ETIOLOGIC ROLE OF HEPATITIS-E VIRUS IN SPORADIC FULMINANT-HEPATITIS

Non-A, non-B hepatitis viruses have been implicated as the etiological agent(s) in up to 60% of patients with fulminant hepatitis. These age nts are reported to induce a higher mortality than other causes of ful minant hepatitis. Hepatitis E virus (HEV) and hepatitis C virus (HCV) at present constitute the major identifiable non-A, non-B hepatitis ag ents. Of these, HEV has been established as the sole cause of epidemic hepatitis in Afro-Asian countries, and fulminant hepatitis has been r ecorded during such epidemics. However, in sporadic cases, the etiolog ical role of HEV in fulminant hepatitis has remained uncertain. The ro le of HCV in acute liver disease and fulminant hepatitis remains uncle ar. The present study was undertaken to investigate the association of HEV and HCV in patients with fulminant hepatitis by direct detection of the viral genome using reverse transcription-polymerase chain react ion (RT-PCR). Serum samples from 50 serelogically identified non-A, no n-B fulminant hepatitis cases negative for cryptic hepatitis B virus ( HBV) infection examined via PCR were tested for HEV and HCV RNA using RT-PCR. For HEV primers from the nonstructural region (ORF-1) were use d, and for HCV primers from the highly conserved 5' untranslated regio ns were used. The products were analysed using agarose gel electrophor esis and confirmed by hybridisation with radiolabelled internal oligon ucleotide probes. HEV was detected in 31 (62%) of the 50 fulminant non -A, non-B hepatitis cases. In 18 (36%) cases, HCV RNA was detected. In 11 (22%) of the HCV cases, the HEV genome was also amplified. In 20 ( 40%) cases, HEV was detected alone. Twelve (24%) patients were negativ e for all viral hepatitis markers. This study establishes HEV as one o f the major agents associated with sporadic fulminant hepatitis in a g eographical region where epidemics of hepatitis caused by HEV are freq uent. (C) 1994 Wiley-Liss, Inc.