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Zhou X, Peng A, Li C, Li L, Yao D, Hao Y, Zhao C, Yan Q, Li Y, Liu J, Liu S, Zhu W, Du Y, Zhang W. Combined central and peripheral demyelination: a case report resembling encephalomyeloradiculoneuropathy. Front Neurol 2024; 14:1288546. [PMID: 38292033 PMCID: PMC10825037 DOI: 10.3389/fneur.2023.1288546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Combined central and peripheral demyelination (CCPD) is an extremely rare disease characterized by inflammatory demyelination in both the central and peripheral nervous systems. Herein, we reported case of a 14-year-old teenager who initially presented with the symptoms of acute myelitis (AM). Subsequently, the patient developed symptoms consistent with Guillain-Barré syndrome (GBS), which was supported by nerve conduction studies (NCV) and cerebrospinal fluid (CSF) analysis. Throughout the course of the disease, the patient experienced abdominal pain and abnormal liver function. After a comprehensive evaluation, we determined that the abnormal liver function was a result of hepatitis E virus (HEV) infection, which may have acted as a trigger for GBS. The patient was treated with corticosteroids, intravenous immunoglobulin and Rituximab, resulting in symptom relief and clinical improvement after therapy and follow-up. This case highlights the potential responsiveness and reversibility of CCPD. Given the heterogeneous nature of CCPD, there is currently no standardized diagnostic criteria or clear consensus on its treatment. Therefore, we recommend a thorough assessment of all possibilities and the development of consolidated management guidelines based on available data for this disorder.
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Affiliation(s)
- Xuan Zhou
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Ali Peng
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Chuan Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Lin Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Dan Yao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Yunfeng Hao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Chao Zhao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Qi Yan
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Ying Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Juntong Liu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Shuyu Liu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Wenping Zhu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Ying Du
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Wei Zhang
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
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Yan T, Sakai Y, Terada K, Okano S, Kawasaki S, Kashiwagi T, Iwabu M. A Case of Hepatitis E Virus Infection: One of Differential Diagnosis of Liver Injury in Patients Undergoing Peritoneal Dialysis. Int Med Case Rep J 2022; 15:557-561. [PMID: 36245962 PMCID: PMC9562814 DOI: 10.2147/imcrj.s385393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are numerous causes of liver function disorder in patients undergoing peritoneal dialysis (PD). Infection with the Hepatitis E virus (HEV) is a rare cause of liver injury, and the behavior of HEV in patients with PD is unclear. Since patients undergoing dialysis are frequently polypharmatic, liver injury caused by HEV infection may be misdiagnosed as drug-induced liver injury. Case Presentation A 61-year-old woman with PD developed abrupt elevation of blood transaminase levels on a routine outpatient session. Since the patient has been receiving tolvaptan as the only new medication, we suspected tolvaptan induced liver injury. In further investigating the cause of liver injury, the blood screening test was found to be positive for HEV-IgA. The patient was diagnosed with HEV infection, and had a self-limited course. Conclusion When encountered with patients developing liver injury during PD, HEV infection should be included in the differential diagnosis.
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Affiliation(s)
- Tomohiro Yan
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukinao Sakai
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan,Correspondence: Yukinao Sakai, Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan, Tel +81-03-3822-2131, Fax +81-3-3822-4865, Email
| | - Kohsuke Terada
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Sho Okano
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Sayuri Kawasaki
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tetsuya Kashiwagi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masato Iwabu
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Behrendt P, Bremer B, Todt D, Steinmann E, Manns MP, Cornberg M, Wedemeyer H, Maasoumy B. Significant compartment-specific impact of different RNA extraction methods and PCR assays on the sensitivity of hepatitis E virus detection. Liver Int 2021; 41:1815-1823. [PMID: 33683813 DOI: 10.1111/liv.14870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/17/2020] [Accepted: 03/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND RNA detection in plasma/stool is the gold-standard for diagnosis of hepatitis E virus (HEV) infection. The impact of viral extraction methods on HEV RNA detection is poorly investigated. METHODS We determined the limit of detection of the RealStar HEV RT-PCR V2.0 Kit (altona Diagnostics, RS) utilizing 3 RNA extraction methods (COBAS® AmpliPrep Total Nucleic Acid Isolation Kit, TNAi Roche; MagNA Pure 96 DNA, Viral NA SV Kit, MgP; QIAamp Viral RNA mini Kit Qiagen; VRK) in plasma and stool. The most sensitive method was evaluated in a total of 307 longitudinal samples of patients with HEV infection (acute = 18/chronic = 36) and compared to results with the former diagnostic standard of our centre (TNAi/FastTrack Diagnostic; FTD). RESULTS The plasma-LOD was 49, 94 and 329 IU/mL for extraction with MgP, VRK and TNAi respectively. In stool, the LOD was 21 IU/mL, 528 IU/mL and indefinable for extraction with TNAi, VRK and MgP respectively. Utilizing longitudinal patient plasma samples, MgP/RS revealed 56 HEV RNA-positive samples in 158 negative samples as determined by TNAi/FTD. In stool, from 37 HEV negative samples (TNAi/FTD), 15 were positive with TNAi/RS. At end of treatment, 8 out of 27 chronically infected patients were RNA positive with MgP/RS, while classified negative with TNAi/FTD. A relapse occurred in 3 of these patients. CONCLUSION Different methods for RNA extraction and quantification have a significant, compartment-specific impact on the sensitivity of HEV detection. Knowledge about the favourable combinations of extraction and quantification has important implications for diagnosis and patients receiving antiviral therapy.
