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Acute infection by hepatitis E virus with a slight immunoglobulin M antibody response

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Abstract

The anti-hepatitis E virus (HEV) immunoglobulin (Ig) M antibody response is generally regarded as a useful marker for diagnosing primary infection. However, in some cases, this antibody is not detected during the acute phase of infection. An 81-year-old man with stable membranous nephropathy who presented with asymptomatic acute liver dysfunction came to our hospital. HEV RNA of genotype 3 was detected in his serum, and he was diagnosed with acute hepatitis E. According to an enzyme-linked immunosorbent assay, high-level positivity for anti-HEV IgG and IgA antibodies was observed, but the assay was negative for IgM antibody throughout the clinical course of infection. The patient was not immunosuppressed. We further investigated the presence of IgM antibody using two other polyclonal antibodies against human IgM as secondary antibodies and another recombinant ORF2 protein of genotype 3 as an immobilized antigen. IgM was weakly detected in the serum during the acute phase only by the test with the antigen of genotype 3. Multi-genotype antigens can detect a slight IgM antibody response; however, anti-HEV IgA is more useful in diagnosing primary HEV infection, particularly in cases with a low IgM antibody response.

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Acknowledgments

This study was supported in part by the Ministry of Health, Labor, and Welfare of Japan (H24-Hepatitis-General-002).

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Authors and Affiliations

  1. Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Yuki Inagaki, Yukio Oshiro & Nobuhiro Ohkohchi

  2. Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Mamiko Imanishi & Kazunori Ishige

  3. Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Masaharu Takahashi & Hiroaki Okamoto

Authors
  1. Yuki Inagaki
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  2. Yukio Oshiro
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  3. Mamiko Imanishi
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  4. Kazunori Ishige
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  5. Masaharu Takahashi
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  6. Hiroaki Okamoto
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  7. Nobuhiro Ohkohchi
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Corresponding author

Correspondence to Yukio Oshiro.

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All the authors declare that they have no conflict of interest.

Human/Animal Rights:

All experimental procedures were in accordance with the ethical standards of the responsible committee on human experimentation and the 2008 revision of the Helsinki Declaration of 1975.

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Informed consent for inclusion in this report was obtained from the patient.

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Inagaki, Y., Oshiro, Y., Imanishi, M. et al. Acute infection by hepatitis E virus with a slight immunoglobulin M antibody response. Clin J Gastroenterol 8, 247–252 (2015). https://doi.org/10.1007/s12328-015-0589-4

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  • DOI: https://doi.org/10.1007/s12328-015-0589-4

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