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Mahajan S, Tiwari SC, Kalra V, Bhowmik DM, Agarwal SK. Factors Affecting the use of Peritoneal Dialysis among the Esrd Population in India: A Single-Center Study. Perit Dial Int 2020. [DOI: 10.1177/089686080402400612] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectivesFactors such as limited health-care budget allotment and poor accessibility of the majority of the population to hemodialysis (HD) facilities should favor the use of peritoneal dialysis (PD) in India. However, only 6% of end-stage renal disease patients undergoing dialysis in India are on PD. We undertook this prospective study to evaluate various factors that could contribute to this low rate of use of PD at a tertiary-care state-run hospital in Northern India.MethodsAll the patients who entered our HD or PD program from August 2001 to December 2003 were interviewed using a preset questionnaire. The questionnaire recorded their basic disease and comorbidity, social and demographic characteristics, awareness of the various modalities of renal replacement therapy (RRT), and the reasons for choosing their present modality of therapy. Treating nephrologists were also interviewed with respect to the factors that, in their opinion, were responsible for the limited use of PD at our institute.ResultsIn total, 342 patients on HD, 66 patients on PD, and 24 nephrologists were interviewed. The rate of PD use was 16.2%. Mean age of patients on HD and PD was 34.6 ± 11.8 years and 62.9 ± 10.3 years respectively ( p < 0.0001). The incidence of diabetes mellitus and coronary artery disease in the HD and PD populations was 2.5% and 62.5%, and 9.1% and 46.7% respectively ( p < 0.0001 for both). Only 30.4% of patients on HD were aware of PD as a modality of RRT and 83.6% of them found PD to be expensive, 65.4% had low enthusiasm toward a domiciliary therapy such as PD, and 61.5% were not recommended PD by their nephrologist. Only 5 (7.6%) patients were initiated on PD directly, the remaining 61 patients were shifted from HD after a mean duration on HD of 185.3 ± 15.4 days: 67.1% were shifted due to poor tolerance of HD, 29.4% were advised to shift to PD because of comorbidity and vascular access problems, and only 3.3% took up PD because of the independent lifestyle it offered. None of the interviewed nephrologists routinely discussed PD in predialysis counseling. They found financial constraints (100%), lack of patient enthusiasm (100%), doubtful patient compliance (83.2%), and lack of an organized PD program (79.2%) to be the main factors limiting more widespread use of PD at our institute.ConclusionsPeritoneal dialysis is an underused modality of RRT at our institute. The patients who are taken up for PD at our institute are elderly and have a higher incidence of other comorbid conditions, such as diabetes mellitus and coronary artery disease. Also, most patients who switch to PD do so due to their unsuitability for HD rather than by their own choice. The factors contributing to this low rate of use of PD are ignorance of PD, increased cost of therapy, low enthusiasm toward domiciliary therapy, and lack of adequate infrastructure for PD at our institute. Effective predialysis counseling, reduction in the cost of the therapy, and development of an adequate infrastructure can increase the rate of use of PD.
