Epidemiological characteristics and clinical manifestations of hepatitis E virus infection in Bulgaria: A report on 20 patients

Baymakova, Magdalena; Sakem, Benjamin; Plochev, K.; Popov, G; Mihaylova-Garnizova, Raynichka; Kovaleva, Valentina; Kundurzhiev, Todor

doi:10.2298/sarh1602063b

Cited by 18 publications

(13 citation statements)

References 25 publications

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“…A retrospective study of 806 cases of acute viral hepatitis was performed at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria, between December 2004 and September 2012. Anti‐HEV‐IgM and anti‐HEV‐IgG antibodies were detected in 20 patients, only (2.48%) …”

Section: Discussionsupporting

confidence: 79%

“…HEV infection is endemic in Bulgaria, as demonstrated by the high proportion of subjects with anti‐HEV antibody in the general population and by the high prevalence of cases with HEV‐AH among patients admitted to infectious diseases departments for acute viral hepatitis of different etiology . Nevertheless, there are no phylogenetic studies able to define the origin and evolution of HEV infection in Bulgaria.…”

Section: Introductionmentioning

confidence: 99%

“…[25][26][27][28][29][30][31][32] HEV infection is endemic in Bulgaria, as demonstrated by the high proportion of subjects with anti-HEV antibody in the general population and by the high prevalence of cases with HEV-AH among patients admitted to infectious diseases departments for acute viral hepatitis of different etiology. [33][34][35] Nevertheless, there are no phylogenetic studies able to define the origin and evolution of HEV infection in Bulgaria. Moreover being a pathogen affecting developing and the developed world, it is important to evaluate the phylogenetic evolution of HEV in Bulgaria by examining HEV sequences isolated in humans in this country.…”

mentioning

confidence: 99%

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Human hepatitis E virus circulation in Bulgaria: Deep Bayesian phylogenetic analysis for viral spread control in the country

Cella

Golkocheva-Markova

Sagnelli

et al. 2018

Journal of Medical Virology

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Hepatitis E virus (HEV) infection in Bulgaria is endemic, as demonstrated by the seroprevalence of antibody against the virus in the general population and by the high prevalence of clinical cases registered. In this study, a deep Bayesian phylogenetic analysis has been performed to provide information on the genetic diversity and the spread of HEV genotypes in Bulgaria. Three different data sets of HEV virus was built for genotyping by the maximum likelihood method, for evolutionary rate estimated by Bayesian Markov Chain Monte Carlo approach, for demographic history investigation and for selective pressure analysis. The evolutionary rate for genotype 3e, was 351 × 10 substitution/site/year (95% highest posterior density [95% HPD]: 145 × 10 -575 × 10 ). The root of the time to the most recent common ancestor of the Bayesian maximum clade credibility tree of HEV 3e genotype corresponded to 1965 (HPD 95% 1949-1994). The Bulgarian sequences mainly clustered in the main clade (clade A). The monophyletic clade included all Bulgarian genotype 3e sequences. The demographic history showed a slight growth from 1995 to 2000, followed by a sort of bottleneck in 2010s, a peak in 2011 and a new growth to 2015. Selection pressure analysis did not show sites under positive pressure but 64 statistically significant sites under negative selection. Molecular epidemiological surveillance by Bayesian phylogeny of HEV virus can contribute to trace the way of human infection after contact with swine source directly or heating meat improving public health control.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Human hepatitis E virus circulation in Bulgaria: Deep Bayesian phylogenetic analysis for viral spread control in the country

Cella

Golkocheva-Markova

Sagnelli

et al. 2018

Journal of Medical Virology

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“…However, Pischke et al [54] concluded that HCV/HBC patients did not present higher risk of HEV infections compared to controls. On the other hand, increased severity of infection in this group has been suggested [87]. Blasco-Perrin et al [276], however, concluded that mortality among HEV patients with and without decompensated chronic liver disease was similar.…”

Section: Routes Of Transmission and Risk Groupsmentioning

confidence: 93%

Hepatitis E Virus in Industrialized Countries: The Silent Threat

Clemente-Casares

Ramos-Romero

Ramirez-Gonzalez

et al. 2016

BioMed Research International

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Hepatitis E virus (HEV) is the main cause of acute viral hepatitis worldwide. Its presence in developing countries has been documented for decades. Developed countries were supposed to be virus-free and initially only imported cases were detected in those areas. However, sporadic and autochthonous cases of HEV infection have been identified and studies reveal that the virus is worldwide spread. Chronic hepatitis and multiple extrahepatic manifestations have also been associated with HEV. We review the data from European countries, where human, animal, and environmental data have been collected since the 90s. In Europe, autochthonous HEV strains were first detected in the late 90s and early 2000s. Since then, serological data have shown that the virus infects quite frequently the European population and that some species, such as pigs, wild boars, and deer, are reservoirs. HEV strains can be isolated from environmental samples and reach the food chain, as shown by the detection of the virus in mussels and in contaminated pork products as sausages or meat. All these data highlight the need of studies directed to control the sources of HEV to protect immunocompromised individuals that seem the weakest link of the HEV epidemiology in industrialized regions.

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“…A high rate of fulminant hepatic failure and death were mentioned among pregnant women in the hyperendemic areas 79,80 . In nonendemic areas, the virus affected mainly elderly men, people with accompanying liver diseases and alcohol abuse [81][82][83] . The autochthonous cases could be manifested as an acute hepatitis, asymptomatic infection, and nonspecific symptoms with anicteric diseases 48 .…”

Section: Clinical Manifestationmentioning

confidence: 99%