title: Autochthonous sporadic acute hepatitis E caused by two distinct subgenotype 3b hepatitis E virus strains with only 90% nucleotide identity.
abstract: Hepatitis E, which is caused by hepatitis E virus (HEV), is a public health concern in Japan, where the zoonotic food-borne transmission of HEV from domestic pigs and wild boars plays an important role. A 44-year-old Japanese man with autochthonous sporadic acute hepatitis E was admitted with general fatigue and moderate liver dysfunction. In the present study, two distinct HEV strains were recovered from the patient, who had consumed the raw or undercooked pig liver and intestine two or three times per week for 3 months before the disease onset. The recovered HEV strains were segregated into two clusters within subgenotype 3b, the open reading frame (ORF)1 and ORF2 sequences of which each showed ~10% difference, indicating HEV mixed infection. Because most notified patients with clinical HEV infection in Japan are diagnosed based on the detection of IgA-class HEV antibodies and because serum samples from only a limited number of HEV-infected patients are subjected to HEV RNA detection and nucleotide sequencing, it is very likely that patients with HEV mixed infection remain largely overlooked. The identification of sources of autochthonous HEV infection remains an important goal. Continued efforts to trace the sources of acute or chronic autochthonous HEV infection are warranted.
authors.affiliation: Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan. htakagi@kusunoki-hp.com.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Maruhashi
authors.affiliation: Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosone
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-Shi, Gunma, 371-8511, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-Shi, Gunma, 371-8511, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-Shi, Gunma, 371-8511, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nagashima
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan. hokamoto@jichi.ac.jp.
authors.forename: Hiroaki
authors.identifier: http://orcid.org/0000-0003-0827-0964
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000208:Acute Disease; D000328:Adult; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D001483:Base Sequence; D060085:Coinfection / Q000821:virology; D005516:Food Microbiology; D016751:Hepatitis E / Q000635:transmission / Q000821:virology*; D016752:Hepatitis E virus / Q000145:classification / Q000235:genetics* / Q000276:immunology; D006801:Humans; D008099:Liver / Q000821:virology; D008297:Male; D008460:Meat / Q000821:virology*; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood; D034421:Sus scrofa; D015047:Zoonoses / Q000635:transmission / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
keywords: Coinfection; Hepatitis E virus; Subgenotype 3b; Zoonosis