title: Molecular analysis of the interspousal transmission of hepatitis B virus in two Japanese patients who acquired fulminant hepatitis B after 50 and 49 years of marriage.
abstract: A 71-year-old (C1I) and 69-year-old (C2I) Japanese female contracted fulminant hepatitis B after 50 and 49 years of marriage, respectively. Both index cases exhibited high levels of anti-HBc IgM antibodies (24.2 and 31.5 S/CO, respectively), suggestive of acute hepatitis B virus (HBV) infection, although they had no discernible risk factors for HBV infection, except for chronically HBV-infected spouses with detectable HBV DNA (3.3 log copies/ml [C1S: 72-year-old] and 7.2 log copies/ml [C2S: 71-year-old]). The HBV genotype/subgenotype was identical in each couple (B/B1 or C/C2). The HBV isolates from the index cases and spouses shared a nucleotide sequence identity of 99.5% and 99.7%, respectively, over the entire genome, and these four isolates had the highest nucleotide sequence identity of only 97% to HBV isolates deposited in DNA databases. Phylogenetic trees confirmed a close relationship of the HBV isolates between C1I and C1S and between C2I and C2S, supported by a high bootstrap value of 100% within each couple, indicating the transfer of HBV infection between spouses. These four isolates shared a precore mutation of G1896A known to be associated with fulminant hepatitis B. Although the history of sexual contact within a reasonable incubation period was obscure for one stable, monogamous couple (C1I and C1S), the other couple had a monogamous sexual relationship within six months prior to disease onset. This study indicates that two elderly Japanese patients with fulminant hepatitis B acquired HBV infection via interspousal (most likely sexual) transmission during long-lasting marriages.
authors.affiliation: Department of Internal Medicine, Iwaki Kyoritsu General Hospital, Fukushima-Ken, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Okamoto
authors.forename: Haruo
authors.initials: H
authors.lastname: Nakayama
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ikeya
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nagashima
authors.forename: Masaharu
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sugai
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D005191:Family Characteristics; D005260:Female; D016679:Genome, Viral; D005838:Genotype; D006509:Hepatitis B / Q000473:pathology* / Q000635:transmission* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007564:Japan; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D017354:Point Mutation; D017422:Sequence Analysis, DNA; D017385:Sequence Homology
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D007075:Immunoglobulin M
keywords: entire genome; hepatitis viruses; phylogenetic analysis; precore mutant