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Acute hepatitis E virus infection in a Cuban patient
International Journal of Infectious Diseases (2005) 9, 286—287
http://intl.elsevierhealth.com/journals/ijid
LETTER TO THE EDITOR Acute hepatitis E virus infection in a Cuban patient Hepatitis E virus (HEV) is an important cause of jaundice in developing countries in tropical and subtropical regions. The virus is transmitted via the fecal-oral route, although the possibility for zoonotic acquisition of HEV infection has been suggested by several studies.1,2 Lemos et al., in a seroprevalence survey, demonstrated that HEV could have been responsible for a considerable number of sporadic viral hepatitis episodes in Cuban patients.3 In August 2003 a 22-year-old man living in a suburb of Havana City was admitted to the gastroenterology service of the Pedro Kourı´Institute. He had not previously traveled abroad and had had no contact with people who had recently arrived from other countries. The patient did not have a history of jaundice, blood transfusion, tattoos or intravenous drug use. He reported 14 days of anorexia and general malaise before progressively developing
jaundice, dark urine and pale feces. A blood sample was negative for hepatitis A virus IgM antibodies; hepatitis B surface antigen; hepatitis B core antibody and hepatitis C virus antibodies using commercially available kits. Laboratory results of initial tests included alanine aminotransferase (ALAT) 103 UI/L; aspartate aminotransferase (ASAT) 144 UI/L, bilirubin 49 mmol/L and alkaline phosphatase 75 UI/L. Liver and gall bladder appeared normal on abdominal ultrasound. The retest of serum samples one week later revealed a diminution of ALAT (65 UI/L) and a minimal decrease of ASAT (110 UI/L). The biochemical recovery was not complete until six months after the onset of the signs and symptoms of viral hepatitis. Acute stage serum was HEV IgM antibody positive (MBC/AMRAD Hepatitis E IgM Diagnostic Kit, Macfarlane Institute, Australia), with sample optical density/cut off ratio (1.337/0.305) greater than 1, according to the manufacturer’s recommendation. HEV IgG antibody levels rose over several determinations, which provided strong evidence of acute HEV infection (MBC/AMRAD Hepatitis E IgG Diagnostic Kit, Macfarlane Institute, Australia). Genome particles of HEV were detected in stool samples using primers described by Schlauder and coworkers.4 (Figure 1). In Latin America, studies on HEV have been carried out in Argentina, Brazil, Mexico, and Venezuela.5—8 This report indicates that HEV should be taken into account in sporadic cases of viral hepatitis diagnosed in Cuba. Further investigations are needed in order to establish antigenic and genotypic characteristic of the Cuban HEV strain. This is the first clinical, virological and epidemiological report on acute hepatitis E in a Cuban patient.
Acknowledgements
Figure 1 Reverse transcription-polymerase chain reaction amplification products of Cuban HEV strain. Lane 1 and 5, molecular weight marker (100 bp); lane 2, positive control; lane 3, stool sample from Cuban patient; lane 4, negative control.
We would like to thank Dr David Anderson and Dr Tian Cheng Li for providing hepatitis E antibody kits and HEV-cDNA as positive control, respectively. Also, we are grateful to Armando Martinez Cambray for reviewing the manuscript. Conflict of interest: Nothing to declare.
1201-9712/$30.00 # 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ijid.2004.10.003
Letter to the Editor
287
Marı´a de la Caridad Montalvo Villalba*,a,b Alejandro Trujillo Ava ´losa ´ ngeles Rodrı´guez Laya,b Licel de los A Angel de Jesu ´s Goyenechea Herna ´ndeza Marite ´ Bello Corredora,b Aidonis Gutierrez Morenoa,b Susel Sariego Frometaa,b
References 1. Panda SK, Jameel S. Hepatitis E virus: from epidemiology and molecular biology. Viral Hepat Rev 1997;3:227—51. 2. Meng XJ. Zoonotic and xenozoonotic risk of the hepatitis E virus. Infect Dis Rev 2000;1:35—41. 3. Lemos G, Jameel S, Pande S, Rivera L, Rodrı´guez L, Gavilondo JV. Hepatitis E virus in Cuba. J Clin Virol 2000;16:71—5. 4. Schlauder GG, Desai SM, Zanetti AR, Tassopoulus NC, Mushawar IK. Novel hepatitis E virus (HEV) isolates from Europe: evidence for additional genotypes of HEV. J Med Virol 1999;57:243—51. 5. Huang CC, Nguyen D, Fernandez J, Jun KY, Fry KE, Bradley DW, et al. Molecular cloning and sequencing of the Mexico isolate of hepatitis E virus (HEV). Virology 1992;191:550—8. 6. Pujol FH, Favorov MO, Marcano T, Este JA, Magris M, Liprandi F, et al. Prevalence of antibodies against hepatitis E virus among urban and rural populations in Venezuela. J Med Virol 1994;42:234—6. 7. Focaccia R, Sette H, Conceicao O. Hepatitis E in Brazil. Lancet 1995;346:1165. 8. Schlauder GG, Frider B, Sookoian S, Castan ˜o GC, Mushahwar IK. Identification of 2 novel isolates of hepatitis E virus in Argentina. J Infect Dis 2000;182:294—7.
