WE would like to report the results of further tests carried out for hepatitis E virus (HEV) on a collection of pig livers collected from retail outlets in Cornwall in 2006 ( VR , February 10, 2007, vol 160, p [202][1]). The 80 samples were collected as part of an investigation into autochthonously

Veterinary RecordVolume 166, Issue 1 p. 29-29 Letter Hepatitis E virus in retail pig livers M. Banks, M. Banks VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorF. Martelli, F. Martelli VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorS. Grierson, S. Grierson VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorH. J. Fellows, H. J. Fellows Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorW. Stableforth, W. Stableforth Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorR. Bendall, R. Bendall Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorH. R. Dalton, H. R. Dalton Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this author M. Banks, M. Banks VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorF. Martelli, F. Martelli VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorS. Grierson, S. Grierson VLA - Weybridge, New Haw, Addlestone, Surrey, KT15 3NBSearch for more papers by this authorH. J. Fellows, H. J. Fellows Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorW. Stableforth, W. Stableforth Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorR. Bendall, R. Bendall Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this authorH. R. Dalton, H. R. Dalton Royal Cornwall Hospital, Truro, TR1 3LJSearch for more papers by this author First published: 02 January 2010 https://doi.org/10.1136/vr.b5602Citations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume166, Issue1January 2010Pages 29-29 RelatedInformation

The incidence of hepatitis A is falling. In contrast, autochthonous hepatitis E is an emerging infection in developed countries. The objective of this study was to compare both laboratory-confirmed cases of hepatitis A and autochthonous hepatitis E over a 2-year period in Cornwall and Devon and anti-hepatitis A virus (HAV) IgG and anti-hepatitis E virus (HEV) IgG seroprevalence in blood donors. The databases of microbiology laboratories in Cornwall and Devon were searched for the number of diagnostic HEV and HAV assays performed during 2005-2006 and the number of confirmed cases of acute hepatitis A and hepatitis E detected. Patients were followed up until recovery or death. Sera from 500 blood donors from the regional centre were tested for HEV and HAV IgG. In total, 28 cases of autochthonous hepatitis E were identified from 838 assays, and 20 cases of hepatitis A were identified from 4503 assays. Compared to hepatitis A cases, patients with hepatitis E were older (mean age 61 vs. 45 years, P = 0.003), less likely to present in winter (P = 0.028) and had more complications (five vs. one). The IgG seroprevalence rates in blood donors were 45% for HAV and 16% for HEV. There was no relationship between HAV and HEV IgG seropositivity. Autochthonous hepatitis E may be more common than hepatitis A, affects older patients, is less likely to occur in winter and may be associated with more complications. Patients with acute hepatitis, whatever their age or travel history, should be tested for HEV.

Results:The mean age was 31+9.5 years, and 1497 (78%) were men.By ultrasound, fatty liver was present in 153 (8%) patients, while steatosis was observed in 260 (14%) liver biopsies.The steatosis involved <33% of hepatocytes in 90% cases, and was more frequent among men (15%) than women (8%).Independent predictors of steatosis included body mass index, serum triglyceride, apolipoprotein B, uric acid, and fasting blood glucose.Two-thirds (178 of 260) of CHB patients with steatosis were HBeAg positive, but there was no correlation with either HBeAg status or serum HBV DNA titer.Necroinflammatory grade and fibrosis stage were less among those with steatosis than those without.Conclusion: Hepatic steatosis is common in Chinese patients with CHB.However, it is associated with metabolic factors not viral ones, and does not appear to affect the severity of liver disease.

Veterinary RecordVolume 160, Issue 6 p. 202-202 Letter Transmission of hepatitis E virus M. Banks, M. Banks VLA — Weybridge, Addlestone, New Haw, Surrey, KT15 3NBSearch for more papers by this authorS. Grierson, S. Grierson VLA — Weybridge, Addlestone, New Haw, Surrey, KT15 3NBSearch for more papers by this authorH. J. Fellows, H. J. Fellows Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorW. Stableforth, W. Stableforth Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorR. Bendall, R. Bendall Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorH. R. Dalton, H. R. Dalton Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this author M. Banks, M. Banks VLA — Weybridge, Addlestone, New Haw, Surrey, KT15 3NBSearch for more papers by this authorS. Grierson, S. Grierson VLA — Weybridge, Addlestone, New Haw, Surrey, KT15 3NBSearch for more papers by this authorH. J. Fellows, H. J. Fellows Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorW. Stableforth, W. Stableforth Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorR. Bendall, R. Bendall Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this authorH. R. Dalton, H. R. Dalton Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJSearch for more papers by this author First published: 10 February 2007 https://doi.org/10.1136/vr.160.6.202Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume160, Issue6February 2007Pages 202-202 RelatedInformation

BACKGROUND:Locally acquired hepatitis E is an emerging infection in developed countries and can be misdiagnosed as drug-induced liver injury.AIM:To study the role of hepatitis E virus (HEV) testing in drug-induced liver injury.METHODS:Retrospective review of a cohort of patients with suspected drug-induced liver injury (n = 69) and hepatitis E (n = 45). The standard criteria for drug-induced liver injury were applied. Patients with suspected drug-induced liver injury who met these criteria were retrospectively tested for HEV on stored sera taken at the time of presentation. The two cohorts were compared to determine variables that predicted either of the diagnoses.RESULTS:Forty-seven out of 69 patients had criterion-referenced drug-induced liver injury. 22/47 were HEV negative and thus had confirmed drug-induced liver injury. 19/47 were not tested for HEV, as there was no sera available from the time of presentation. 6/47 were HEV positive and thus did not have drug-induced liver injury, but had hepatitis E infection. Compared to patients with confirmed drug-induced liver injury, patients with hepatitis E were significantly more likely to be male (OR 3.09, CI 1.05-9.08); less likely to present in November and December (0.03, CI 0.01-0.52); have lower serum bilirubin (P = 0.015); and higher serum alanine aminotransferase (P < 0.001) and alanine aminotransferase/alkaline phosphatase ratio (P < 0.001).CONCLUSION:The diagnosis of drug-induced liver injury is not secure without testing for HEV.