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Affiliation(s)
- Patrick Behrendt
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Institute of Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research, A Joint Venture Between the Medical School Hannover (MHH), and the Helmholtz Centre for Infection Research (HZI, ), Hannover, Germany.,German Centre for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany.,European Virus Bioinformatics Center (EVBC), Jena, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Michael Peter Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany.,Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany.,Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany.,Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
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Sayed IM, Seddik MI, Gaber MA, Saber SH, Mandour SA, El-Mokhtar MA. Replication of Hepatitis E Virus (HEV) in Primary Human-Derived Monocytes and Macrophages In Vitro. Vaccines (Basel) 2020; 8:E239. [PMID: 32455708 DOI: 10.3390/vaccines8020239] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022] Open
Abstract
HEV is the most causative agent of acute viral hepatitis globally. HEV causes acute, chronic, and extrahepatic manifestations. Chronic HEV infection develops in immunocompromised patients such as organ transplant patients, HIV-infected patients, and leukemic patients. The source of chronic HEV infection is not known. Also, the source of extrahepatic manifestations associated with HEV infection is still unclear. Hepatotropic viruses such as HCV and HBV replicate in peripheral blood mononuclear cells (PBMCs) and these cells become a source of chronic reactivation of the infections in allograft organ transplant patients. Herein, we reported that PBMCs and bone marrow-derived macrophages (BMDMs), isolated from healthy donors (n = 3), are susceptible to HEV in vitro. Human monocytes (HMOs), human macrophages (HMACs), and human BMDMs were challenged with HEV-1 and HEV-3 viruses. HEV RNA was measured by qPCR, the marker of the intermediate replicative form (ds-RNA) was assessed by immunofluorescence, and HEV capsid protein was assessed by flow cytometry and ELISA. HEV infection was successfully established in primary HMOs, HMACs, and human BMDMs, but not in the corresponding cells of murine origin. Intermediate replicative form (ds RNA) was detected in HMOs and HMACs challenged with HEV. The HEV load was increased over time, and the HEV capsid protein was detected intracellularly in the HEV-infected cells and accumulated extracellularly over time, confirming that HEV completes the life cycle inside these cells. The HEV particles produced from the infected BMDMs were infectious to naive HMOs in vitro. The HEV viral load was comparable in HEV-1- and HEV-3-infected cells, but HEV-1 induced more inflammatory responses. In conclusion, HMOs, HMACs, and human BMDMs are permissive to HEV infection and these cells could be the source of chronic and recurrent infection, especially in immunocompromised patients. Replication of HEV in human BMDMs could be related to hematological disorders associated with extrahepatic manifestations.
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Situ J, Wang W, Long F, Yang W, Yang C, Wei D, Yu W, Huang F. Hepatitis E viral infection causes testicular damage in mice. Virology 2019; 541:150-159. [PMID: 32056713 DOI: 10.1016/j.virol.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
Hepatitis E virus (HEV) is the main pathogen of hepatitis E infections with multiple extrahepatic replication sites. The presence of HEV RNA in the semen of infertile males suggests HEV replicates in the male genital tract. However, the mechanism is largely remained elusive. A BALB/c-based animal model was used to evaluate the effects of HEV infection on the testicular damage. HEV RNA was detected in feces, blood and livers from 7 to 28 days post-inoculation (dpi), while was positive in male genital tract from 7 to 70 dpi. Positive signals of HEV antigens were observed in testes, epididymides and seminal vesicles (SVs). Impaired sperm quality, destroyed the blood-testis barrier (BTB) and drastically decreased spermatogonia suggested that HEV infection causes testicular damage. Antiviral immune response was barely found in the testes. Results demonstrated that HEV replicates in male genital tract, causes testicular damage, and consequently results in flawed fertility.