a
Institute for Tropical Medicine ‘‘Pedro Kourı´’’ Havana City, Cuba b National Reference Laboratory on Viral Hepatitis Havana City, Cuba *Corresponding author. Tel.: +537 2020450 fax: +537 2046051 E-mail address: [email protected] Corresponding Editor: Jane Zuckerman London, UK 21 September 2004
http://intl.elsevierhealth.com/journals/ijid
LETTER TO THE EDITOR Acute hepatitis E virus infection in a Cuban patient Hepatitis E virus (HEV) is an important cause of jaundice in developing countries in tropical and subtropical regions. The virus is transmitted via the fecal-oral route, although the possibility for zoonotic acquisition of HEV infection has been suggested by several studies.1,2 Lemos et al., in a seroprevalence survey, demonstrated that HEV could have been responsible for a considerable number of sporadic viral hepatitis episodes in Cuban patients.3 In August 2003 a 22-year-old man living in a suburb of Havana City was admitted to the gastroenterology service of the Pedro Kourı´Institute. He had not previously traveled abroad and had had no contact with people who had recently arrived from other countries. The patient did not have a history of jaundice, blood transfusion, tattoos or intravenous drug use. He reported 14 days of anorexia and general malaise before progressively developing
jaundice, dark urine and pale feces. A blood sample was negative for hepatitis A virus IgM antibodies; hepatitis B surface antigen; hepatitis B core antibody and hepatitis C virus antibodies using commercially available kits. Laboratory results of initial tests included alanine aminotransferase (ALAT) 103 UI/L; aspartate aminotransferase (ASAT) 144 UI/L, bilirubin 49 mmol/L and alkaline phosphatase 75 UI/L. Liver and gall bladder appeared normal on abdominal ultrasound. The retest of serum samples one week later revealed a diminution of ALAT (65 UI/L) and a minimal decrease of ASAT (110 UI/L). The biochemical recovery was not complete until six months after the onset of the signs and symptoms of viral hepatitis. Acute stage serum was HEV IgM antibody positive (MBC/AMRAD Hepatitis E IgM Diagnostic Kit, Macfarlane Institute, Australia), with sample optical density/cut off ratio (1.337/0.305) greater than 1, according to the manufacturer’s recommendation. HEV IgG antibody levels rose over several determinations, which provided strong evidence of acute HEV infection (MBC/AMRAD Hepatitis E IgG Diagnostic Kit, Macfarlane Institute, Australia). Genome particles of HEV were detected in stool samples using primers described by Schlauder and coworkers.4 (Figure 1). In Latin America, studies on HEV have been carried out in Argentina, Brazil, Mexico, and Venezuela.5—8 This report indicates that HEV should be taken into account in sporadic cases of viral hepatitis diagnosed in Cuba. Further investigations are needed in order to establish antigenic and genotypic characteristic of the Cuban HEV strain. This is the first clinical, virological and epidemiological report on acute hepatitis E in a Cuban patient.
Acknowledgements
Figure 1 Reverse transcription-polymerase chain reaction amplification products of Cuban HEV strain. Lane 1 and 5, molecular weight marker (100 bp); lane 2, positive control; lane 3, stool sample from Cuban patient; lane 4, negative control.
We would like to thank Dr David Anderson and Dr Tian Cheng Li for providing hepatitis E antibody kits and HEV-cDNA as positive control, respectively. Also, we are grateful to Armando Martinez Cambray for reviewing the manuscript. Conflict of interest: Nothing to declare.
1201-9712/$30.00 # 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ijid.2004.10.003
Letter to the Editor
287
Marı´a de la Caridad Montalvo Villalba*,a,b Alejandro Trujillo Ava ´losa ´ ngeles Rodrı´guez Laya,b Licel de los A Angel de Jesu ´s Goyenechea Herna ´ndeza Marite ´ Bello Corredora,b Aidonis Gutierrez Morenoa,b Susel Sariego Frometaa,b
References 1. Panda SK, Jameel S. Hepatitis E virus: from epidemiology and molecular biology. Viral Hepat Rev 1997;3:227—51. 2. Meng XJ. Zoonotic and xenozoonotic risk of the hepatitis E virus. Infect Dis Rev 2000;1:35—41. 3. Lemos G, Jameel S, Pande S, Rivera L, Rodrı´guez L, Gavilondo JV. Hepatitis E virus in Cuba. J Clin Virol 2000;16:71—5. 4. Schlauder GG, Desai SM, Zanetti AR, Tassopoulus NC, Mushawar IK. Novel hepatitis E virus (HEV) isolates from Europe: evidence for additional genotypes of HEV. J Med Virol 1999;57:243—51. 5. Huang CC, Nguyen D, Fernandez J, Jun KY, Fry KE, Bradley DW, et al. Molecular cloning and sequencing of the Mexico isolate of hepatitis E virus (HEV). Virology 1992;191:550—8. 6. Pujol FH, Favorov MO, Marcano T, Este JA, Magris M, Liprandi F, et al. Prevalence of antibodies against hepatitis E virus among urban and rural populations in Venezuela. J Med Virol 1994;42:234—6. 7. Focaccia R, Sette H, Conceicao O. Hepatitis E in Brazil. Lancet 1995;346:1165. 8. Schlauder GG, Frider B, Sookoian S, Castan ˜o GC, Mushahwar IK. Identification of 2 novel isolates of hepatitis E virus in Argentina. J Infect Dis 2000;182:294—7.
a
Institute for Tropical Medicine ‘‘Pedro Kourı´’’ Havana City, Cuba b National Reference Laboratory on Viral Hepatitis Havana City, Cuba *Corresponding author. Tel.: +537 2020450 fax: +537 2046051 E-mail address: [email protected] Corresponding Editor: Jane Zuckerman London, UK 21 September 2004