Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hepatitis E virus is endemic in countries with poor sanitation, where it has many similarities with the hepatitis A virus. It causes a strictly human, feco-oral transmitted, acute, self-limited hepatitis in young adults. The outcome is excellent, except in pregnant women and cirrhotic patients, who experience a high mortality rate. The first cases described in industrialized countries were travellers coming from endemic areas. However, there is now growing evidence that locally-acquired hepatitis E is common in these areas, where it is an emergent disease, despite it is still misdiagnosed. In industrialized countries, hepatitis E spreads sporadically and has a predilection for elderly men with comorbidity, particularly chronic liver diseases. The mortality seems to be higher in this population. In these areas, hepatitis E is due to the genotype 3 virus that is thought to be zoonotically transmitted by pigs and wild boar. Hepatitis E may evolve towards a chronic infection in immunocompromised subjects, particularly in solid organ-transplanted patients. In case of chronic infection, it may cause liver fibrosis and cirrhosis. The diagnosis of hepatitis E is based on serological tests (IgM and IgG) and detection of the viral genome by reverse transcription polymerase chain reaction (RT-PCR) on blood and stools. Acute hepatitis E does not require any treatment but in chronically infected patients, a sustained viral response and finally a definitive viral clearance has been observed after a three-month course of low-dose ribavirin (600 to 800 mg/day). Two vaccines underwent successful human trials but are not yet commercially available.
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PMID:[Hepatitis E: an emerging disease]. 2240 25

Hepatitis E virus (HEV) infection is an underdiagnosed disease in the developed world. In pediatric and adult organ transplant patients HEV infection can cause chronic hepatitis, which can lead to cirrhosis. Extra-hepatic manifestations, such as neurological symptoms and kidney injury, have been also reported in transplant patients. In this comprehensive minireview, we summarize the current knowledge on HEV infection in transplant patients, that is, its prevalence, incidence, natural history and therapy.
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PMID:Hepatitis E virus: what transplant physicians should know. 2254 4

Hepatitis E virus (HEV) infections are responsible for chronic hepatitis in immunocompromised patients, and this can evolve to cirrhosis. Like all RNA viruses, HEV exists as a mixture of heterogeneous viruses defining quasispecies. The relationship between the genetic heterogeneity described as a quasispecies, cytokine secretion, and the outcome of acute hepatitis in immunocompromised patients remains to be elucidated. We cloned and sequenced the region encoding the M and P capsid domains of HEV from eight solid-organ transplant (SOT) patients with acute HEV infection who subsequently cleared the virus and from eight SOT patients whose infection became chronic. We analyzed the cytokines and chemokines in the sera of these SOT patients by multianalyte profiling. The nucleotide sequence entropy and genetic distances were greater in patients whose infections became chronic. A lower K(a)/K(s) ratio was associated with the persistence of HEV. The patients who developed chronic infection had lower serum concentrations of interleukin-1 (IL-1) receptor antagonist and soluble IL-2 receptor. Increased concentrations of the chemokines implicated in leukocyte recruitment to the liver were associated with persistent infection. Those patients with chronic HEV infection and progressing liver fibrosis had less quasispecies diversification during the first year than patients without liver fibrosis progression. Great quasispecies heterogeneity, a weak inflammatory response, and high serum concentrations of the chemokines involved in leukocyte recruitment to the liver in the acute phase were associated with persistent HEV infection. Slow quasispecies diversification during the first year was associated with rapidly developing liver fibrosis.
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PMID:Hepatitis E virus quasispecies and the outcome of acute hepatitis E in solid-organ transplant patients. 2276 86

