cWe describe a case of chronic hepatitis E virus (HEV) infection in a 13-year-old female liver transplant recipient with recurrent increased aminotransferase levels and acute cellular rejection. This finding demonstrates that chronic HEV infection can occur and should be further investigated in immunocompromised patients in Latin America. CASE REPORTA 4-year-old girl who had undergone orthotopic liver transplantation in 2003 presented with increased aminotransferase levels and biopsy-confirmed acute cellular rejection in 2006. Liver enzyme levels were normalized after 3 days of methylprednisolone pulse therapy and increased tacrolimus dosage. In 2009, the alanine aminotransferase concentration reached 715 IU per liter and thereafter plateaued at nearly 2.5 times the upper limit of the normal range. Acute cellular rejection was additionally confirmed by biopsy. Results of serology and molecular testing for hepatitis A virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and Epstein-Barr virus were negative. Results of molecular testing for cytomegalovirus and Epstein-Barr virus in liver tissue and testing for autoantibodies and antinuclear antibodies were also negative. Serum transaminase levels remained elevated, and in 2011, histological examination showed prominent inflammatory activity and fibrosis compatible with viral infection. Hepatitis E was diagnosed in February 2012 on the basis of positive results for anti-hepatitis E virus (HEV) IgG and IgM antibody testing (Mikrogen, Germany) and, later, in May 2013, HEV RNA detection (genotype 3b, Brazil h4; GenBank accession number KF152884), with a load of 4.5 log 10 copies per ml. The patient did not report any recent travel, and no potential route of HEV transmission other than consumption of pork was identified. The living organ donor tested negative for anti-HEV antibodies. No prior serum samples were available. However, retrospective examination of viral RNA extracted from paraffin-embedded formalin-fixed liver tissue (RNeasy FFPE kit; Qiagen, Germany) from 2009 showed the presence of HEV with Ͼ99% homology to the sequence found in the serum sample from 2013, thus characterizing chronic hepatitis E infection (Brazil h4.1; GenBank accession number KM502569). At the time of HEV RNA detection, the alanine aminotransferase concentration was 120 IU per liter. The patient received ribavirin treatment (500 mg/day) for 10 months, and her HEV RNA load became undetectable (Ͻ100 copies per liter) in August 2013.Infections caused by HEV can become chronic, with persistently elevated aminotransferase levels and persistent viremia in immunocompromised adults and children; certain chronic cases have been described in pediatric patients with HIV or hematological malignancies and in pediatric patients who have received solid-organ transplants (1-4).Increased levels of aminotransferases are frequently observed after solid-organ transplantation (5). In certain patients, after ruling out viral and alcohol-, toxin-, and drug-related causes, no etiology is established. I...

Brazil has been classified as moderately endemic for hepatitis E virus (HEV) infection. However, data on the seroprevalence of HEV in this region are limited. This study evaluated the prevalence of past or present HEV infection among blood donors in the metropolitan area of Itajai Valley, Southern Brazil, a region of predominant German heritage, where cultural habits result in a high consumption of pork. Serum samples from 300 blood donors were tested in December 2014 using serological and molecular methods. Anti-HEV IgG antibodies were detected in 30 (10%) subjects, and categorized age groups revealed an age-dependent increase of HEV seroprevalence. Only one subject had anti-HEV IgM, whereas none tested positive for HEV-RNA. The present data demonstrate a higher seroprevalence of anti-HEV IgG in blood donors than previously reported in Brazil.

Brazil is a non-endemic country for hepatitis E virus (HEV) infection with seroprevalence from 1% to 4% in blood donors and the general population. However, data on seroprevalence of HEV in the country are still limited. This study evaluated the prevalence of past or present HEV infection in a group of blood donors representative of the general population of the city of Sao Paulo, Southeastern Brazil. Serum samples from 500 blood donors were tested from July to September 2014 by serological and molecular methods. Anti-HEV IgG antibodies were detected in 49 (9.8%) subjects and categorized age groups revealed an age-dependent increase of HEV seroprevalence. Among the anti-HEV IgG positive subjects, only 1 had anti-HEV IgM while none tested positive for HEV-RNA. The present data demonstrate a higher seroprevalence of anti-HEV IgG than previously reported in the region.

Introduction: Data on hepatitis E virus (HEV) in Brazil are limited. We analyzed 15 years of HEV surveillance data in a major clinical laboratory in São Paulo, Brazil. Methods: The seroprevalence of HEV of 2,271 patients subjected to anti-HEV tests from 1998 to 2013 were analyzed. Results: HEV seroprevalence was 2.1%, and the anti-HEV IgM positivity rate was 4.9%.Six hepatitis E patients were identifi ed. Conclusions: HEV seroprevalence and detection rates appear to have increased in recent years. Hepatitis E should be investigated further and included in the differential diagnosis of hepatitis in Brazil.

Hepatitis E virus is responsible for acute and chronic liver infections worldwide. Swine hepatitis E virus has been isolated in Brazil, and a probable zoonotic transmission has been described, although data are still scarce. The aim of this study was to investigate the frequency of hepatitis E virus infection in pigs from a small-scale farm in the rural area of Paraná State, South Brazil. Fecal samples were collected from 170 pigs and screened for hepatitis E virus RNA using a duplex real-time RT-PCR targeting a highly conserved 70 nt long sequence within overlapping parts of ORF2 and ORF3 as well as a 113 nt sequence of ORF2. Positive samples with high viral loads were subjected to direct sequencing and phylogenetic analysis. hepatitis E virus RNA was detected in 34 (20.0%) of the 170 pigs following positive results in at least one set of screening real-time RT-PCR primers and probes. The swine hepatitis E virus strains clustered with the genotype hepatitis E virus-3b reference sequences in the phylogenetic analysis and showed close similarity to human hepatitis E virus isolates previously reported in Brazil.