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Affiliation(s)
- Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Suresh C. Tiwari
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vikram Kalra
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dipankar M. Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Fabrizi F, Lunghi G, Martin P. Treatment of HCV-related Liver Disease in the Dialysis Population: A Novel Challenge for Clinical Nephrologists. Int J Artif Organs 2018. [DOI: 10.1177/039139880102400602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- F. Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milan - Italy
| | - G. Lunghi
- Institute of Hygiene and Preventive Medicine, Maggiore Hospital, IRCCS, Milan - Italy
| | - P. Martin
- Liver Transplant Program, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA - USA
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Fabrizi F, Martin P, Lunghi G, Locatelli F. Membrane Compatibility, Flux and HCV Infection in Dialysis Patients: Newer Evidence. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- F. Fabrizi
- Nephrology and Dialysis Division, Maggiore Policlinico Hospital, IRCCS, Milano - Italy
- Division of Digestive Diseases and Dumont-UCLA Transplant Program, UCLA School of Medicine, Los Angeles, CA- USA
| | - P. Martin
- Division of Digestive Diseases and Dumont-UCLA Transplant Program, UCLA School of Medicine, Los Angeles, CA- USA
| | - G. Lunghi
- Institute of Hygiene and Preventive Medicine, Maggiore Policlinico Hospital, IRCCS, Milano
| | - F. Locatelli
- Nephrology and Dialysis Division, Hospital Lecco - Italy
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Fabrizi F, Martin P, Lunghi G, Ponticelli C. Nosocomial Transmission of Hepatitis C virus Infection in Hemodialysis Patients: Clinical Perspectives. Int J Artif Organs 2018. [DOI: 10.1177/039139880002301205] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F. Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital IRCCS, Milano - Italy
| | - P. Martin
- Division of Digestive Diseases and Dumont-UCLA Transplant Center, UCLA School of Medicine, Los Angeles, California - USA
| | - G. Lunghi
- Institute of Hygiene and Preventive Medicine, Maggiore Hospital IRCCS, Milano - Italy
| | - C. Ponticelli
- Division of Nephrology and Dialysis, Maggiore Hospital IRCCS, Milano - Italy
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Kwon E, Cho JH, Jang HM, Kim YS, Kang SW, Yang CW, Kim NH, Kim HJ, Park JM, Lee JE, Jung HY, Choi JY, Park SH, Kim CD, Kim YL. Differential Effect of Viral Hepatitis Infection on Mortality among Korean Maintenance Dialysis Patients: A Prospective Multicenter Cohort Study. PLoS One 2015; 10:e0135476. [PMID: 26263373 PMCID: PMC4532453 DOI: 10.1371/journal.pone.0135476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023] Open
Abstract
The role of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in terms of survival among dialysis patients remains incompletely understood. In the present multicenter prospective cohort study, we investigated the prevalences of HBV and HCV infection among 3,321 patients receiving maintenance dialysis in Korea, and assessed the impacts of these infections on survival. All included patients underwent hepatitis B antigen (HBsAg) and HCV antibody (Ab) testing, which revealed that 236 patients (7.1%) were HBsAg-positive, and 123 patients (3.7%) were HCV Ab-positive. HBsAg-positive and HCV Ab-positive patients were matched to hepatitis virus-negative patients using a propensity score at a ratio of 1:2. The prevalences of HBV and HCV infection did not significantly differ according to dialysis modality. Linear-by-linear association analysis revealed that hepatitis B prevalence significantly increased with increasing dialysis vintage (p = 0.001), and hepatitis C prevalence tended to be higher with increasing dialysis vintage (p = 0.074). We compared the survival of HBsAg-positive and HCV Ab-positive patients to that of hepatitis virus-negative patients. After propensity score matching, cumulative survival did not differ between HBsAg-positive and HBsAg-negative patients (p = 0.37), while HCV Ab-positive patients showed significantly lower survival than HCV Ab-negative patients (p = 0.03). The main conclusions of the present study are that HBV infection prevalence increased with longer dialysis vintage, and that both HBV and HCV infections were most prevalent among patients with the longest dialysis vintage. Additionally, HCV infection among maintenance dialysis patients is associated with an increased risk of mortality.
