Two Cases of Travel-Related Acute Hepatitis E

Abstract

Hepatitis E virus (HEV) infection is an acute viral hepatitis that is transmitted primarily by the fecal-oral route. The highest incidence of HEV infection is in Asia, Africa, the Middle East, and Central America, and HEV is the second most common cause of sporadic hepatitis in North Africa and the Middle East. In western countries, although sporadic cases are limited to visitors who traveled to areas of the world in which the infection is endemic, cases unassociated with travel are also reported. In this article, we describe acute viral hepatitis E diagnosed in two travelers from a nonendemic region, Australia, in whom the transmission of the infection was related to their travel to an endemic region. The couple, each aged 52 years, admitted to the hospital with the complaint of jaundice. On the physical examination, both patients appeared well, except for subicteric sclerae and skin. Alanine aminotransferase (ALT) was 2992 U/L and 1849 U/L in the male and female patient, respectively. They had a history of travel to India approximately three months before admission, and no other risk factor was found. HBsAg and anti-HAV IgM, anti-HCV, and anti-HBc IgM and IgG antibodies were negative, while anti-HEV IgM and anti-HEV IgG antibodies were positive in both patients. At the third week, ALT had decreased to 143 U/L and 100 U/L in the male and female patient, respectively, and both were discharged. These cases are presented to highlight the importance of medical history regarding travel in patients with acute viral hepatitis