Fulminant reactivation of hepatitis B due to envelope protein mutant that escaped detection by monoclonal HBsAg ELISA.
The detection of a fatal case of reactivation of hepatitis B, in a previously vaccinated Indonesian patient after withdrawal of chemotherapy for lymphoma, was delayed because HBsAg was negative in a widely used monoclonal-antibody-based ELISA. The serum was later found to be strongly reactive for HBsAg by the polyclonal radioimmunoassay and for HBV DNA. PCR sequencing revealed a substitution of arginine for glycine at position 145 of HBsAg in the major neutralising epitope cluster, the a determinant, as well as a 2-aminoacid insertion of asparagine and threonine between positions 122 and 123, immediately upstream of this determinant.
Carman
W F
WF
Institute of Virology, University of Glasgow.
Korula
J
J
Wallace
L
L
MacPhee
R
R
Mimms
L
L
Decker
R
R
D000595:Amino Acid Sequence; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D016174:Hepacivirus / Q000276:immunology; D006508:Hepatitis Antibodies / Q000302:isolation & purification; D006509:Hepatitis B / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000235:genetics* / Q000302:isolation & purification; D006515:Hepatitis B virus / Q000235:genetics* / Q000276:immunology; D018937:Hepatitis C Antibodies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D016133:Polymerase Chain Reaction; D014759:Viral Envelope Proteins / Q000235:genetics
D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D014759:Viral Envelope Proteins