Polyphyletic Strains of Hepatitis E Virus Are Responsible for Sporadic Cases of Acute Hepatitis in Japan

Among 87 patients who were previously treated for acute hepatitis of unknown etiology between 1992 and 2001 at five hospitals in Japan, 11 (13%) patients were positive for immunoglobulin M-class antibodies to hepatitis E virus (HEV) by enzyme immunoassay and had detectable HEV RNA by reverse transcription-PCR with two independent sets of primers derived from well-conserved genomic areas in open reading frames 1 and 2. Clinical HEV infection was significantly associated with male sex (9 of 11 versus 29 of 76 patients [P < 0.01]) and older age (52 ± 11 [mean ± standard deviation] versus 41 ± 17 years [P < 0.05]), and its prevalence differed by geographic region (6 to 25%), with a higher rate in the northern part of Japan. At admission, the 11 patients with HEV-associated hepatitis had elevated alanine aminotransferase levels of 914 to 4,850 IU/liter, and all but 1 had elevated bilirubin levels of 1.5 to 24.0 mg/dl. The 11 HEV isolates were of genotype III or IV and were segregated into three groups with intergroup nucleotide differences of 9.5 to 22.0%. Phylogenetic analysis revealed that four isolates of genotype III were closely related to a Japanese isolate, while the other four isolates of the same genotype were nearest those from the United States. The remaining three isolates were close to known isolates of genotype IV in China and Taiwan but shared less than 88% identity with them. These results indicate that multiple genotypes of HEV cocirculate in Japan and contribute to the development of sporadic acute hepatitis, with the prevalence differing by age, sex, and geographic region

Impact of platelet transfusion on survival of patients with intracerebral hemorrhage after administration of anti-platelet agents at a tertiary emergency center.

This study examined the impact of platelet transfusion (PLT) on the survival of intracerebral hemorrhage (ICH) patients who had been administered anti-platelet agents (APA). This retrospective cohort analysis investigated 432 patients (259 men, 60%) who were newly diagnosed with ICH between January 2006 and June 2011 at the tertiary emergency center of Kitasato University Hospital. Median age on arrival was 67.0 years (range, 40-95 years). ICH was subcortical in 72 patients (16.7%), supratentorial in 233 (53.9%), and infratentorial in 133 (30.8%). PLT was performed in 16 patients (3.7%). Within 90 days after admission to the center, 178 patients (41.2%) had died due to ICH. Before the onset of ICH, 66 patients had been prescribed APA because of atherosclerotic diseases. Multivariate regression analysis indicated APA administration was an independent risk factor for death within 7 days (odds ratio, 5.12; P = 0.006) and within 90 days (hazard ratio, 1.87; P = 0.006) after arrival. Regarding the effect of a PLT in ICH patients with APA, no patient with PLT died. PLT had a survival benefit on patients with ICH, according to our analysis. Further prospective analysis is necessary to confirm the effects of PLT on survival in ICH with APA

Details of anti-platelet agents.

<p>Numerical variables are given as N (%).</p

Patient demographics and background characteristics.

<p>Numerical variates are given as N (%) and are compared with the</p><p>chi-square test or Fisher's exact test, as appropriate.</p><p>N.D.:not done.</p><p>ICH: intracerebral hemorrhage. APA: anti-platelet agents.</p><p>IVH: intraventricular hemorrhage.</p

Impact of platelet transfusion and patient factors on the mortality at day 7.

<p>CHD: coronary heart disease; PH of TIA: past history of transient ischemic attack; APA: anti-platelet agents; IVH: intraventricular hemorrhage.</p><p>ICH: intracerebral hemorrhage; PT: prothrombin time; aPTT: activated partial thromboplastin time; OR: odds ratio; CI: confidence interval.</p

Patient characteristics.

<p>Continous variables are presented as median (25, 75 percentile) and are compared using the Wilcoxon's test.</p><p>Elasped time: time at arrival at emergency treatment center minus estimated onset time.</p><p>aPTT: activated partial thromboplastin time. APA: anti-platelet agents.</p

Patient Characteristics.

<p>Continous variables are presented as median (25, 75 percentile) and are compared using the Wilcoxon's test.</p><p>Elasped time: time at arrival at emergency treatment center minus estimated onset time.</p><p>aPTT: activated partial thromboplastin time. APA: anti-platelet agents.</p