Aspects cliniques et épidémiologiques des infections à virus de l'hépatite B en République Centrafricaine

Hepatitis B virus (HBV) strains have been classified into eight genotypes A to H. Recent studies have shown that the HBV genotype E (HBV/E) predominates in a vast crescent spanning from Senegal to Angola. The Central African Republic (CAR) is an endemic country for HBV infection and prevalence of chronic infection in adults is estimated to be about 15.4%. A survey of 196 patients attending local hospital with symptoms of hepatitis has permitted to obtain 66 complete or partial sequences of HBV DNA. Phylogenetic analyses have shown that 62 strains belonged to Genotype E while one was of genotype A1, and three of genotype D. One strain presented a recombination between genotypes E and D. Genotype E is thus predominant in RCA as in most Sub-Saharan countries. The variability of strains is limited not only among CAR strains but when all strains isolated so far are compared (1.67 %), suggesting a recent introduction of HBV in the human species with a rapid expansion. A simian origin of the genotype E is possible considering the DNA sequence identities with chimpanzee HBV DNA. The second part of this study is a clinical and biological survey of 68 patients attending the "Hôpital de l'Amitié" of Bangui for a suspicion of hepatocellular carcinoma (HCC). All the patients (100 %) have been infected by HBV. Echography confirmed the suspicion of HCC in 43 patients and cytopathology ascertained the diagnosis for 14 patients for whom cytoponction was feasible. Hepatitis B surface antigen (HBsAg) was present in 10 of these 43 patients, of whom 7 were co-infected with HDV. The average level of alpha-fetoprotein (AFP) was 10394 UI/mL. For the 25 other patients, HBsAg was detected in 21 of whom 11 were co-infected with HDV. Low level of AFP was observed (mean: 9UI/mL). This study shows that HBV related HCC is common in the country and that patients come to hospital late in the evolution of this disease. This study also confirms the association between HBV and HCC in CAR. HDV is associated with severe symptoms of hepatitis B. Serum and HCC lesions samples will be used to study variability of X gene and its relation with HCC.La population du virus de l'hépatite B (VHB) a été classée en huit génotypes allant de A à H. Des études récentes ont montré que le génotype E du VHB (VHB/E) prédomine sur un vaste territoire allant du Sénégal à l'Angola. La République centrafricaine (RCA) est située en zone de forte endémie où la prévalence de l'infection chronique par le VHB est estimée à 15,4% chez les adultes. Une étude menée chez 196 patients atteints d'hépatite B chronique a permis d'obtenir 66 séquences complètes ou partielles d'ADN des VHB. L'analyse phylogénétique a montré que 62 souches appartenaient au génotype E, une au génotype A1 et 3 au génotype D. Une souche était un recombinant des génotypes E/D. Comme dans la plupart des pays d?Afrique Sub-saharienne le génotype E du VHB prédomine nettement en RCA, avec une faible variabilité (1,67%) sur l'ensemble des souches du génotype E déjà décrites. Ces résultats sont en faveur d'une introduction récente du génotype E dans l'espèce humaine avec un essaimage rapide dans les populations concernées. Une origine simienne de ces souches est possible étant donné les identités de séquences entre l'ADN du VHB/E et l'ADN du VHB du chimpanzé. La deuxième partie du travail est une étude clinique et biologique chez 68 patients hospitalisés pour une suspicion de carcinome hépatocellulaire (CHC). Tous les patients recrutés (100%) étaient infectés par le VHB. L'échographie a permis de confirmer un CHC chez 43 patients et la cytoponction a permis un diagnostic de certitude chez 14 malades. L'antigène HBs (AgHBs) était présent chez 10 de ces 43 patients et 7 sur ces 10 étaient co-infectés par le VHD. La moyenne du dosage de l'alpha-foetoprotéine était de 10394 UI/mL. Chez les 25 autres patients, 21 avaient de l'AgHBs, parmi ceux-ci 11 étaient co-infectés par le VHD. La moyenne du dosage de l'AFP était de 9 UI/mL. Le CHC est donc fréquent en RCA et les patients consultent à un stade terminal de la maladie. Ce travail confirme aussi la relation entre VHB et CHC en RCA. Le VHD est associé aux formes graves d'hépatite B chronique. Les prélèvements de sérum et de lésions hépatiques qui ont été obtenus permettront par la suite d'étudier la variabilité du gène X et ses relations avec le CHC

Clinical and epidemiological aspects of hepatitis B virus infections in Central Africa Republic

