The First Report of Coxiella burnetii as a Potential Neglected Pathogen of Acute Hepatitis of Unknown Causes in Egypt

Epidemiological and molecular survey of Coxiella burnetii from the serum of patients suspected of brucellosis in west of Iran

Q fever is a global bacterial disease that affects both humans and animals. The etiological agent of the disease is Coxiella burnetii. The aim of the investigation was to detect the existence of C. burneti in the serum samples of patients with symptoms of fever and suspicion of brucellosis in the west of Iran. In the current survey, 150 Wright agglutination assay were collected from health centers in Lorestan, Hamadan, Ilam, Kermanshah, and Kurdistan provinces in 2023. DNA was extracted from all these samples, which were taken from individuals suspected of having brucellosis. Then, a nested PCR reaction was applied to diagnose C. burnetii for the transposon gene IS1111. The IS1111 gene replication assays, indicated that 3.3 % (95 % CI: 1.43 %-3.33 %) of the tested serum samples, were positive for C. burnetii. The highest prevalence of C. burnetii infection was found in the Kurdistan province at 6.67 % (95 % CI: 1.85 %-21.33 %). Additionally, a high affinity (ranging from 99 % to 100 %) was recognized among the IS1111 gene sequenced in the present study and those from different area around the world. These results provide strong evidence that individuals with brucellosis in west of Iran may also have C. burnetii co-infection with coxiellosis. Therefore, it is important to consider Q fever as a co-infection in patients suspected of brucellosis.

Emerging Pathogens Causing Acute Hepatitis

Acute hepatitis is defined as an inflammation or injury in the hepatocytes that continues for a short period of time (less than 6 months) [...].

Evidence of a Link between Hepatitis E Virus Exposure and Glomerulonephritis Development

Viruses can trigger glomerulonephritis (GN) development. Hepatitis viruses, especially Hepatitis C virus and Hepatitis B viruses, are examples of the viruses that trigger GN initiation or progression. However, the proof of a correlation between GN and Hepatitis E virus infection is not clear. Some studies confirmed the development of GN during acute or chronic HEV infections, mainly caused by genotype 3. While others reported that there is no relation between HEV exposure and GN development. A recent study showed that a reduced glomerular filtration rate was developed in 16% of acute HEV genotype 1 (HEV-1) infections that returned to normal during recovery. HEV-1 is endemic in Egypt with a high seroprevalence among villagers and pregnant women. There is no available data about a link between HEV and GN in Egypt.

METHODS

GN patients (n = 43) and matched healthy subjects (n = 36) enrolled in Assiut University hospitals were included in this study. Blood samples were screened for hepatotropic pathogens. Tests for HEV markers such as HEV RNA and anti-HEV antibodies (IgM and IgG) were performed. Laboratory parameters were compared in HEV-seropositive and HEV-seronegative GN patients.

RESULTS

Anti-HEV IgG was detected in 26 (60.5%) out of 43 GN patients. HEV seroprevalence was significantly higher in GN than in healthy controls, suggesting that HEV exposure is a risk factor for GN development. None of the GN patients nor the healthy subjects were positive for anti-HEV IgM or HEV RNA. There was no significant difference between seropositive and seronegative GN patients in terms of age, gender, albumin, kidney function profiles, or liver transaminases. However, anti-HEV IgG positive GN patients had higher bilirubin levels than anti-HEV IgG negative GN patients. HEV-seropositive GN patients had a significantly elevated AST level compared to HEV-seropositive healthy subjects.

CONCLUSION

exposure to HEV infection could be complicated by the development of GN.

Human-biting ticks and zoonotic tick-borne pathogens in North Africa: diversity, distribution, and trans-Mediterranean public health challenges

North Africa is home to more than 200 million people living across five developing economies (Egypt, Libya, Tunisia, Algeria, and Morocco) and two Spanish exclaves (Ceuta and Melilla), many of whom are impacted by ticks and tick-borne zoonoses. Populations in Europe are also increasingly vulnerable to North African ticks and tick-borne zoonoses due to a combination of climate change and the movement of ticks across the Mediterranean on migratory birds, human travellers, and trafficked wildlife. The human-biting ticks and tick-borne zoonoses in North Africa are reviewed along with their distribution in the region. We also assess present and future challenges associated with ticks and tick-borne zoonoses in North African and highlight opportunities for collaboration and coordination between governments in Europe and North Africa to address public health challenges posed by North African ticks and tick-borne zoonoses.

First Report on Abnormal Renal Function in Acute Hepatitis E Genotype 1 Infection

Impaired renal functions have been reported with Hepatitis E virus (HEV) infections, especially with genotypes 3 and 4. These complications were reported during the acute and chronic phases of infection. HEV genotype 1 causes acute infection, and the effect of HEV-1 infections on renal functions is not known. We examined the kidney function parameters in the serum of HEV-1 patients (AHE, n = 31) during the acute phase of infection. All of the included patients developed an acute self-limiting course of infection, without progression to fulminant hepatic failure. We compared the demographic, laboratory, and clinical data between AHE patients with normal kidney function parameters and those with abnormal renal parameters. Out of 31 AHE patients, 5 (16%) had abnormal kidney function tests (KFTs) during the acute phase of infection. Three patients had abnormal serum urea and creatinine, and two patients had either abnormal urea or creatinine. Four out of five patients had an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m². AHE patients with abnormal KFTs were older and had a lower level of albumin, but a slightly elevated alanine transaminase (ALT) compared to AHE patients with normal KFTs. There were no significant differences between the two groups in terms of age, sex, liver transaminase levels, and the viral load. Similarly, the clinical presentations were comparable in both groups. Interestingly, these KFTs in patients with abnormal renal parameters returned to normal levels at the recovery. The serum creatinine level was not correlated with patients' age or liver transaminase levels, but it was significantly negatively correlated with albumin level. In conclusion, this study is the first report that evaluated KFTs in patients during the acute phase of HEV-1 infections. Impaired KFTs in some AHE patients resolved at convalescence. KFTs and renal complications should be monitored during HEV-1 infections.