Role of formalin fixed paraffin embedded liver tissues in the diagnosis of viral hepatitis E in patients with undiagnosed acute liver failure

  • Radha Kanta RathoEmail author
  • Vikram Thakur
  • Manasi Majumdar
  • Mini P. Singh
  • Ashim Das
  • Ajay Duseja
  • Jasmine Khurana
Short Communication


Viral hepatitis E is gaining importance as an emerging worldwide disease. Though viral hepatitis E (HEV) has been attributed as an etiology of acute liver failure (ALF), however its actual incidence and the immunopathogenesis are being under explored. The present study is aimed at detecting HEV in post mortem liver tissues of patients with undiagnosed ALF. Twenty six liver tissues of ALF patients died of unknown etiology are subjected to nested reverse transcriptase PCR with HEV ORF1 gene targeted primers and HEV RNA is detected in 30.4% (7/23) of ALF cases. Out of seven HEV RNA positive cases, three (42.8%) had HEV antigen positivity by immunohistochemistry on liver tissues using HEV ORF2 antibody. Histopathological examination by H&E staining shows multiacinar confluent hepatic necrosis, bile ductular proliferation, bridging hepatic and periportal necrosis in 4, 4, 2 and 1 cases respectively. The isolates were sequenced using RdRp gene specific primers and found to HEV genotype-1. Quantitative TaqMan real time PCR estimated the viral load ranged between 7.77 × 103 and 1.44 × 107 viral copies/µl. HEV has been associated with 30.4% (7/23) of undiagnosed ALF cases. Immuno-histochemistry along with molecular testing in FFPE biopsies might be useful for the detection of HEV in undiagnosed cases.


Hepatitis E virus Acute liver failure Genotype-1 Formalin-fixed paraffin-embedded Immuno-histochemistry 



The grant-in-aid was funded by Postgraduate Institute of Medical Education and Research (PGIMER) (Project Grant No. 71/6-Edu/13/1769, dated 25/07/2014) to Prof. R K Ratho. Authors are grateful to Mr. Dinesh for helping in immune-histochemistry.

Supplementary material

13337_2018_503_MOESM1_ESM.doc (37 kb)
Supplementary material 1 (DOC 37 kb)


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Copyright information

© Indian Virological Society 2019

Authors and Affiliations

  1. 1.Department of Virology, Research Block APost Graduate Institute of Medical Education and Research, PGIMERChandigarhIndia
  2. 2.Department of HistopathologyPost Graduate Institute of Medical Education and Research, PGIMERChandigarhIndia
  3. 3.Department of HepatologyPost Graduate Institute of Medical Education and Research, PGIMERChandigarhIndia

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