title: Toga-like virus as a cause of fulminant hepatitis attributed to sporadic non-A, non-B.
abstract: Virus-like particles (60-70 nm) with spiked surfaces budding into cell vacuoles and rod-shaped inclusions were detected in nuclei of hepatocytes from a British patient transplanted for sporadic non-A, non-B fulminant hepatitis (NANB-FHF), probably contracted in Kenya. Identical particles were seen in two successive grafts (days 2 and 10) at regrafting for recurrent FHF. Ultrastructural features resembled those of the RNA-containing arbovirus, Rift Valley fever virus, but serological markers against a representative panel for arboviruses (Togaviruses) and transmission in mice proved negative. The particles shared features with the different arboviruses seen in the hepatectomy specimen of a second patient with NANB-FHF, and in both patients an insect vector was implicated in the clinical history. The particles were identical in size to those of a third patient with NANB-FHF, who had remained in the United Kingdom. These findings, together with the recent report of isolation of an RNA-containing virus resembling the Togaviridae, in parenteral NANB, suggest that several exotic virus-like agents resembling the arboviruses may be involved in the aetiology of NANB, including in the sporadic forms of FHF in the United Kingdom.
authors.affiliation: Liver Unit, King's College Hospital, Denmark Hill, London, England.
authors.forename: E A
authors.initials: EA
authors.lastname: Fagan
authors.forename: D S
authors.initials: DS
authors.lastname: Ellis
authors.forename: G M
authors.initials: GM
authors.lastname: Tovey
authors.forename: G
authors.initials: G
authors.lastname: Lloyd
authors.forename: B
authors.initials: B
authors.lastname: Portmann
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: A J
authors.initials: AJ
authors.lastname: Zuckerman
mesh_terms: D000293:Adolescent; D000956:Antigens, Viral / Q000276:immunology; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006525:Hepatitis, Viral, Human / Q000209:etiology*; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D008099:Liver / Q000382:microbiology / Q000473:pathology / Q000648:ultrastructure; D016031:Liver Transplantation; D012698:Serologic Tests; D014035:Togaviridae / Q000276:immunology / Q000302:isolation & purification* / Q000648:ultrastructure
chemical_list: D000956:Antigens, Viral; D007075:Immunoglobulin M