Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad.

The within-outbreak diversity of hepatitis E virus (HEV) was studied during the outbreak of hepatitis E that occurred in Sudan in 2004. Specimens were collected from internally displaced persons living in a Sudanese refugee camp and two camps implanted in Chad. A comparison of the sequences in the ORF2 region of 23 Sudanese isolates and five HEV samples from the two Chadian camps displayed a high similarity (>99.7%) to strains belonging to Genotype 1. But four isolates collected in one of the Chadian camps were close to Genotype 2. Circulation of divergent strains argues for possible multiple sources of infection

Hepatitis induced by noni juice from Morinda citrifolia: A rare cause of hepatotoxicity or the tip of the iceberg?

A 24-year-old female patient presented to her community hospital with mild elevations of serum transaminase and bilirubin levels. Because of multiple sclerosis, she was treated with interferon beta-la for 6 weeks. After exclusion of viral hepatitis due to hepatitis A-E, interferon beta-la was withdrawn under the suspicion of drug-induced hepatitis. One week later, she was admitted again to her community hospital with severe icterus. The transaminase and bilirubin levels were highly elevated, and a beginning impairment of the liver synthesis was expressed by a reduced prothrombin time. The confinement to our department occurred with a fulminant hepatitis and the suspicion of beginning acute liver failure. There was no evidence for hepatitis due to potentially hepatotoxic viruses, alcoholic hepatitis, Budd-Chiari syndrome, hemochromatosis, and Wilson's disease. In her serum there were high titers of liver-kidney microsomal type 1 autoantibody; the serum gamma globulin levels were in the normal range. Fine-needle aspiration biopsy of the liver ruled out an autoimmune hepatitis but showed signs of drug-induced toxicity. During the interview, she admitted that for `general immune system stimulation' she had been drinking Noni juice, a Polynesian herbal remedy made from a tropical fruit (Morinda citrifolia), during the past 4 weeks. After cessation of the Noni juice ingestion, her transaminase levels normalized quickly and were in the normal range within 1 month. Copyright (c) 2006 S. Karger AG, Basel

Viruses and drinking water

There is no evidence to indicate that there is a risk of acquiring a virus infection through the consumption of properly treated drinking water, provided the integrity of the distribution system is maintained and there is no post-treatment contamination. The consumption of inadequately treated, untreated or post-treatment contaminated water is, however, associated with a risk of hepatitis A, hepatitis E and viral gastroenteritis. The use of the standard bacterial indicators for water monitoring provides an adequate safeguard against viral contamination

First report of acute autochthonous hepatitis E in Portugal

Hepatitis E infection is usually a self-limiting disease. In industrialized countries, sporadic cases of acute hepatitis E virus (HEV) infections have been described; their number seems to be increasing in European countries. We report the first human case of autochthonous acute hepatitis E confirmed in Portugal. Patients with acute non-A-C hepatitis should be tested for HEV in Portugal and hepatitis E infection should be considered in the differential diagnosis of unexplained hepatitis cases

Persistence of hepatic hepatitis B virus after serological clearance of HBsAG with autologous peripheral stem cell transplantation

Delayed clearance of hepatitis B surface antigen was previously reported in a 38 year old woman after high dose chemotherapy with autologous peripheral blood stem cell rescue. Sixteen months later, this patient remained hepatitis B surface antigen negative, hepatitis B surface anti-body positive, and serum hepatitis B DNA negative by polymerase chain reaction. Serial liver biopsies (one at hepatitis B e antigen positive stage, one at hepatitis B e antibody positive stage, and one at hepatitis B surface antigen negative and hepatitis B surface antibody positive stage) showed a gradual resolution of the inflammatory activity with loss of hepatitis B e antigen and then hepatitis B surface antigen in the serum. However, the degree of fibrosis, though mild, remained the same. With the serological clearance of hepatitis B surface antigen, a small amount of hepatitis B virus DNA was still detectable in the nuclei of liver cells.published_or_final_versio

Correlation between hepatitis B G1896A precore mutations and HBeAg in chronic HBV patients

Background: Hepatitis B virus (HBV) infection is an important health concern worldwide, with critical outcomes. Hepatitis B e antigen (HBeAg) negative chronic hepatitis B is frequently caused by a mutation (G1896A) in the hepatitis B virus (HBV) precore (PC) reading frame, which creates a stop codon, causing premature termination of the HBe protein. Objectives: This study aimed to investigate the G1896A PC mutation and its effect on HBeAg detection in chronic HBV patients. Patients and Methods: In this study, 120 chronic HBV patients neither vaccinated or who had benefited from immunoglobulin therapy, were recruited. The HBV-DNA was extracted from plasma and polymerase chain reaction (PCR) was performed. Positive PCR products were subjected to automated sequencing. The HBV serological markers hepatitis B s antigen (HBsAg), HBeAg were tested. Results: One hundred out of 120 (83.3%) patients were HBeAg negative and 100% were HBsAg positive. The comparison of nucleotide sequences with the reference sequence (Accession number: AB033559) in HBeAg negative patients showed that there was a high rate of mutations in G1896A (93.18%). Conclusions: This study indicates that the rate of G1896A mutation at the PC region among HBeAg negative patients, in the Golestan province of Iran, was similar to the average rate encountered in other parts of Iran. The PC stop codon mutation was detected in 93.18% of HBeAg negative patients. Further studies with larger sample sizes are required to elucidate the exact role of these mutations in the clinical course of chronic HBV infection. © 2015, Ahvaz Jundishapur University of Medical Sciences

