title: Phylogenetic demonstration of hepatitis E infection transmitted by pork meat ingestion.
abstract: Hepatitis E virus (HEV) is responsible for a small number of acute hepatitis in developed countries. In this setting, HEV infection seems to be a zoonosis, although this has not been completely demonstrated. High morbidity and mortality associated with severe acute infections have been described, as well as the possible role of ribavirin therapy in those cases. We describe a case of acute hepatitis after pork meat ingestion in a patient with Waldeström macroglobulinemia with immunoglobulin A deficiency. Acute hepatitis E was diagnosed based on positive IgM anti-HEV antibodies and HEV RNA detected by real-time PCR. Because of clinical and analytical worsening, ribavirin was initiated, achieving sustained virologic response after 12 weeks of treatment. The phylogenetic analysis revealed the same HEV strain genotype 3 in both plasma and consumed meat samples, proving the zoonotic transmission. Regarding immunocompromised patients, acute hepatitis E can be associated to high morbidity and mortality rate, so dietetic recommendations may be needed to avoid the virus transmission.
authors.affiliation: *Liver Unit, Department of Internal Medicine ‡Departments of Biochemistry and Microbiology (Virology Unit), Vall d'Hebron Hospital, Autonomous University of Barcelona †Department of Microbiology, University of Barcelona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Riveiro-Barciela
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mínguez
authors.forename: Rosa
authors.initials: R
authors.lastname: Gironés
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Frías
authors.forename: Josep
authors.initials: J
authors.lastname: Quer
authors.forename: María
authors.initials: M
authors.lastname: Buti
mesh_terms: D000208:Acute Disease; D000368:Aged; D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005516:Food Microbiology; D005838:Genotype; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D016752:Hepatitis E virus / Q000187:drug effects / Q000235:genetics* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008460:Meat / Q000821:virology*; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood / Q000235:genetics*; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013552:Swine; D016896:Treatment Outcome; D015047:Zoonoses
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006508:Hepatitis Antibodies; D012367:RNA, Viral; D012254:Ribavirin