Skip to main content

Advertisement

SpringerLink
Log in

Role of formalin fixed paraffin embedded liver tissues in the diagnosis of viral hepatitis E in patients with undiagnosed acute liver failure

  • Short Communication
  • Published:
VirusDisease Aims and scope Submit manuscript

Abstract

Viral hepatitis E is gaining importance as an emerging worldwide disease. Though viral hepatitis E (HEV) has been attributed as an etiology of acute liver failure (ALF), however its actual incidence and the immunopathogenesis are being under explored. The present study is aimed at detecting HEV in post mortem liver tissues of patients with undiagnosed ALF. Twenty six liver tissues of ALF patients died of unknown etiology are subjected to nested reverse transcriptase PCR with HEV ORF1 gene targeted primers and HEV RNA is detected in 30.4% (7/23) of ALF cases. Out of seven HEV RNA positive cases, three (42.8%) had HEV antigen positivity by immunohistochemistry on liver tissues using HEV ORF2 antibody. Histopathological examination by H&E staining shows multiacinar confluent hepatic necrosis, bile ductular proliferation, bridging hepatic and periportal necrosis in 4, 4, 2 and 1 cases respectively. The isolates were sequenced using RdRp gene specific primers and found to HEV genotype-1. Quantitative TaqMan real time PCR estimated the viral load ranged between 7.77 × 103 and 1.44 × 107 viral copies/µl. HEV has been associated with 30.4% (7/23) of undiagnosed ALF cases. Immuno-histochemistry along with molecular testing in FFPE biopsies might be useful for the detection of HEV in undiagnosed cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Aggarwal R, Krawczynski K. Hepatitis E: an overview and recent advances in clinical and laboratory research. J Gastroenterol Hepatol. 2000;15:9–20.

    Article  CAS  PubMed  Google Scholar 

  2. Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484–93.

    Article  Google Scholar 

  3. Bastien P, Procop GW, Reischl U. Quantitative real-time PCR is not more sensitive than conventional PCR. J Clin Microbiol. 2008;46:1897–900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Drebber U, Odenthal M, Aberle SW, Winkel N, Wedemeyer I, Hemberger J. Hepatitis E in liver biopsies from patients with acute hepatitis of clinically unexplained origin. Front Physiol. 2013. https://doi.org/10.3389/fphys.2013.00351.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Echevarria JM, Fogeda M, Avellon A. Diagnosis of acute hepatitis E by antibody and molecular testing: a study on 277 suspected cases. J Clin Virol. 2011;50:69–71.

    Article  CAS  PubMed  Google Scholar 

  6. Gupta P, Jagya N, Pabhu SB, Durgapal H, Acharya SK, Panda SK. Immunohistochemistry for the diagnosis of hepatitis E virus infection. J Viral Hepat. 2012;19:e177–83.

    Article  CAS  PubMed  Google Scholar 

  7. Jameel S, Durgapal H, Habibullah CM, Khuroo MS, Panda SK. Enteric non-A, non-B hepatitis: epidemics, animal transmission and hepatitis E virus detection by the polymerase chain reaction. J Med Virol. 1992;37:263–70

    Article  CAS  PubMed  Google Scholar 

  8. Khuroo MS, Kamili S. Aetiology and prognostic factors in acute liver failure in India. J Viral Hepat. 2003;10:224–31.

    Article  CAS  PubMed  Google Scholar 

  9. Khuroo MS, Khuroo MS. Hepatitis E: an emerging global disease from discovery towards control and cure. J Viral Hepat. 2016;23:68–79.

    Article  CAS  PubMed  Google Scholar 

  10. Khuroo MS, Teli MRS, Kidmore S, Sofi MA, Khuroo MI. Incidence and severity of viral hepatitis in pregnancy. Am J Med. 1981;70:252–65.

    Article  CAS  PubMed  Google Scholar 

  11. Khuroo MS. Discovery of hepatitis E: the epidemic non-A, non-B hepatitis 30 years down the memory lane. Virus Res. 2011;161:13–4.

    Article  CAS  Google Scholar 

  12. Khuroo MS. Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med. 1980;68:818–24.

    Article  CAS  PubMed  Google Scholar 

  13. Majumdar M, Ratho RK, Chawla Y, Singh MP. High levels of circulating HMGB1 as a biomarker of acute liver failure in patients with viral hepatitis E. Liver Int. 2013;33:1341–8.

    Article  CAS  Google Scholar 

  14. Majumdar M, Singh MP, Pujhari SK, Bhatia D, Chawla Y, Ratho RK. Hepatitis E virus antigen detection as an early diagnostic marker: report from India. J Med Virol. 2013;85(5):823–7.

    Article  CAS  PubMed  Google Scholar 

  15. Malcolm P, Dalton H, Hussaini HS, Mathew J. The histology of acute autochthonous hepatitis E virus infection. Histopathology. 2007;51:190–4.

    Article  CAS  PubMed  Google Scholar 

  16. Vishwanathan R. Infectious hepatitis in Delhi (1955–1956): a critical study: epidemiology. Indian J Med Res. 1957;45:1–29.

    Google Scholar 

Download references

Acknowledgements

The grant-in-aid was funded by Postgraduate Institute of Medical Education and Research (PGIMER) (Project Grant No. 71/6-Edu/13/1769, dated 25/07/2014) to Prof. R K Ratho. Authors are grateful to Mr. Dinesh for helping in immune-histochemistry.

Author information

Authors and Affiliations

  1. Department of Virology, Research Block A, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India

    Radha Kanta Ratho, Vikram Thakur, Manasi Majumdar, Mini P. Singh & Jasmine Khurana

  2. Department of Histopathology, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India

    Ashim Das

  3. Department of Hepatology, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India

    Ajay Duseja

Authors
  1. Radha Kanta Ratho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vikram Thakur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manasi Majumdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mini P. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashim Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ajay Duseja
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jasmine Khurana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radha Kanta Ratho.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 37 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ratho, R.K., Thakur, V., Majumdar, M. et al. Role of formalin fixed paraffin embedded liver tissues in the diagnosis of viral hepatitis E in patients with undiagnosed acute liver failure. VirusDis. 30, 302–306 (2019). https://doi.org/10.1007/s13337-018-0503-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13337-018-0503-z

Keywords

Search

Navigation