SPECTRUM OF HEPATITIS-E VIRUS-INFECTION IN INDIA

A solid phase enzyme linked immunosorbent assay (ELISA) that detects I gM and IgG to hepatitis E virus (HEV) was used to study seroepidemiolo gy in 40 healthy subjects and 227 consecutive patients with liver dise ases in an endemic area. Fifty-two of the liver diseases patients (22. 9 percent) had acute hepatitis E. In contrast, none of the 40 healthy subjects were positive for IgM anti-HEV, validating the ELISA assay. T wenty-three of 25 (92%) patients with epidemic non-A, non-B hepatitis were confirmed as having acute hepatitis E. Only 1 of the 10 patients with sporadic, fulminant hepatic failuire of non-A, non-B, non-C etiol ogy was positive for IgM anti-HEV. Five (31.2%) of the 16 patients wit h acute hepatitis in HBsAg carriers were positive for IgM anti-HEV. On e patient with acute hepatitis B was coinfected with acute hepatitis E . Acute hepatitis was a disease of the adult population, with peak att ack rates in the second and third decades of life. This disease was se en in only 4 (16%) of the 25 patients with acute viral hepatitis occur ring below 14 years of age. Cholestasis was predominant in 25% of pati ents, enzyme elevation was monophasic, and all patients had clinical a nd biochemical recovery from the disease. The data suggest that the ma jority of patients with acute sporadic non-A, non-B, non-C hepatitis i n India have hepatitis E. However, fulminant hepatic failure to sporad ic nature is rarely from hepatitis E. (C) 1994 Wiley-Liss, Inc.