Foetal outcome in pregnancy complicated with viral hepatitis

Background: The purpose of this study is to study foetal outcome in pregnancy complicated with viral hepatitis, rate of NICU admission and foetal death.Methods: This is a cross sectional observational study undertaken in the Department of Obstetrics and Gynaecology at the tertiary care centre for the study period from October 2015 to October 2016 approved by ethical committee.Results: There were 6555 deliveries in study period of October 2015-2016 in which 54 patients were diagnosed with viral hepatitis in pregnancy. Out of 54 patients of viral hepatitis, 30 cases (55.55%) of Hepatitis E virus, 22 cases (40.74%) of Hepatitis B virus, 2 cases (3.7%) of Hepatitis C virus. No case was found for Hepatitis A virus infection. Higher incidence of NICU admission (56.66%), preterm delivery (36.66%) and intra uterine death (23.33%) was observed with Hepatitis E infection.Conclusions: Foetal outcome was poor in Hepatitis E virus followed by Hepatitis B virus. Acute viral hepatitis is more common cause of hepatitis in pregnancy. Hepatitis E virus was the most common cause of acute infection with adverse fetal outcome. Fetal loss including intra uterine death and preterm neonate was statistically significant with Hepatitis E viral infection. Health education, early diagnosis and multidisciplinary approach is the key to reduce foetal morbidity and mortality. As HBV infection in hepatitis in pregnancy is second most common cause of viral hepatitis, complete immunization against HBV in reproductive age group before first pregnancy is recommended

Shear wave elastography-based liver fibrosis assessment in patients with chronic hepatitis E displays elevated liver stiffness regardless of previous antiviral therapy

Background: Hepatitis E virus (HEV) infection especially in immunocompromised individuals can lead to chronic hepatitis. Aggressive courses of chronic hepatitis E leading to liver cirrhosis in a short period of time have been described, but evidence on the degree of liver involvement in chronic hepatitis E is rare. Vie therefore aimed to quantify liver fibrosis in patients with chronic active hepatitis E compared to patients with sustained virological response after ribavirin (RBV) treatment using 2D-shear wave elastography (2D-SWE) to measure liver stiffness. Methods: Patients with chronic hepatitis E underwent 2D-SWE, B-mode and Doppler ultrasound and laboratory testing in order to assess severity of liver involvement. Results: In this cross-sectional study, we included 14 patients of whom 8 had ongoing chronic hepatitis E and 6 patients had been successfully treated for chronic hepatitis E. The most frequent cause for immunosuppression was prior kidney transplantation (n = 12), one patient was a multivisceral transplant recipient, one had been treated for lymphoma. Five patients cleared HEV after RBV therapy, one patient reached viral clearance after reduction of his immunosuppressive medication. Using 2D-SWE measurement, 71.4% displayed increased stiffness indicative of liver fibrosis: 57.1% classified as significant fibrosis and 14.3% as severe fibrosis. Liver stiffness did not differ between patients with active chronic hepatitis E and in patients who had cleared HEN (1.59 and 1.54 m/S respectively). Compared with a control group of kidney transplant recipients without hepatitis E (1.44 m/S), the patients with a history of hepatitis E displayed a significantly higher liver stiffness (P=0.04). Conclusions: In our cohort of chronic hepatitis E patients, elevated liver stiffness indicating liver fibrosis was common and significantly higher than in controls. This is consistent with prior sparse reports of the presence of liver fibrosis or cirrhosis in chronic hepatitis E and emphasizes the need for HEV testing, therapy and research on new therapeutic options. As elevated liver stiffness was also present in patients after HEV treatment, continuous liver surveillance including elastography and ultrasound should be considered

Direction Of Hepatitis Supported Research At Namru-2

Titik berat penelitian hepatitis di NAMRU-2 pada saat ini adalah: I) penelitian binatang untuk mengetahui populasi reservoar HEV; 2) penggunaan model hewan untuk lebih diketahuinya transmisi HEV pada populasi reservoar yang dicurigai; 3) diketahuinya akurasi alat diagnostik yang digunakan (untuk semua marker); 4) diketahuinya lama pengeluaran virus hepatitis E pada kotoran manusia yang menderita hepatitis akut maupun dari model hewan; 5) diketahuinya insidens hepatitis E akut melalui pencarian kasus dengan menggunakan metode penelitian lapangan di masyarakat; dan 6) serokonversi infeksi hepatitis E pada anak-anak. Hubungan erat dengan berbagai universitas dan instansi pemerintah yang terkait dengan penanganan kasus-kasus hepatitis, telah dan masih menjadi bagian penting bagi suksesnya penelitian hepatitis di NAMRU-2. Hasil yang dicapai berdasarkan program penelitian di atas antara lain: 1) seminar hepatitis E di Kalimantan Barat; 2) tersedianya kemampuan diagnostik pada laboratorium setempat; 3) pembinaan peneliti di Indonesia dan Asia Tenggara dalam hal epidemiologi; serta 4) alih teknologi dalam pelaksanaan penelitian yang dapat melibatkan minat para peneliti pada penyakit hepatitis di Indonesia