Incidence of hepatitis E virus among elevated liver enzyme (ALT, AST) Sudanese patients, Khartoum, Sudan

doi:10.21203/rs.3.rs-1739559/v1

Background

Hepatitis E Virus (HEV) infection is a newly recognized serious threat to global public health and Africa is suspected to be among the most severely affected regions in the world.

Objective

This study aimed to detect the frequency of anti-hepatitis E IgM, among elevated liver enzyme patients.

Methods

The current study is descriptive cross-sectional study carried out between April to august 2016, Ninety Patients with high liver enzyme ALT&AST and non B non C hepatitis attended Ibn senaa hospital Khartoum north, Omdurman teaching hospital and bahri teaching hospital bahri north, sedan were collected and tested by using (ELISA) kit

Results

show that Out of the 90 samples tested in order to evaluate the effect of age on HEV seropositivity, there was a significant difference (P < 0.05) between HEV seropositivity and age group,

Conclusion

study demonstrates the high prevalence rate of HEV seropositivity among non-hepatitis patients with high level enzyme ALT, AST. This will raise the potential risk of HEV infection by blood transfusion and may be the source of the outbreak.

anti-HEV IgM

Hepatitis E virus

ALT Alanine Amino Transferase

AST Aspartate Ammino Transferase

Hepatitis E is a liver disease caused by the hepatitis E virus, a non-enveloped, positive-sense, single-stranded ribonucleic acid (RNA) virus. Hepatitis E should therefore be considered a risk to transfusion safety, especially in high-risk recipients (pregnant females, patients with pre-existing chronic liver disease, and immunocompromised patients), for two reasons. Firstly, the HEV-positive donor may have asymptomatic viraemia with normal aspartate transaminase and ALT and (1, 2) secondly; the time of seroconversion is not clearly defined (3). Viraemia in individuals infected with HEV is usually of short duration but there are reported instances of protracted viraemia such as after acute HEV hepatitis in children (4). A brief incubation period can be followed by asymptomatic phase although the infection in the recipient is generally asymptomatic apart from mild jaundice and elevated ALT. Elevated ALT and AST levels are associated with a recent acute HEV infections this provided a unique opportunity to diagnose asymptomatic and symptomatic HEV infection in an occupationally exposed group (5). The presence of seropositive anti-HEV and increased levels of ALT and AST usually indicate recent HEV infection (6) and may signify a recent introduction of HEV.

The current study is descriptive cross sectional study carried out between April to august 2016, Ninety Patients with high liver enzyme ALT&AST and non B non C hepatitis attended Ibn senaa hospital Khartoum north, Omdurman teaching hospital and bahri teaching hospital bahri north, Sudan were recruited in this study this study was approved by alzaeim alazhari university , Ethics was approved by the ministry of health Medical specialization Ethics Review Board, Sudan. The blood specimens were collected by vein puncture in sterile plain containers for serological analysis samples were centrifuged, and sera were collected immediately. Sera were stored at -20c till processed and tested by (ELISA) the presence of anti-HEV IgM antibody was considered as evidence for new exposure.

Statistics:

Data were entered in to the computer using SPSS and doubled checked before analysis. Significance of differences was determined using the chi-square test. Statistical significance was set at P values < 0.05.

Frequency of HEV IgM among elevated liver enzyme ALT, AST.

Out of the 90, samples tested 34 subjects (37.7%) were HEV IgM positive, while 56 subjects (62.2%) were negative for HEV IgM (Table 1).

Influence of gender on HEV IgM seropositvity elevated liver enzyme ALT, AST:

The result presented in table demonstrates that there was no significant difference (P>0.05) between males and females (Table 2).

Influence of age on HEV IgG seropositivity among elevated liver enzyme ALT, AST.

The age range of the patients was from 20-29 was5( 35.8%) positive , 9(64.2) negative , from 30-39 was 4 (20%) positive 16(80%) negative , from 40-49 was 21was 11(34.4%) positive, 21 (65.6%),from 50 and above was 20 (83.3%) positive 4 (16,7%) negative, there was significant difference (P< 0.05) between HEV seropositivity and age group (Table 3).

Influence of residence on HEV IgM seropositivity among elevated liver enzyme ALT, AST:

The results presented in (table 4) demonstrate that there was significant difference (P< 0.05) between the residence in rural and urban and HEV IgM seropositivity (Table 4)

(Table1) Frequency of HEV IgM among elevated liver enzyme ALT, AST

Valid	Frequency	Percent
Negative	56	62.2%
Positive	34	37.7%
Total	90	100%

(Table 2) Influence of gender on HEV IgM seropositvity elevated liver enzyme ALT, AST:

Gender	N and p	Negative	Positive	total
Male	Number	27	27	54
Male	percent	30%	30%	60.0%
Female	Number	23	13	36
Female	Percent	25%	14.4	40.0
Total	Number	50	40	90
Total	Percent	55%	44.4%	100.0%

(Table 3) Influence of age on HEV IgM seropositivity among elevated liver enzyme ALT, AST.