Large outbreaks of acute hepatitis E, caused by hepatitis E virus (HEV) genotypes 1 and 2, are known from developing countries with suboptimal sanitation infrastructure. An increasing incidence of HEV infections is being reported in industrialised countries, caused mainly by HEV genotypes 3 and 4, which are often found among pigs. Recent evidence suggests that in immunocompromised patients about 50% of the cases of acute hepatitis E evolve to chronic hepatitis with rapid progression to cirrhosis. Thus, HEV should be considered a cause of chronic hepatitis in immunocompromised patients, such as solid organ transplant recipients. Because an antibody response to HEV may be absent in these patients, an HEV RNA test should be carried out when serum liver tests are elevated over months. In small case series, ribavirin has been shown to represent a promising treatment option for chronic HEV infection. To increase the awareness for HEV infection in immunocompromised patients, a representative case report of an HEV-infected renal transplant recipient with chronic hepatitis E, successfully treated with ribavirin, is presented. Studies are required to determine the optimal duration of ribavirin therapy and to assess outcome for solid organ transplant recipients with chronic HEV infection.
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PMID:Chronic hepatitis E after solid organ transplantation. 2285 17

Liver disease presents with classic symptoms: fatigue, anorexia that progresses to nausea and vomiting, muscle and joint pain, and jaundice. Its most common cause is viral infection (hepatitis) with one of the hepatotropic hepatitis viruses. Although all types of hepatitis cause liver disease, their modes of transmission differ, and treatment may or may not be an option. In all types of hepatitis, people older than 65 years of age tend to develop more severe disease than those who are younger. Hepatitis A is rare in the United States, usually resolves completely with rest and supportive care, and there is no drug treatment. The Food and Drug Administration has approved several medications for hepatitis B, although comorbidities in the elderly may preclude their use. Hepatitis C is generally treated with interferon alpha and ribavirin in patients who can tolerate these agents. Chronic hepatitis D infection is more aggressive than chronic hepatitis B infection, leading to cirrhosis within two years in 10% to 15% of patients. Treatment with interferon for at least one year is recommended, but may not help. Hepatitis E virus infection-typically associated with large waterborne epidemics and endemic in Asia, Africa, and Mexico-is poorly understood and reported only sporadically in the United States. Consultant pharmacists can provide invaluable input concerning management of patients with hepatitis since few guidelines are available. Treatment is complex and often associated with side effects, and it is costly to treat. Complete adherence is critical. Residents, their families, and long-term care staff will need education and support in treating these patients. Pharmacist involvement is especially important as newly approved agents become available; side effects can cause clinicians and patients to abandon treatment.
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PMID:Hepatitis in the elderly: still a scourge. 2291 Jan 28

Hepatitis E belongs to the group of enetral hepatites. Its earlier cases caused by genotype I and II viruses were reported largely from epidemics affecting tropical and subtropical countries. Sporadic cases of hepatitis E recorded later in West Europe, North America, Southeast Asia, and Oceania were caused by genotype III and IV viruses. Until recently the disease has been supposed to be reversible and have positive outcome barring women at late stages of pregnancy in whom cases of fulminate clinical course and death were described. This review focuses on recent publications devoted to hepatitis E in immunodeficient patients, such (as recipients of solid organ transplants, HIV-infected subjects and those treated with chemotherapy. Immunosuppression was shown to turn the disease into the chronic form or liver cirrhosis. Also, the infection has extrahepatic, mostly autoimmune complications. Current approaches to antiviral therapy and prevention of hepatitis E are discussed.
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PMID:[Hepatitis E: current concepts]. 2299 13

