BackgroundHepatitis A virus (HAV) and hepatitis E virus (HEV) are both transmitted by the faecal-oral route, and represent common causes of acute hepatitis in developing countries. The endemicity of HAV infection has shifted from high to moderate in Brazil. Human cases of HEV infection seem to be rare, although the virus has been detected in swine livestock and effluents of slaughterhouses. This study was to determine the epidemiology of hepatitis A and E in one of the largest agricultural settlements in the Amazon Basin of Brazil.MethodsSerum samples collected from 397 individuals aged between 5 and 90 years during a population-based cross-sectional survey were tested for anti-HAV and anti-HEV antibodies. Associated risk factors and spatial clustering of HAV and HEV seropositivity were also analyzed.ResultsThe overall rate of HAV seropositivity was 82.9% (95% confidence interval (CI), 79.2-86.6%). Multilevel logistic regression analysis identified increasing age (in years; odds ratio (OR), 1.097; 95% CI, 1.050-1.147; P < 0.001) and crowding (OR, 1.603; 95% CI, 1.054-2.440; P = 0.028) as significant risk factors for HAV seropositivity. Anti-HEV IgG was detected in 50/388 settlers (12.9%, 95% CI, 9.5-16.2%). Anti-HEV IgM was detected in 7/43 (16.3%) anti-IgG positive samples, and 4 of them had a confirmed result by immunoblot. Increasing age was the only significant determinant of HEV seropositivity (OR, 1.033; 95% CI, 1.016-1.050; P < 0.001). No significant spatial clustering of HAV and HEV seropositivity was detected in the area.ConclusionsBoth HAV and HEV are endemic, with differing rates of infection in children and adults in this rural setting of the Brazilian Amazon. Anti-HEV prevalence was considerably higher than those previously reported in Brazil. The detection of HEV- specific IgM antibodies in four asymptomatic individuals is highly suggestive of the circulation of HEV in this rural population.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-458) contains supplementary material, which is available to authorized users.

Hepatitis E is an infectious disease which virus (HEV) is highly disseminated in swine herd populations. Sporadic acute human hepatitis E cases have been associated to genotype 3 and 4 strains of HEV also reported in swine populations of endemic and non-endemic areas. With the aim to evaluate the incidence of animals with current infection of HEV, 115 bile samples were collected from three slaughterhouses under inspection by Animal Sanitary Protection Agency of Rio de Janeiro, Brazil. In parallel, effluent samples were collected from six sewage pipe exit sites of two slaughterhouses. HEV RNA was detected in 11 out of 115 (9.6%) bile samples collected and three waste samples from one slaughterhouse. Viral loads observed for bile samples varied from 10(1)-10(5) genome copies/mL and for effluent samples mean load was 10(2) genome copies/mL. Sequencing and phylogenetic analysis classified samples within genotype 3 subtype 3b closely related to the sample obtained from the first reported autochthonous human case and samples from swine of commercial herds in Brazil. Our data demonstrates that although most animals achieve slaughter age (around 20 weeks old) already immune to HEV, a significant number of animals are with current infection at commercial age. Further studies should be addressed to consider risk analysis and possible evaluation of inspection regulations considering food safety measures regarding hepatitis E zoonotic aspect in Brazil.

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A recent report has described the molecular cloning and characterization of a novel, single-stranded DNA virus, named TT virus (TTV), which was present in the sera of Japanese patients with posttransfusion hepatitis of unknown etiology [Okamoto et al. (1998) Hepatology Research 10:1-16]. Using a nested polymerase chain reaction assay, sera from Brazilian patients with acute non A-C hepatitis and blood donors were examined for the presence of TTV DNA sequences. Thirty-seven of 52 (71%) patients with acute non A-C hepatitis and 45 of 72 (62%) blood donors were found to have TTV sequences in their sera. Such a high proportion in blood donors indicated that TTV infection is common in the general Brazilian population. Partial nucleotide sequences (326 bases in open reading frame 1) from seven isolates were determined. By phylogenetic analysis, four TTV strains were classified into the genomic subgroup G1a described previously. The three others belonged to subgroup G1b. Sequence homologies between strains belonging to a same subgroup were 92.9-99.1%, whereas homologies of 85.9-90.2% were calculated between isolates from different subgroups.

Epidemiological studies found that hepatitis E virus genotype 3 (HEV-3) infection was associated with chronic hepatitis and cirrhosis in immunocompromised patients. Our study aimed to investigate the relationship between the host immunosuppressive status and the occurrence of HEV-related chronic hepatitis. Here we describe a successful experimental study, using cynomolgus monkeys previously treated with tacrolimus, a potent calcineurin inhibitor immunosuppressant, and infected with a Brazilian HEV-3 strain isolated from naturally infected pigs. HEV infected monkeys were followed up during 160 days post infection (dpi) by clinical signs; virological, biochemical and haematological parameters; and liver histopathology. The tacrolimus blood levels were monitored throughout the experiment. Immunosuppression was confirmed by clinical and laboratorial findings, such as: moderate weight loss, alopecia, and herpes virus opportunistic infection. In this study, chronic HEV infection was characterized by the mild increase of liver enzymes serum levels; persistent RNA viremia and viral faecal shedding; and liver histopathology. Three out of four immunosuppressed monkeys showed recurrent HEV RNA detection in liver samples, evident hepatocellular ballooning degeneration, mild to severe macro and microvesicular steatosis (zone 1), scattered hepatocellular apoptosis, and lobular focal inflammation. At 69 dpi, liver biopsies of all infected monkeys revealed evident ballooning degeneration (zone 3), discrete hepatocellular apoptosis, and at most mild portal and intra-acinar focal inflammation. At 160 dpi, the three chronically HEV infected monkeys showed microscopic features (piecemeal necrosis) corresponding to chronic hepatitis in absence of fibrosis and cirrhosis in liver parenchyma. Within 4-months follow up, the tacrolimus-immunosuppressed cynomolgus monkeys infected with a Brazilian swine HEV-3 strain exhibited more severe hepatic lesions progressing to chronic hepatitis without liver fibrosis, similarly as shown in tacrolimus-immunosuppressed solid organ transplant (SOT) recipients. The cause-effect relationship between HEV infection and tacrolimus treatment was confirmed in this experiment.