La population du virus de l’hépatite B (VHB) a été classée en huit génotypes allant de A à H. Des études récentes ont montré que le génotype E du VHB (VHB/E) prédomine sur un vaste territoire allant du Sénégal à l'Angola. La République centrafricaine (RCA) est située en zone de forte endémie où la prévalence de l’infection chronique par le VHB est estimée à 15,4% chez les adultes. Une étude menée chez 196 patients atteints d’hépatite B chronique a permis d’obtenir 66 séquences complètes ou partielles d’ADN des VHB. L’analyse phylogénétique a montré que 62 souches appartenaient au génotype E, une au génotype A1 et 3 au génotype D. Une souche était un recombinant des génotypes E/D. Comme dans la plupart des pays d’Afrique Sub-saharienne le génotype E du VHB prédomine nettement en RCA, avec une faible variabilité (1,67%) sur l’ensemble des souches du génotype E déjà décrites. Ces résultats sont en faveur d’une introduction récente du génotype E dans l’espèce humaine avec un essaimage rapide dans les populations concernées. Une origine simienne de ces souches est possible étant donné les identités de séquences entre l’ADN du VHB/E et l’ADN du VHB du chimpanzé. La deuxième partie du travail est une étude clinique et biologique chez 68 patients hospitalisés pour une suspicion de carcinome hépatocellulaire (CHC). Tous les patients recrutés (100%) étaient infectés par le VHB. L’échographie a permis de confirmer un CHC chez 43 patients et la cytoponction a permis un diagnostic de certitude chez 14 malades. L’antigène HBs (AgHBs) était présent chez 10 de ces 43 patients et 7 sur ces 10 étaient co-infectés par le VHD. La moyenne du dosage de l’alpha-foetoprotéine était de 10394 UI/mL. Chez les 25 autres patients, 21 avaient de l’AgHBs, parmi ceux-ci 11 étaient co-infectés par le VHD. La moyenne du dosage de l’AFP était de 9 UI/mL. Le CHC est donc fréquent en RCA et les patients consultent à un stade terminal de la maladie. Ce travail confirme aussi la relation entre VHB et CHC en RCA. Le VHD est associé aux formes graves d’hépatite B chronique. Les prélèvements de sérum et de lésions hépatiques qui ont été obtenus permettront par la suite d’étudier la variabilité du gène X et ses relations avec le CHC.Hepatitis B virus (HBV) strains have been classified into eight genotypes A to H. Recent studies have shown that the HBV genotype E (HBV/E) predominates in a vast crescent spanning from Senegal to Angola. The Central African Republic (CAR) is an endemic country for HBV infection and prevalence of chronic infection in adults is estimated to be about 15.4%. A survey of 196 patients attending local hospital with symptoms of hepatitis has permitted to obtain 66 complete or partial sequences of HBV DNA. Phylogenetic analyses have shown that 62 strains belonged to Genotype E while one was of genotype A1, and three of genotype D. One strain presented a recombination between genotypes E and D. Genotype E is thus predominant in RCA as in most Sub-Saharan countries. The variability of strains is limited not only among CAR strains but when all strains isolated so far are compared (1.67 %), suggesting a recent introduction of HBV in the human species with a rapid expansion. A simian origin of the genotype E is possible considering the DNA sequence identities with chimpanzee HBV DNA. The second part of this study is a clinical and biological survey of 68 patients attending the “Hôpital de l’Amitié” of Bangui for a suspicion of hepatocellular carcinoma (HCC). All the patients (100 %) have been infected by HBV. Echography confirmed the suspicion of HCC in 43 patients and cytopathology ascertained the diagnosis for 14 patients for whom cytoponction was feasible. Hepatitis B surface antigen (HBsAg) was present in 10 of these 43 patients, of whom 7 were co-infected with HDV. The average level of alpha-fetoprotein (AFP) was 10394 UI/mL. For the 25 other patients, HBsAg was detected in 21 of whom 11 were co-infected with HDV. Low level of AFP was observed (mean: 9UI/mL). This study shows that HBV related HCC is common in the country and that patients come to hospital late in the evolution of this disease. This study also confirms the association between HBV and HCC in CAR. HDV is associated with severe symptoms of hepatitis B. Serum and HCC lesions samples will be used to study variability of X gene and its relation with HCC

Free-living amoebae isolated in the Central African Republic: epidemiological and molecular aspects

International audienceAmong the many species of free-living amoebae infecting humans, only Naegleria fowleri, a few species of Acanthamoeba, Balamuthia mandrillaris recently Sappinia diploïdea and Paravahlkampfia Francina are responsible for human diseases especially deadly encephalitis outside of Acanthamoeba keratitis related. In the Central African Republic (CAR), no studies have previously been conducted about free amoebae and no suspicious cases of encephalitis or amoebic keratitis was reported even though the ecosystem supported the proliferation of these microorganisms. The objective of this study was to identify free-living amoebae present in CAR and to define the molecular characteristic. Bathing sites and cerebrospinal fluid from patients died of bacterial meningitis untagged were explored by culture and PCR and the amplicons were sequenced which allowed to characterize the species found. Only species of the genus Tetramitus, namely T. Entericus, T. waccamawensis and T.sp similar to those already described in the world and not pathogenic for humans were found in bathing sites, the cerebrospinal fluid meanwhile remained negative. Although no pathogen species such as Naegleria fowleri or species of Acanthamoeba have been isolated, this study worth pursuing because this investigation was very limited in space because of the insecurity in the country