In countries where hepatitis A is highly endemic, exposure to hepatitis A virus (HAV) is almost universal before the age of 10 years, and large-scale immunization efforts are not required. In contrast, in areas of intermediate endemicity or in transition from high to intermediate endemicity, where transmission occurs primarily from person to person in the general community (often with periodic outbreaks), control of hepatitis A may be achieved through widespread vaccination programmes. Hepatitis B virus (HBV) is one of the world's most widespread infectious agents and the cause of millions of infections each year. Between 500,000 and 700,000 people die each year from chronic infection-related cirrhosis, hepatocellular carcinoma (HCC) or from acute hepatitis B. Hepatitis B vaccine provides protection against infection and its complications including liver cirrhosis and HCC. It is therefore, the first vaccine against a cancer, the first vaccine protecting from a sexually transmitted infection, and the first vaccine against a chronic disease ever licensed. Control and significant reduction in incidence of new HBV infections as well as hepatocellular carcinoma has repeatedly been reported in countries in East Asia (i.e. Taiwan) and Africa (i.e. The Gambia). Two experimental vaccines against hepatitis E have been developed; one of them has been recently licensed but is not yet widely available. Attempts to develop a hepatitis C vaccine were so far unsuccessful.
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PMID:Viral hepatitis: global goals for vaccination. 2299

In developed countries, HEV infection was still recently considered as rare, and as an imported disease from endemic areas by travellers. Hepatitis E virus is now mainly recognized as an autochthonous disease in these countries. Although the sources and the routes of contamination remain uncertain, several cases of foodborne (zoonotic transmission) and blood borne transmission have been recently reported. HEV infection may evolve towards a chronic hepatitis in immunocompromised patients (mostly in solid organ transplant recipients and patients with HIV) which can evolve to cirrhosis. The mortality rates in industrialized countries seem to be higher than in endemic areas. By contrast, whereas mortality rate reaches 20% during pregnancy in developing countries, no death in pregnant woman secondary to an autochthonous case has been reported so far in developed countries.
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PMID:[Autochthonous hepatitis E: an emerging and still unrecognized disease]. 2323 56

Hepatitis E virus (HEV) is an emerging cause of acute hepatitis in Europe, particularly in southern France, and HEV is a new causative agent of chronic hepatitis and cirrhosis in immunocompromised patients. However, the data regarding HEV infection after kidney transplantation are still scarce with respect to the clinical issues that have been raised, and no study has specifically focused on kidney transplant recipients. This study described the clinical features and outcomes of HEV infections in a cohort of kidney transplant recipients living in southeastern France. The epidemiological, clinical, and virological characteristics of HEV infections diagnosed by PCR over a 53-month period were retrospectively analyzed in a cohort of 1,350 kidney transplant recipients monitored at the Marseille University Hospital. Sixteen HEV infections were diagnosed, all of which were autochthonous and involved genotype 3 viruses (HEV-3). Chronic infections occurred in 80% of these patients and resolved in half of the cases after a median time of 39 months. The rate of HEV clearance was 54% after a decrease in the dose of immunosuppressants. One patient developed liver cirrhosis 14 months after infection and experienced acute rejection after a decrease in the dose of immunosuppressants. Autochthonous HEV-3 infections in kidney transplant recipients progress to chronicity in most cases and might be complicated by early liver cirrhosis. Chronic HEV infection can resolve following the reduction of immunosuppressive therapy, but ribavirin may be required if reduction of the immunosuppressant dose is not associated with HEV clearance or is inappropriate for the patient management.
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PMID:Infection with hepatitis E virus in kidney transplant recipients in southeastern France. 2323 66

Interest in hepatitis E virus (HEV) infection has increased over the last few years since chronic HEV infection was first reported in transplant patients. Chronic genotype-3 HEV infections have been now reported in patients with a solid-organ transplant, hematology disease, and in those who are human immunodeficiency virus-positive. Cases of HEV-related cirrhosis have been also reported. Furthermore, HEV associated extrahepatic manifestations, including neurologic symptoms, kidney injuries, and hematological disorders, have been reported. Antiviral therapies, such as pegylated-interferon and ribavirin, have been found to be efficient in treating HEV infection. The aim of this review is to summarize the incidence, natural history, risk factors, and treatment of HEV infections in immunosuppressed patients. HEV-induced extrahepatic manifestations are described.
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PMID:Hepatitis E virus infection in immunosuppressed patients: natural history and therapy. 2356 90


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