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BackgroundHepatitis E virus (HEV) has been described as an emerging pathogen in Brazil and seems to be widely disseminated among swine herds. An autochthonous human case of acute hepatitis E was recently reported. To obtain a better understanding of the phenotypic profiles of both human and swine HEV strains, a experimental study was conducted using the animal model, Macaca fascicularis.MethodsSix cynomolgus monkeys (Macaca fascicularis) were inoculated intravenously with swine HEV genotype 3 that was isolated from naturally and experimentally infected pigs in Brazil and the Netherlands. Two other monkeys were inoculated with HEV genotype 3 that was recovered from Brazilian and Argentinean patients with locally acquired acute and fulminant hepatitis E. The haematological, biochemical, and virological parameters of all animals were monitored for 67 days.ResultsSubclinical hepatitis was observed in all monkeys after inoculation with HEV genotype 3 that was recovered from the infected swine and human patients. HEV RNA was detected in the serum and/or faeces of 6 out of the 8 cynomolgus monkeys between 5 and 53 days after inoculation. The mild inflammation of liver tissues and elevations of discrete liver enzymes were observed. Seroconversions to anti-HEV IgM and/or IgG were detected in 7 animals. Reactivities to anti-HEV IgA were also detected in the salivary samples of 3 animals. Interestingly, all of the infected monkeys showed severe lymphopenia and a trend toward monocytosis, which coincided with elevations in alanine aminotransferase and antibody titres.ConclusionsThe ability of HEV to cross the species barrier was confirmed for both the swine (Brazilian and Dutch) and human (Argentinean) strains, thus reinforcing the zoonotic risk of hepatitis E in South America. Cynomolgus monkeys that were infected with HEV genotype 3 developed subclinical hepatitis that was associated with haematological changes. Haematological approaches should be considered in future studies of HEV infection.

Recently a new human virus, TT virus (TTV) was identified in the serum of a patient with posttransfusion hepatitis of unknown aetiology. Comparative sequence analysis of a 222 nt fragment of ORF1 of TTV was performed to assess the genomic variability of this virus. Phylogenetic analysis of the nucleotide sequences of 76 TTV isolates collected in 17 countries segregated them into two major groups : TTV 1 and TTV 2. The TTV 1 group comprised two distinct subgroups, which corresponded to previously described TTV subtypes 1a and 1b. The TTV 2 group was separated into four main branches, two of which included sequences previously provisionally attributed as TTV types 2 and 3. Bootstrap resampling, however, did not support the reliability of this grouping, suggesting that the isolates in the TTV 2 group should be considered as subtypes of a single type rather than different TTV types.Recently, a novel human infectious agent was identified in a serum sample of a Japanese patient with post-transfusion hepatitis of unknown aetiology (Nishizawa et al., 1997 ;Okamoto et al., 1998). This agent was designated TT virus (TTV), after the name of the patient. The TTV genome is a single-stranded DNA of at least 3739 bases and contains two overlapping open reading frames (ORF1 and ORF2), encoding 770 and 202 amino acids, correspondingly. TTV is resistant to Tween 80 treatment and has a buoyant density of 1n26 g\ml in Author for correspondence : Sergei Viazov (at University of Essen).Fax j49 201 723 5929. e-mail sergei.viazov!uni-essen.deThe GenBank accession numbers of the sequences reported in this paper are AF067973-AF067984, AF081078-AF081087 and AF084105-AF084137. a sucrose gradient. Viral DNA can be detected in plasma but also in liver tissues of infected subjects, suggesting that TTV is hepatotropic. No serological tests for TTV infection markers are available and PCR is at present the only available diagnostic tool. Use of PCR has demonstrated that TTV causes both acute and persistent infections in humans but the epidemiology and clinical significance of these infections remain uncertain. TTV can be transmitted parenterally by blood and blood products (Nishizawa et al., 1997 ;Okamoto et al., 1998 ; Simmonds et al., 1998) and probably also non-parenterally by a faecal-oral route . TTV DNA is present in a large proportion of patients with different forms of non-A-G hepatitis. For example, it was detected in 47 % of patients with fulminant hepatitis and 46 % of patients with chronic liver disease of unknown aetiology in Japan (Nishizawa et al., 1997 ;Okamoto et al., 1998), in 19 % of patients with fulminant hepatic failure from Scotland (Simmonds et al., 1998), and in 25 % of patients with chronic liver disease from England (Naoumov et al., 1998). Of importance is the fact that in the last study the majority of TTV-positive patients had no biochemical or histological evidence of significant liver damage. This finding, as well as the data on the presence of TTV DNA in a surprisingly high proportion (1n9-63 %) of evidently hea...