| Resum: |
Hepatitis E virus (HEV) is a non-enveloped single stranded RNA virus member of the Hepeviridae family and genus Orthohepevirus, which is a common cause of acute hepatitis worldwide and, in high-risk groups, can develop into a chronic infection. An epidemiological study of the from Hospital Universitari Vall d'Hebron (HUVH) HEV Data Base was carried out to study which is the most probable source of infections, risk factors, and diagnosis confidence test based on clinical data. Our results suggest that there HEV infection is associated with old age and/or immunocompromised status. A deeper analysis should be performed. Interestingly, our results show that HEV subtyping diagnosis classification should be improved, especially to classify HEV genotypes 3 infected patients. Sliding windows analysis was used to identify a short region of 400 nucleotides able to confidently classify genotype 3 genomes into subtypes. From the clinical analysis, we identified an HEV food-borne infected patient who got infected in 2012 and developed a long-lasting chronic infection having still HEV-RNA positive detection in 2017 samples. Surprisingly, this patient had HEV-RNA serum negativization periods (between 2014-2015). To study whether this patient had got multiple infections or whether it was the result of reactivation of the original infection, a sample from 2012 before starting Ribavirin treatment (pre-treatment) and a sample obtained in 2016 (post-treatment) were compared using Next Generation Sequencing (NGS). Reactivation of the original infection was demonstrated by phylogenetic and genetic distance studies. This result has important clinical implications, since any patient that develop a chronic infection, despite negativization of circulating HEV-RNA in serum sample, should be followed up for several months or years with highly sensitive test before assuring that HEV infection has been completely resolved. Also, one described resistance-variant was observed and a list of variants were identificated in pre-ttm and post-ttm samples. This study is a translational study which has a clinical relevance and which opens new lines of research for new future projects. |
visitant ::
identificació