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Affiliation(s)
- Jianwen Situ
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Wenjing Wang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Feiyan Long
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Weimin Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Chenchen Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Daqiao Wei
- Medical School, Kunming University of Science and Technology, Kunming, China.
| | - Wenhai Yu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
| | - Fen Huang
- Medical School, Kunming University of Science and Technology, Kunming, China.
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Baymakova M, Popov GT, Pepovich R, Tsachev I. Hepatitis E Virus Infection in Bulgaria: A Brief Analysis of the Situation in the Country. Open Access Maced J Med Sci 2019; 7:458-460. [PMID: 30834019 PMCID: PMC6390163 DOI: 10.3889/oamjms.2019.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND: Over the past two decades, more thorough investigations for hepatitis E virus (HEV) infection have been done in the world. Reports from Southeast European countries have increased. AIM: The current article presents a critical analysis of all studies for HEV in Bulgaria. MATERIAL AND METHODS: A literature search was done using available medical databases. We analysed the literature in PubMed databases and Bulgarian medical databases for English and Bulgarian languages sources. Preference was given to the sources published within the past 24 years (January 1995 – September 2018). RESULTS: Two thousand two hundred and fifty-seven blood serums were tested for the analysed period (1995 – 2018), and 13.1% of them were positive for acute HEV (Mean ± SD: 20.38 ± 25.77%; 95% CI: 1.29 – 39.47%). The following subtypes were established in the country – HEV Subtype 3e, HEV Subtype 3f, HEV Subtype 3c, HEV Subtype 3i, HEV Subtype 3hi and HEV Subtype 1. CONCLUSION: We hope that the National Health Organizations will take adequate and timely measures to increase the knowledge and research for HEV among Bulgarian citizens.
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Affiliation(s)
- Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Georgi T Popov
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Roman Pepovich
- Department of Infectious Pathology, Hygiene, Technology and Control of Foods from Animal Origin, Faculty of Veterinary Medicine, University of Forestry, Sofia, Bulgaria
| | - Ilia Tsachev
- Department of Microbiology, Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria
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Schultze D, Etter H, Mani B, Dollenmaier G. [Not Available]. Praxis (Bern 1994) 2016; 105:1313-1318. [PMID: 27805857 DOI: 10.1024/1661-8157/a002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Entgegen früherer Annahmen wird die Hepatitis-E-Virus(HEV)-Infektion nicht nur auf Auslandsreisen, sondern auch hierzulande durch kontaminierte Lebensmittel erworben, mit teilweise chronischen Verläufen und neurologischen Komplikationen. Insbesondere Ärzte, die immunsupprimierte Patienten betreuen, sollten HEV-Infektionen auf ihren «differenzialdiagnostischen Radar» nehmen, da chronische Verläufe mit fibrotischem Leberumbau einhergehen können und therapierbar sind.
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Abstract
Hepatitis E virus (HEV) is a viral pathogen transmitted primarily via fecal-oral route. In humans, HEV mainly causes acute hepatitis and is responsible for large outbreaks of hepatitis across the world. The case fatality rate of HEV-induced hepatitis ranges from 0.5 to 3% in young adults and up to 30% in infected pregnant women. HEV strains infecting humans are classified into four genotypes. HEV strains from genotypes 3 and 4 are zoonotic, whereas those from genotypes 1 and 2 have no known animal reservoirs. Recently, notable progress has been accomplished for better understanding of HEV biology and infection, such as chronic HEV infection, in vitro cell culture system, quasi-enveloped HEV virions, functions of the HEV proteins, mechanism of HEV antagonizing host innate immunity, HEV pathogenesis and vaccine development. However, further investigation on the cross-species HEV infection, host tropism, vaccine efficacy, and HEV-specific antiviral strategy is still needed. This review mainly focuses on molecular biology and infection of HEV and offers perspective new insight of this enigmatic virus.
