Role of real-time polymerase chain reaction in diagnosing Hepatitis E, the commonest cause of acute hepatitis in adult patients seeking institutional care Namdeo D, Shrivastava P, Garg G, Vyas AK, Nema RK, Singhai A, Nema S, Biswas D,

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Role of real-time polymerase chain reaction in diagnosing Hepatitis E, the commonest cause of acute hepatitis in adult patients seeking institutional care Divya Namdeo¹, Pratima Shrivastava², Garima Garg², Ashish K Vyas², Ram K Nema¹, Abhishek Singhai³, Shashwati Nema⁴, Debasis Biswas⁵ ¹ Regional Virology Lab, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India ² Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India ³ Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India ⁴ Regional Virology Lab; Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India ⁵ Regional Virology Lab; Departments of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Correspondence Address: Debasis Biswas, Department of Microbiology, Principal Investigator, Regional Virology Lab, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh - 462 020 India Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijpm.ijpm_693_22

Background: This cross-sectional study was performed with the aim of determining the prevalence of hepatitis E virus (HEV) infection among acute hepatitis patients attending a tertiary care teaching hospital in a developing country and to determine the relative performance of prevalent diagnostic assays in establishing its diagnosis. Materials and Methods: A total of 46 adult patients were included in this study, all of whom presented with jaundice of <4 weeks' duration and elevation of AST and ALT above 500 U/L. The prevalence of HEV among patients with acute hepatitis was calculated on the basis of the proportion of recruited patients reacting positively in serum anti-HEV immunoglobulin M (IgM) and real-time polymerase chain reaction (RT-PCR) assays. Results: Among the recruited patients, 11 (23.91%) and 15 (32.6%) patients were positive for anti-HEV IgM and RT-PCR, respectively. The two tests demonstrated poor inter-test agreement, thereby implying the necessity of performing both tests for reliable diagnosis of acute HEV virus infection. We also observed a significant difference in the duration of illness between RT-PCR positive and negative patients (P = 0.008). The mean (±SD) duration of illness in the two groups was 8.6 (±3.50) and 11.66 (± 5.15) days, respectively. Combining the results of IgM ELISA and RT-PCR, we observed that 23 out of 46 patients (50%) had evidence of acute HEV virus infection among our patients. Conclusion: Our study suggests that HEV is the commonest cause of acute hepatitis in adult patients attending a tertiary care teaching hospital and that the diagnostic algorithm for its confirmation should include both IgM ELISA and RT-PCR assays.

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    -  Namdeo D
    -  Shrivastava P
    -  Garg G
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    -  Singhai A
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    -  Biswas D

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