(O5) Acute Hepatitis E Virus Genotype 3 Infection Associated with Acute Pancreatitis
Miriam Karlsson[1,2], Heléne Norder, Marie Karlsson, Rune Wejstål, Åsa Alsiö, Maria Bergström, Per-Ola Park, Anders Rosemar, Martin Lagging, Åsa Mellgren
Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden  Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden  Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden  Clinic of Infectious Diseases, Skaraborg hospital, Skövde, Sweden  Department of Surgery, South Älvsborg Hospital, Borås, Sweden  Clinic of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden 
Background and aims: Hepatitis E virus (HEV) genotype 3 is endemic in Sweden. In spite of a high seroprevalence of anti-HEV antibodies of approximately 17%, only 43 clinical cases were notified to the Public Health Agency of Sweden in 2017. Patients suffering from HEV infection may be misdiagnosed because of overlapping symptoms and laboratory abnormalities, e.g. abdominal pain and elevated liver enzymes. The aim of this study was to investigate the prevalence of acute HEV infection in patients with elevated liver transaminases admitted to acute surgical wards.
Methods: Inclusion criteria were age above 18 years and admission to an acute surgical ward with elevated liver transaminases (greater than twice the upper limit of normal). Patients were prospectively enrolled during 2016 and 2017. Serum samples were analyzed for anti-HEV IgM and IgG antibodies, and HEV RNA. Medical records were reviewed.
Results: A total of 148 patients were enrolled. Seven of these patients (7/148, 4.7%) had acute HEV infection, defined as either reactive anti-HEV IgM serology (n=2) and/or detectable HEV RNA (n=6). Four of the seven HEV infected patients were diagnosed with acute pancreatitis and the remaining three were diagnosed with biliary colic, bowel obstruction, and pancreatic malignancy. The HEV strains from four patients could be genotyped, all were genotype 3 (HEV3). Forty-two of the 148 patients (28%) had anti-HEV IgG, indicating previous infection.
Conclusions: Acute HEV3 infection is associated with acute pancreatitis in patients with gallstones and may also be present in other patients with elevated liver enzymes admitted to surgical wards. These findings suggest that diagnostics for hepatitis E including analysis for HEV RNA should be considered in patients with abdominal pain and elevated liver transaminases.