Hepatitis E and meat carcasses

I would like to report an interesting case of hepatitis. The patient is a 54-year-old butcher who presented in January with nausea and vomiting. On examination he was mildly jaundiced and reported dark urine. Biochemical profile confirmed jaundice with a bilirubin of 76 and an ALT of 560. The patient had had no recent foreign travel, no blood transfusion and no history of IV drug use. His only risk factor appeared to be his occupation. Discussion with a consultant medical microbiologist suggested testing for Hepatitis A, B, C and E plus other viral antigens. Hepatitis E IgG was present, while antibody tests for Hepatitis A, B and C were negative. The patient recovered after 6 weeks and his liver function tests have returned to normal.

Hepatitis E is prevalent in large parts of the world though it is uncommon in the UK. It is usually associated with contaminated water supplies but is known to occur in animals, particularly pigs. The patient spent much of his time butchering pork carcasses imported from the European Community and the Far East. It is likely he became infected while eating his lunch without appropriate handwashing. One other patient who worked as the same butcher's was found to have hepatitis E antibodies. Hepatitis E should be considered as a case of hepatitis in patients exposed to raw meat carcasses.