title: Persistent hepatitis e virus genotype 4 infection in a child with acute lymphoblastic leukemia.
abstract: BACKGROUND
  In general, the hepatitis E virus (HEV) causes acute, self-limiting hepatitis. Prolonged and chronic infections caused by HEV genotype 3 have been found in some immunosuppressed patients in developed countries.
  
  
  METHODS
  Here we report a Chinese boy with acute lymphoblastic leukemia, who developed hepatitis E during a period of intensive chemotherapy. Twenty months after the initial infection, HEV viremia was reappeared in the patient, with detectable anti-HEV IgM and IgG and modestly elevated serum transaminases. Sequence analysis of the viral RNAs revealed the reactivation of the HEV genotype 4d strain, indicating viral persistence in the patient.
  
  
  CONCLUSIONS
  To our knowledge, this is the first chronic case confirmed by the prolonged presence of HEV RNA in china. It is also the first reported persistent hepatitis E infection caused by HEV genotype 4.
authors.affiliation: Health Science Center, Hebei University, Baoding, China.
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Geng
authors.affiliation: Health Science Center, Hebei University, Baoding, China.
authors.forename: Hongxin
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Division of HIV/AIDS and Sex-Transmitted Virus Vaccines, National Institutes for Food and Drug Control, Tiantanxili, Beijing, China.
authors.forename: Weijin
authors.initials: W
authors.lastname: Huang
authors.affiliation: Division of Medicine, University College London Medical School, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: J Harrison
authors.affiliation: Baoding Hospital for Infectious Disease, Baoding, China.
authors.forename: Kunjing
authors.initials: K
authors.lastname: Geng
authors.affiliation: Affiliate Beijing You'an Hospital, Capital University of Medical Sciences, Hepatitis Institute of Beijing Municipal Health Bureau, Beijing, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of HIV/AIDS and Sex-Transmitted Virus Vaccines, National Institutes for Food and Drug Control, Tiantanxili, Beijing, China.
authors.forename: Youchun
authors.initials: Y
authors.lastname: Wang
keywords: Chronic Hepatitis; Hepatitis E virus; Persistent Infection; Precursor Cell Lymphoblastic Leukemia-Lymphoma