ROLE OF HEPATITIS-E VIRUS IN SPORADIC CASES OF ACUTE AND FULMINANT-HEPATITIS IN AN ENDEMIC AREA (CHAD)

Forty-one patients with acute or fulminant hepatitis and 86 control pa tients were entered into a study of sporadic, acute, and fulminant hep atitis in the N'Djamena area of Chad in 1993. Acute hepatitis B was di agnosed in nine (22%) patients and acute hepatitis E in 27 (66%) patie nts. No acute hepatitis A was observed and 10% of the patients had ser ologic markers of hepatitis C virus (HCV) infection. Dual acute hepati tis B and E were observed in four patients (10%) and acute HEV infecti on was associated with chronic hepatitis B surface antigen carriage in 16 (39%). Epidemiologic findings concerning HBV from Chad suggest tha t these patients had undiagnosed chronic liver disease due to HBV, wit h acute deterioration caused by superimposed MEV replication. Moreover , it is obvious that In developing countries only the most severe case s of hepatitis are seen in hospital settings and a large proportion of them are related to superinfection with HBV and HEV. Antibody to HEV was observed in 22% of the control patients. This observation and the fact (hat epidemic and sporadic cases of HEV are observed in Chad indi cates that HEV is highly endemic in this country.