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Accession information: (99)00129-5h.htm (shortcode: fig002sjd); 6 December 1999
Time course of hepatitis E virus infection
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Figure 2. Time course of hepatitis E virus infection. Biochemical markers (e.g. serum ALT levels) and symptomatic markers (e.g. jaundice) of viral hepatitis are correlated with detection of HEV RNA by RT-PCR in the bloodstream, or shedding of virus in stools, and the immune response is measured as anti-HEV IgM or IgG levels, detected by enzyme immunoassay on serum samples. Four to eight weeks after exposure to HEV, there is a rise in ALT and the appearance of jaundice. Immediately prior to the onset of clinical symptoms, HEV can be detected in the bloodstream for ~1–2 weeks and is shed in the stools for ~3–4 weeks. At the onset of clinical symptoms, HEV is lost from the bloodstream, but continues to be shed in stools. Anti-HEV IgM and IgG titres continue to increase in the asymptomatic phase. The anti-HEV IgM titre peaks during the symptomatic phase and declines thereafter to baseline values within 3–6 months of symptomatic disease. The anti-HEV IgG titre remains detectable for 2–13 years as determined in various studies. Abbreviations: ALT, alanine aminotransferase; HEV, hepatitis E virus; Ig, immunoglobulin; RT-PCR, reverse transcriptase polymerase chain reaction. Modified from the viral hepatitis slide set published by the US Centers of Disease Control and Prevention, Atlanta, GA, USA, at http://www.cdc.gov/ncidod/diseases/hepatitis/slideset (fig002sjd).
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