Short communicationIdentifications of polyphyletic variants in acute hepatitis suggest an underdiagnosed circulation of hepatitis E virus in Argentina
Section snippets
Background
Hepatitis E virus (HEV) is the only member of the genus Hepevirus in the family Hepeviridae.1 In low endemic regions, imported and autochthonous sporadic hepatitis E cases have been reported, and the close genetic relationship between swine and human variants strongly suggests their zoonotic spread.2, 3, 4, 5
Although seroprevalence of antibodies to HEV (anti-HEV) has been determined in different population groups in Latin America, and although IgM anti-HEV in acute hepatitis has been found in
Objective
This study was conducted to serologically diagnose and molecularly characterize new cases of hepatitis E in patients in Argentina.
Study population
Samples (sera and feces) from 76 adults (52% female, median age: 40 years; range: 18–74) and 155 children (55% female, median age: 7.3 years) with acute non-A-C hepatitis, referred from hospitals located both in Buenos Aires and environs and in certain Argentine provinces, were studied at the National Reference Laboratory for viral hepatitis from January 2005 to December 2010.
Additional samples from 15 children with fulminant liver failure (FHF) and hepatitis A (8 female, median age: 7.5 years)
Results
During the six-year period studied, fifteen patients (13 adults and 2 children) were diagnosed with acute hepatitis E. Seven required hospitalization due to its severity. Additional information on patients is summarized in Table 1; where patients acquired the infection is indicated in Fig. 1.
Nine cases were nested RT-PCR HEV RNA-positive for the ORF 2 region. In five of them, an ORF1 fragment was also sequenced. The lower sensitivity for ORF 1 has been previously reported.18, 19
The genotype and
Discussion
The above results show that HEV has continued circulating in Argentina during the last six years. The different subgenotypes and polyphyletic variants found suggest multiple sources of infection.
Subgenotype 3i, the first described in humans and swine in Argentina, is still circulating. In this study, we found this subgenotype not only in Buenos Aires, but also in the province of Mendoza (center-west). The precedent of having traveled abroad would support the assumption of an imported case when
Conflict of interest statement
None.
Acknowledgments
We thank to Drs Fainboin, Schroder, Paz and Estepo from Hospital Muñiz, Drs Ciocca and Cuarterolo from Hospital Garrahan, Drs Alessio and Frider from Hospital Argerich, Drs Bonacci and Gadano from Hospital Italiano, Drs Gruz and Descalzi from Fundación Favaloro, Drs Martínez and Poncino from Sanatorio Méndez, and Drs Espul and Vicente from Mendoza.
Special thanks are given to the “Red Iberoamericana para la Investigación de la Hepatitis E (RIHEPE)” and to Dr José Manuel Echevarría.
References (29)
- et al.
An emerging awareness of an old disease
J Hepatol
(2008) - et al.
Acute hepatitis E in south-west France over a 5-year period
J Clin Virol
(2009) - et al.
Serological and molecular evidence of hepatitis E virus in swine in Brazil
Vet J
(2009) - et al.
First report of a human autochthonous hepatitis E virus infection in Brazil
J Clin Virol
(2010) - et al.
First report of an autochthonous Hepatitis E virus genotype 3 infection in a 5 month old female child in Germany
J Clin Virol
(2011) - et al.
Acute hepatitis E: a cause of lymphocytic destructive cholangitis
Hum Pathol
(2005) - et al.
Differential diagnosis of hepatitis E virus, cytomegalovirus and Epstein-Barr virus infection in patients with suspected hepatitis E
J Clin Virol
(2009) - et al.
Diagnosis of acute hepatitis E by antibody and molecular testing: a study on 277 suspected cases
J Clin Virol
(2011) - et al.
Epidemiology of hepatitis E: current status
J Gastroenterol Hepatol
(2009) - et al.
Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease
Eur J Gastroenterol Hepatol
(2008)
Imported and autochthonous hepatitis E virus strains in Spain
J Med Virol
Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba 1998–2003
J Med Virol
Hepatitis E virus genotype 1, Cuba
Emerg Infect Dis
Identification of 2 novel isolates of hepatitis E virus in Argentina
J Infect Dis
Cited by (19)
Serologic evidence of the circulation of the hepatitis E virus and the prevalence of antibodies against hepatitis A in an indigenous population in northern Argentina
2021, Revista Argentina de MicrobiologiaCitation Excerpt :Otherwise, the presumptive diagnosis of such patients is idiopathic hepatotoxicity. Detection of HEV RNA in 15.8% of patients with acute non-A non-B hepatitis evidenced circulation of the virus in central Argentina36 (Table 1). Further, the virus was detected in rivers and sewage samples in 2013 in the central region of Argentina during an environmental surveillance study32.
Acute hepatitis E virus infection and association with a subacute thyroiditis
2015, Annals of HepatologyCitation Excerpt :Both of them showed a homology of 92 to 94% with human and swine 3a variants from Japan. The homology with other human HEV 3a variants characterized in Argentina varied between 72 and 85%.8 The patient had spontaneous improvement with a gradual decrease in the symptoms.
First detection of hepatitis E virus in Central Argentina: Environmental and serological survey
2014, Journal of Clinical VirologyCitation Excerpt :Even though ORF-2 region has been extensively studied to infer phylogenetic relationships among HEV genotypes and subtypes [30–32], phylodynamic and coalescent studies among this region has been recently reported [12,29,33,34]. Detection of subtypes 3a and 3b agrees with subtypes previously detected in clinical samples from Argentinean patients [10]. Subtype 3c had not been previously described in our region.
Updating the knowledge of hepatitis E: New variants and higher prevalence of anti-HEV in Argentina
2014, Annals of HepatologyCitation Excerpt :This is in agreement with those previously characterized in Buenos Aires province in 2002.11 Swine subgenotypes 3a or 3b HEV variants that relate to the human ones that have been found in Argentina since 2004 have not yet been detected.8 Many studies have demonstrated HEV RNA in the pork chain food, seafood and crops.1,2,24,26