HEPATITIS E U HRVATSKOJ – SMJERNICE ZA DIJAGNOSTIKU I LIJEČENJE

Oktavija Đaković Rode, Lorena Jemeršić, Adriana Vince

Hepatitisu E pridaje se velika pozornost kao emergentnoj zoonozi koja se pojavljuje diljem svijeta. Kliničke slike variraju od teških fulminantnih oblika u nerazvijenim zemljama do blažih, dijagnostički neprepoznatih hepatitisa u razvijenima. Sve se češće opisuje kronični hepatitis E u osoba s transplantiranim solidnim organima i HIV-bolesti. Dijagnoza hepatitisa E postavlja se određivanjem protutijela anti-HEV-IgM i IgG uz potvrdni Western blot te dokazivanjem HEV RNK. U Hrvatskoj je prvi slučaj autohtone bolesti dokazan 2012. godine uzrokovan HEV-om genotipa 3 (HEV-3). Prikazujemo suvremene spoznaje o hepatitisu E, nadopunjene vlastitim rezultatima testiranja u Klinici za infektivne bolesti u Zagrebu te smjernice za dijagnostiku i liječenje imunokompetentnih i imunokompromitiranih osoba. Od 2011. do 2014. godine HEV je testiran u 1107 bolesnika, a anti-HEV-protutijela imalo je njih 117 (10,6%). Akutna HEV-infekcija dijagnosticirana je u 25 (2,3%) bolesnika. S obzirom na utvrđenu prevalenciju protutijela, zaključujemo da HEV-dijagnostika treba biti dio dijagnostičkog panela za bolesnike s povišenim aminotransferazama.

Hepatitis E is attributed great attention as an emerging worldwide-distributed zoonosis. The clinical presentation varies from severe fulminant in underdeveloped to milder forms of diagnostically unrecognized hepatitis cases in developed countries. Chronic hepatitis E is more often described in subjects with transplanted solid organs and HIV disease. The diagnosis of hepatitis E is established by determination of anti-HEV IgM and IgG with Western blot confirmation and detection of HEV RNA. In Croatia, the first case of indigenous disease caused by HEV genotype 3 (HEV-3) was detected in 2012. In this paper we present current knowledge on hepatitis E supplemented by own results obtained at the University Hospital for Infectious Diseases in Zagreb and guidelines for diagnosis and treatment of immunocompetent and immunocompromised individuals. In the period from 2011-2014, HEV was tested in 1107 patients, of whom 117 (10.6%) had anti-HEV antibodies. Acute HEV infection was diagnosed in 25 (2.3%) patients. Considering the prevalence of antibodies we can conclude that HEV diagnostics should be included in the diagnostic panel for patients with elevated aminotransferases.