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Affiliation(s)
- Eugene Kwon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Hye Min Jang
- Department of Statistics, Kyungpook National University, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Chul Woo Yang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Hyun-Ji Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Jeung-Min Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Ji-Eun Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea
- BK21Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Korea
- * E-mail:
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Lezaic V, Stosovic M, Marinkovic J, Rangelov V, Djukanovic L. Hepatitis B and Hepatitis C Virus Infection and Outcome of Hemodialysis and Kidney Transplant Patients. Ren Fail 2009; 30:81-7. [DOI: 10.1080/08860220701742211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Töz H, Nart D, Turan I, Ersöz G, Seziş M, Aşçi G, Ozkahya M, Zeytinoğlu A, Erensoy S, Ok E. The acquisition time of infection: a determinant of the severity of hepatitis C virus-related liver disease in renal transplant patients. Clin Transplant 2009; 23:723-31. [PMID: 19573091 DOI: 10.1111/j.1399-0012.2009.01017.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to compare the clinical and histopathological course of HCV infection acquired before and during or after renal transplantation. METHODS According to HCV status, 197 RT patients were divided into three groups. At the time of RT, anti-HCV antibody was positive in 47 patients (pre-RT HCV group). In 27 patients, in whom anti-HCV negative at the time of RT, anti-HCV and/or HCV RNA was found to be positive following an ALT elevation episode after RT (post-RT HCV group). Both anti-HCV and HCV RNA were negative at all times in remaining 123 patients (control group). RESULTS Liver biopsy was performed in 31 of 47 patients in pre-RT and 24 of 27 in post-RT HCV group after RT. Duration of follow-up was similar in all groups with a mean of 7.1 +/- 4.0 yr. Ascites and encephalopathy were seen in only post-RT HCV group (22%). Histological grade (6.5 +/- 2.7 vs. 4.1 +/- 1.4) and stage (2.0 +/- 1.5 vs. 0.8 +/- 0.8) was significantly severe in post-RT HCV group (p < 0.01). Three patients died due to liver failure in post-RT HCV group. CONCLUSIONS HCV infection acquired during or after RT shows a severe and rapidly progressive clinicopathological course, which is significantly different from pre-transplant anti-HCV positive patients.
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Affiliation(s)
- H Töz
- Division of Nephrology, Ege University Medical School, Izmir, Turkey.
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Ahn YS, Lim HS. Occupational infectious diseases among Korean health care workers compensated with Industrial Accident Compensation Insurance from 1998 to 2004. INDUSTRIAL HEALTH 2008; 46:448-454. [PMID: 18840934 DOI: 10.2486/indhealth.46.448] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Using the database of the Korea Labor Welfare Corporation (KLWC), which is the public organization for workers' compensation in Korea, we analyzed the occupational infectious diseases among the health care workers who were compensated by the Industrial Accident Compensation Insurance (IACI). From January 1998 to December 2004, 307 cases of infectious diseases were approved as being cases of occupational diseases. Women accounted for 83% (254 cases) of the compensated cases. The most common age group was 20-29 yr of age (228 cases, 74.3%). The majority of infections were tuberculosis (203 cases, 66.1%), hepatitis (42 cases, 13.7%), chickenpox (11 cases, 3.6%), AIDS (8 cases, 2.6%) and scabies (7 cases, 2.3%). The major types of occupations were nurses, including 18 aid-nurses (223 cases, 72.6%), doctors (37 cases, 12.1%), clinical pathology technicians (18 cases, 5.9%) and workers who were taking care of patients (8 cases, 2.6%). The mean working duration after infection was 3.9 yr and the mean duration of recuperation was 9.7 months. The most common department where the infected workers were working was the inpatient ward (161 cases, 52.4%), followed by the intensive care unit (51 cases, 16.6%). Through this study, we were able to elucidate the characteristics of occupational infectious diseases among Korean health care workers. These results have to be considered when establishing the management policy for prevention of occupational infectious diseases among Korean health care workers. Also, all knowledge from these Korean cases will be helpful to make good practices to promote occupational safety and health in the new era of globalization.
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Affiliation(s)
- Yeon-Soon Ahn
- Department of Occupational Medicine, Dongguk University International Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773, Republic of Korea
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Selcuk H, Kanbay M, Korkmaz M, Gur G, Akcay A, Arslan H, Ozdemir N, Yilmaz U, Boyacioglu S. Distribution of HCV genotypes in patients with end-stage renal disease according to type of dialysis treatment. Dig Dis Sci 2006; 51:1420-5. [PMID: 16868830 DOI: 10.1007/s10620-005-9025-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 09/06/2005] [Indexed: 12/13/2022]
Abstract
The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.