Age	negative	Positive	total
20-29	9(64.2%)	5(35.8%)	14
30-39	16(80%)	4(20%)	20
40-49	21(65.6%)	11(34.4%)	32
50and and above	4(16.7%)	20(83.3%)	24
Total	50	40	90

(Table 4) Influence of residence on HEV IgM seropositivity among elevated liver enzyme ALT, AST.

Residence	N and P	negative	positive	Total
Rural	Number	33	9	42
Rural	Percent	36.7	10.0%	53.3%
Urban	Number	17	31	48
Urban	Percent	18.9%	34.4%	46.7%
Total	Number	50	40	90
Total	Percent	55.6%	44.4%	100%

Type E hepatitis is one of the important hygienic infectious problems of developing countries as like as other oral-fecal transmitted infections and the development of serological methods provided useful clinical and epidemiological information about this infection (7–8).

We studied the anti-HEV seropositivity in a group of non-hepatitis B non C patiens with high liver enzyme and noticed a prevalence of 37.7%, which correlates with the prevalence of endemic areas. The obtained value is higher than those obtained. The overall prevalence of anti-HEV IgM antibody among our study, which is higher than those reported by Johargy et al(2009) in Makkah, Saudi Arabia (18.7%)(55), Gotanda et al in Japan 2007 among voluntary blood donors with an elevated alanine aminotransferase (ALT) level, Japanese Red Cross Blood Center was (7.1%),(54) Aminiafshar 2004 was (7%)(60) Also higher than that reported by Adjei in accra gana 2010 (15.5%)(56), Lauren in blood transfusion Center of Suez Canal University Hospital, 2010 was (20.9%)(57) Ahmed et al 2015 was (26%)(59). Growing evidence suggest that elevated ALT and AST levels are associated with recent acute HEV infection (26–30). Similar results were obtained in our study and thus provided a unique opportunity to diagnose asymptomatic and symptomatic HEV infection. The presence of seropositive IgM anti-HEV and increased levels of ALT and AST usually indicate recent HEV infection (26) and may signify recent introduction of HEV. Seroprevalence in Sudan was lower than countries of the Eastern Mediterranean Region where reports of up to 52% seroprevalence for anti-HEV have been reported (27).

We noticed no sex association of anti-HEV seropositivity which correlates with other studies that similar to that found by Ahmed et al 2015(59). ,adjei 2010(58).

In the current study, seroprevalence of anti-HEV IgM increased with age, (35.8%) in subjects from 20–29 years to (83.3%) in subject more than 50 years, that was similar with Johargy et al(2009) (55), adjei et al 2010 (58), Ahmed et al (2015)(59). Aminiafsha et al (2004) (60) Christensen (2003) which stated that older age was higher HEV seroprevalence rates. Other studies have found older age to be a risk factor for anti-HEV positivity (22, 29). It is probable that this represents cumulative exposure over time.

In terms of area of residence, (34.4%) %of the patients who lived in the urban area were positive for IgM antibody to HEV while (10.0%) were positive in those who lived in rural are (P = .000).This similar to Ahmed et al (2009) (60). but disagree with Mansury et al(2011) in South West Franc (3). Which stated that the prevalence rate was more in rural as compared to that in the urban subjects, these results indicate that the populations with higher density may be at greater risk of hepatitis E.

This study demonstrates the high prevalence rate of HEV seropositivity among non-hepatitis patients with high level enzyme ALT, AST. This will raise the potential risk of HEV infection by blood transfusion and may be source of outbreak. Importance of evaluating HEV screening for blood donors to avoid the transmission of HEV to the patients and The high prevalence of HEV infection coupled with the elevated ALT and AST values suggest that HEV infection should be treated as an occupational illness and therefore suggest the urgent need for the introduction of some of the range of effective preventive strategies to improve settings in the community.

Ethical approval:

This study was approved by ministry of health Medical specialization Ethics Review Board, Sudan.

Consent for publication:

Authors are revised and agree for publish.

Data availability:

The data supporting this review are from previously reported studies which have been cited.

Competing of interest:

The authors declare that they have no competing of interests.

Funding:

NO funding is declared for this study.

Authors contributions:

Myada Haroon : design of the study, data collection and analysis drafting of the article, Amira Osman : supervising and final approval for publication.

Acknowledgements:

The authors thank all staff in alzaeim alazhari university, IBN Senaa hospital Khartoum sudan.

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No competing interests reported.

Incidence of hepatitis E virus among elevated liver enzyme (ALT, AST) Sudanese patients, Khartoum, Sudan

Status:

Version 1

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction And Literature Review

Methods

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1