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Affiliation(s)
- Yuchen Nan
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Northwest A&F UniversityYangling, China; Molecular Virology Laboratory, VA-MD College of Veterinary Medicine and Maryland Pathogen Research Institute, University of Maryland, College Park, College ParkMD, USA
| | - Yan-Jin Zhang
- Molecular Virology Laboratory, VA-MD College of Veterinary Medicine and Maryland Pathogen Research Institute, University of Maryland, College Park, College Park MD, USA
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van Tong H, Hoan NX, Wang B, Wedemeyer H, Bock CT, Velavan TP. Hepatitis E Virus Mutations: Functional and Clinical Relevance. EBioMedicine 2016; 11:31-42. [PMID: 27528267 PMCID: PMC5049923 DOI: 10.1016/j.ebiom.2016.07.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis E virus (HEV) infection is a major cause of acute hepatitis and affects more than 20 million individuals, with three million symptomatic cases and 56,000 recognized HEV-related deaths worldwide. HEV is endemic in developing countries and is gaining importance in developed countries, due to increased number of autochthone cases. Although HEV replication is controlled by the host immune system, viral factors (especially specific viral genotypes and mutants) can modulate HEV replication, infection and pathogenesis. Limited knowledge exists on the contribution of HEV genome variants towards pathogenesis, susceptibility and to therapeutic response. Nonsynonymous substitutions can modulate viral proteins structurally and thus dysregulate virus-host interactions. This review aims to compile knowledge and discuss recent advances on the casual role of HEV heterogeneity and its variants on viral morphogenesis, pathogenesis, clinical outcome and antiviral resistance. HEV causes acute hepatitis and recently comes into focus because of persistent infection in immunocompromised patients. HEV variability can be associated with clinical pathogenesis and transmission dynamics. Mutations in the HEV genome can influence HEV physiology and virus-host interaction. HEV mutations and variability are likely associated with fulminant hepatic failure and chronic hepatitis E. The Y1320H and G1634R/K mutations in the RdRp domain contribute to antiviral resistance through enhancing HEV replication.
We searched MEDLINE database and PubMed for articles from 1980 through June 30, 2016. Search terms used in various combinations were “hepatitis E”, “hepatitis E virus”, “hepatitis E virus infection”, “hepatitis E virus mutation”, “HEV variability”, “HEV genotype”, “HEV drug resistance”, “HEV replication” and “ribavirin”. Articles resulting from these searches and relevant references cited in those articles were selected based on their related topics and were reviewed. Abstracts and reports from meetings were also included. Articles published in English were included.
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Affiliation(s)
- Hoang van Tong
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Nghiem Xuan Hoan
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Bo Wang
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - C-Thomas Bock
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.
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Andonov A, Rock G, Lin L, Borlang J, Hooper J, Grudeski E, Wu J. Serological and molecular evidence of a plausible transmission of hepatitis E virus through pooled plasma. Vox Sang 2014; 107:213-9. [PMID: 24830322 DOI: 10.1111/vox.12156] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Recently, hepatitis E virus has been recognized as a new transfusion-associated risk; however, its efficiency of transmission through blood products requires further investigation. Asymptomatic viremia of short duration has been observed in blood donors from several European countries to the rate of <1:10,000 and HEV transmission in recipients of blood products has been documented in Japan and Europe. Although HEV RNA was detected in large plasma fractionation pools used for manufacturing of plasma derived products, HEV transmission has not been demonstrated so far. In this study, we investigated the possibility of HEV transmission in patients with thrombotic thrombocytopenic purpura whose treatment included up to 40 l of plasma exchange. MATERIALS AND METHODS Thirty-six TTP patients received either solvent-detergent-treated plasma prepared by pooling of 2500 single-donor or cryosupernatant plasma. Three samples were collected from TTP patients at time 0, 1 and 6 months post-treatment and tested for anti-HEV antibodies. Patients with HEV seroconversion were also tested for viremia by PCR. RESULTS Two of seventeen TTP patients treated with SDP showed serological evidence of HEV infection. The 1-month samples from these patients were also positive for HEV RNA. A distinct rise of anti-HEV IgG level was detected in two other TTP patients with weak pre-existing immunity to HEV; this observation is indicative of a possible immune response boost due to a breakthrough infection. CONCLUSION This work provides, for the first time, indirect evidence of HEV transmission by pooled plasma and warrants further studies.
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Affiliation(s)
- A Andonov
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada
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