First Human Case of Co-Infection with Two Different Subtypes of Hepatitis E Virus

Abstract

Hepatitis E virus (HEV), the main etiologic agent of enterically transmitted acute hepatitis in developing countries, is now recognized as an emerging agent of autochthonous disease and chronic hepatitis E in immunocompromised patients in Europe where HEV infection is probably zoonotically acquired. We describe the first human case of acute HEV infection with two genotype 3 viruses in a French kidney transplant recipient, probably acquired through consumption of uncooked pig liver sausage (figatellu). The patient presented two viral sequences nearly identical to sequences recovered from figatelli. Autochthonous co-infections with different genotype 3 HEV strains can occur in our geographical area.

Host Immune Status and Response to Hepatitis E Virus Infection

“…The first observation, in 2002, documented two different swine-associated genotypes of HEV (HEV-3 and HEV-4) in an otherwise-healthy Japanese sushi chef who presented with acute viral hepatitis (251,252). More recently, a chronic coinfection was reported, with two distinct variants of genotype 3 (3c and 3e) repeatedly detected in serum from a French kidney transplant recipient who had consumed figatellu, an often-undercooked pig liver sausage known to be a frequent vehicle for HEV transmission in the region (253). An additional genotype 3 coinfection was detected in an immunocompetent man in Scotland who developed severe icteric hepatitis.…”

Genome Sequence of a Hepatitis E Virus of Genotype 3e from a Chronically Infected Kidney Transplant Recipient

“…This genotype was described in pigs and humans in Japan and Europe (including France, Spain, the United Kingdom, and Greece) (4) and was involved in a minority of infections in France, including infections in solid organ transplant recipients (12–14). In our center, HEV-3e was mostly detected in other kidney transplant recipients (12, 15). The HEV genome described here is the first of subtype 3e, and the second overall, recovered from solid organ transplant recipients.…”

Clinical features and determinants of chronicity in hepatitis E virus infection

“…The concentration of soluble interleukin‐2 receptor (sIL‐2R), which is a marker of T‐cell activation, was higher in a group of SOT patients with HEV infection who cleared the virus than in those whose infection became chronic. This also correlated with elevation of transaminases in this group . HEV‐specific T‐cell responses could be restored in vitro by blocking co‐inhibitory receptors programmed death ligand‐1 (PD‐1) and cytotoxic T‐lymphocyte‐associated protein 4 (CTLA‐4).…”