Chronic Diarrhea, Hemorrhagic Colitis, and Hemolytic-Uremic Syndrome Associated with HEp-2 Adherent Escherichia coli in Adults Infected with Human Immunodeficiency Virus in Bangui, Central African Republic

In human immunodeficiency virus (HIV)-infected adults from the Central African Republic, the occurrence of chronic diarrhea due to HEp-2 adherent Escherichia coli (EAEC) harboring virulence markers (eaeA, BFP, EAF, astA determinant of EAST/1, positive FAS test, enteropathogenic E. coli O serogroup) was shown to be associated with AIDS. We also show that EAEC that produce verotoxin (Stx2) but do not harbor the genetic markers for classical enterohemorrhagic E. coli are involved in hemorrhagic colitis and hemolytic-uremic syndrome in patients with HIV

Droplet digital PCR detects high rate of TP53 R249S mutants in cell-free DNA of middle African patients with hepatocellular carcinoma

International audienceHepatocellular carcinoma (HCC) is still a major killing malignancy in sub-Saharan Africa. Lifelong intoxication with aflatoxin B1 is considered as one of the primary causes of this situation. The role of aflatoxin in HCC from a given population is commonly estimated through the prevalence of R249S mutation of TP53, a hallmark for previous exposure to the mycotoxin. However, the role of AFB1 is barely known in large part of Africa. We conducted a survey on circulating cell-free DNA from 149 patients with HCC and 213 control subjects with and without liver diseases from Cameroon and Central African Republic using droplet digital PCR technique. We observed a mutation prevalence of 24.8% (n = 37/149) in patients with tumor and 5.6% (n = 12/213) in controls (P = 2.2E-07). Patients with mutations usually displayed significantly increased circulating alpha-fetoprotein (AFP) values, high hepatitis B virus (HBV) DNA loads as well as worsened values of blood cells count. Interestingly, the fraction of droplets positive for R249S was significantly larger in patients with liver cancer (15.3 ± 3.7%) than in controls (0.5 ± 0.3%, P = 7.1E-04). Our survey indicates that AFB1 is instrumental for HCC development in Middle Africa and that droplet digital PCR might be used in the region both to diagnose HCC and to conduct public health surveys on populations at risk of chronic aflatoxin intoxication

APOBEC3C S188I Polymorphism Enhances Context-Specific Editing of Hepatitis B Virus Genome

International audienceSingle-nucleotide polymorphism in APOBEC3C (resulting in a serine to isoleucine in position 188) is present in approximately 10% of African populations and greatly enhances restriction against human immunodeficiency virus-1 and simian immunodeficiency virus by improving dimerization and DNA processivity of the enzyme. In this study, we demonstrated in culture and in infected patients that hepatitis B virus (HBV) could be edited by APOBEC3CS188I. Using next-generation sequencing, we demonstrated that APOBEC3CS188I led to enhanced editing activity in 5ʹTpCpA→5ʹTpTpA context. This constitutes a new hallmark of this enzyme, which could be used to determine its impact on HBV or nuclear DNA

Seroprevalence and molecular characterization of viral hepatitis and HIV co-infection in the Central African Republic.

BackgroundThe Central African Republic (CAR) is one of the countries with the highest prevalence of viral hepatitis infection in the world. Coinfection with HIV increases the morbidity and mortality beyond that of mono-infection with either hepatitis or HIV. The present study describes the geographic distribution of viral hepatitis infections and molecular characterization of these viruses in the CAR.MethodologyOut of 12,599 persons enrolled during the fourth Multiple Indicator Cluster Survey of 2010 in the CAR, 10,621 Dried Blood Spot (DBS) samples were obtained and stored at -20°C. Of these DBS, 4,317 samples were randomly selected to represent all regions of the CAR. Serological tests for hepatitis B, D, and C viruses were performed using the ELISA technique. Molecular characterization was performed to identify strains.ResultsOf the 4,317 samples included, 53.2% were from men and 46.8% from women. The HBsAg prevalence among participants was 12.9% and that HBc-Ab was 19.7%. The overall prevalence of HCV was 0.6%. Co-infection of HIV/HBV was 1.1% and that of HBV/HDV was 16.6%. A total of 77 HBV, 6 HIV, and 6 HDV strains were successfully sequenced, with 72 HBV (93.5%) strains belonging to genotype E and 5 (6.5%) strains belonging to genotype D. The 6 HDV strains all belonged to clade 1, while 4 recombinants subtype were identified among the 6 strains of HIV.ConclusionOur study found a high prevalence of HBV, HBV/HDV and HBV/HIV co-infection, but a low prevalence of HCV. CAR remains an area of high HBV endemicity. This study's data and analyses would be useful for establishing an integrated viral hepatitis and HIV surveillance program in the CAR