases in hepatic enzymes with prolonged prothrombin time. Serology for hepatitis A, C and B virus was negative. IgM rapid diagnostic test was positive for hepatitis E.

Hepatitis E is seen in Nepal in sporadic form. Though fatal in pregnant women, it may have increased morbidity among other population. Provision of safe drinking water, sanitation, and hand hygiene can prevent this disease.

--
Communicated by:
Dr Anup Bastola, MD, MCTM
Consultant Tropical Medicine Physician
Sukraraj Tropical and Infectious Disease Hospital,
Teku, Kathmandu
<docanup11@gmail.com>

[ProMEd thanks Dr Pun and Dr Bastola for the submission.

Hepatitis E genotypes 1 and 2 are the major waterborne forms of HEV and they tend to occur in the developing world especially Africa and Asia. These types can cause significant outbreaks (as what is occurring currently in Niger) with acute hepatitis deaths especially in 2nd and 3rd trimester pregnant women. Genotypes 3 and 4 are zoonotic with swine being a major reservoir and tend to be seen in the developed world. Type 3 in particular can cause chronic infection, especially in the immunocompromised host.

Genotypes 5, 6 and 7 are rarely mentioned in clinical reports on human HEV [hepatitis E virus] infection; 5 and 6 have been isolated from wild boar only and 7 from camels and a single human. Regarding the genotypes, the following is extracted from Lhomme S, Marion O, Abravanel F, Chapuy-Regaud S, Kamar N and Izopet J: Hepatitis E pathogenesis. Viruses. 2016 Aug; 8(8): 212:

"The increasing number of HEV strains identified in various hosts has led to a taxonomic scheme that divides the family _Hepeviridae_ into 2 genera: _Piscihepevirus_ (cutthroat trout virus) and _Orthohepevirus_ (mammalian and avian strains) [10,11]. This last genus has been divided into 4 species, _Orthohepevirus A_, _Orthohepevirus B_ (infecting birds), _Orthohepevirus C_ (infecting rodents, soricomorphs, and carnivores), and _Orthohepevirus D_ (infecting bats). The largest species, _Orthohepevirus A_, includes 7 genotypes that infect humans (HEV1, 2, 3, 4, and 7), pigs (HEV3 and 4), rabbits (HEV3), wild boar (HEV3, 4, 5, and 6), mongooses (HEV3), deer (HEV3), yaks (HEV4) and camels (HEV7). Among the 4 major genotypes, HEV1 and HEV2 are restricted to humans and are found in developing countries. HEV3 is widely distributed around the world and HEV4 is found mainly in Asia. The HEV3 and HEV4 genotypes are transmitted zoonotically from pigs, wild boars, deer, and mongooses [12]. Rabbit strains that are closed to HEV3 have recently been described in humans [13]. A liver transplant recipient who had consumed camel meat and milk was found to harbor camel HEV [14]. The transmission of HEV from ferrets, rats, bats, birds, or trout to humans has not yet been demonstrated [12].

10. Smith DB, Simmonds P., International Committee on Taxonomy of Viruses Hepeviridae Study Group: Consensus proposals for classification of the family Hepeviridae. J Gen Virol. 2014;95(Pt 10): 2223-32.
11. Smith DB, Simmonds P, Izopet J, et al: Proposed reference sequences for Hepatitis E virus subtypes. J Gen Virol 2016;97: 537-42.
12. Meng XJ: Zoonotic and foodborne transmission of Hepatitis E virus. Semin. Liver Dis. 2013;33: 41-9.
13. Izopet J, Dubois M, Bertagnoli S, et al: Hepatitis E virus strains in rabbits and evidence of a closely related strain in humans, France. Emerg Infect Dis 2012;18: 1274-81.
14. Lee GH, Tan BH, Chi-Yuan Teo E, et al: Chronic infection with camelid Hepatitis E virus in a liver transplant recipient who regularly consumes camel meat and milk. Gastroenterology. 2016;150: 355-357". - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/12834, http://healthmap.org/promed/p/2877.]

Annotations

by : Judith Shalidisease : Hepatitis E place : Nepal Number of cases : unknown

by : Timothy Muokadisease : Hepatitis E place : Nepal Number of cases : unknown

by : Walter Ndegwadisease : Hepatitis E place : India Number of cases : 2

by : Stephen Mutuvidisease : Hepatitis place : Nepal Number of cases : 1

Annotation

Consult the guidelines

Disease

enter a new one

Location

enter a new one

Number
of Cases Comment

See Also

Annotations

Annotation

Consult the guidelines