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Affiliation(s)
- Haldun Selcuk
- Department of Gastroenterology, Baskent University School of Medicine, 35 sokak 81/5 Emek, Ankara 06490, Turkey
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Olut AI, Ozsakarya F, Dilek M. Seroprevalence of hepatitis C virus infection and evaluation of serum aminotransferase levels among haemodialysis patients in Izmir, Turkey. J Int Med Res 2006; 33:641-6. [PMID: 16372581 DOI: 10.1177/147323000503300605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The seroprevalence of hepatitis C virus (HCV) infection was investigated among haemodialysis (HD) patients. Mean serum aminotransferase levels were also compared over 3 months in HCV-seropositive patients with and without viraemia, as well as in HCV-seronegative HD patients and HCV-seropositive, non-uraemic, viraemic patients. Seroprevalence of HCV infection was 19% among the 437 HD patients tested. Of the 61 HD HCV-seropositive, hepatotoxic medication- and alcohol-free patients, 38 (62%) were found to be viraemic, using quantitative HCV-RNA, on at least one occasion. Mean serum aminotransferase levels were significantly higher in viraemic HD patients (compared with non-viraemic patients), suggesting that HCV-RNA positivity is an important predictor of increased enzyme activity in these patients. As expected, aminotransferase levels in HCV-seropositive HD patients tended to be lower than levels in HCV-seropositive non-uraemic patients.
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Affiliation(s)
- A I Olut
- Department of Infectious Diseases and Clinical Microbiology, Tepecik SSK Training Hospital, Izmir, Turkey.
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Adiloglu AK, Basak PY, Baysal V. Clinical evaluation of vitiligo and its relationship with viral hepatitis. J Eur Acad Dermatol Venereol 2003; 17:365-6. [PMID: 12702096 DOI: 10.1046/j.1468-3083.2003.00792_13.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fabrizi F, Lunghi G, Poordad FF, Martin P. Peritoneal dialysis and infection by hepatitis B and C virus. Int J Artif Organs 2003; 26:278-88. [PMID: 12757026 DOI: 10.1177/039139880302600402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- F Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milano, Italy.
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Zeytinoğlu A, Erensoy S, Abacioğlu H, Sayiner AA, Ozacar T, Başçi A, Kaplan H, Simmonds P, Bilgiç A. Nosocomial hepatitis C virus infection in a renal transplantation center. Clin Microbiol Infect 2002; 8:741-4. [PMID: 12445013 DOI: 10.1046/j.1469-0691.2002.00442.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nosocomial hepatitis C virus (HCV) infections were recorded in the renal transplantation unit of the university hospital. There were cases of acute HCV infection with aggressive clinical courses diagnosed from a positive HCV RNA test in the early post-transplantation period and which remained anti-HCV negative. Their anti-HCV seronegativity was attributed to them having acquired HCV under intense immunosuppressive therapy and suggested that the aggressive clinical course could be due to the deficient immune response resulting in an inability to limit viral replication. There were also donors diagnosed as having acute HCV infection in the early post-operative period. Genotyping and sequence analysis for HCV were performed on the isolates of eight of these patients who were consecutively transplanted and of three donors whose recipients were infected with HCV prior to transplantation, and who acquired acute HCV infection after transplantation. Of the eight recipients in the first group three were genotype 1a, three were genotype 1b, one was genotype 3a, and the last one was genotype 4 according to Simmond's classification. Of the three donor-recipient couples both the HCV isolates from one couple were genotyped as 1b and the phylogenetic analysis indicated that the patients were infected with a common variant of HCV, but the genotypes of HCV isolates from the other couples were different. Recipients were genotype 1b and the donors were genotype 1a in these couples. Genotype results of the first group and donor-recipient couples, and sequence analysis of genotype 1b and 1a isolates, showed that the source of infection was not a unique strain and there were multiple breaks in universal precautions while managing these patients.
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Affiliation(s)
- A Zeytinoğlu
- Department of Microbiology and Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey.
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