Hepatitis B virus and hepatitis delta virus genotypes in outbreaks of fulminant hepatitis (Labrea black fever) in the western Brazilian Amazon region

Abstract

The genotypes of hepatitis B (HBV) and delta (HDV) viruses circulating among fulminant hepatitis cases from the western Amazon Basin of Brazil were characterized in this study. HBV and HDV isolates were obtained from liver samples from 14 patients who developed fulminant hepatitis and died during [1978][1979][1980][1981][1982][1983][1984][1985][1986][1987][1988][1989]. HBV DNA and HDV RNA were detected in all samples. Phylogenetic analyses of HDV sequences showed that they all clustered with previously characterized sequences of HDV genotype 3 (HDV-3). HBV genotypes F, A and D were found in 50.0, 28.6 and 21.4 % of cases, respectively. These results confirm the predominance of HDV-3 in South America and its association with the severe form of hepatitis, and the finding of the co-infection of HDV-3 with different genotypes of HBV suggests that the association between HDV-3 and HBV-F is not necessarily causally related to a more severe clinical course of infection.The Brazilian western Amazon Basin is considered a highly endemic area for hepatitis B (HBV) and delta (HDV) viruses (Bensabath & Dias, 1983; Bensabath et al., 1987;Braga et al., 2001;Fonseca et al., 1988;Viana et al., 2005). Severe hepatitis cases with peculiar clinical and histopathological features have been reported in this region. Cases of fulminant hepatitis with similar features have been described in other countries in northern South America (Colombia, Venezuela, Peru and Ecuador) and in the Central African Republic. This severe form of liver disease has been identified as HBV and HDV super-or coinfection (Bensabath et al., 1987; Buitrago et al., 1986;Casey, 1996;Casey et al., 1996; Hadler et al., 1984;Lesbordes et al., 1987;Ljunggren et al., 1985;Manock et al., 2000;Popper et al., 1983;Sjogren & Colichon, 1991;Torres & Mondolfi, 1991).The disease associated with HDV infection is typically more severe than that due to HBV infection alone, but its clinical spectrum ranges from asymptomatic carriage of the virus to very severe disease. A factor that may influence the course of disease is the genetical heterogeneity of HDV prevalent in different geographical areas (Casey, 1996;Rizzetto & Durazzo, 1991;Smedile et al., 1982). Only HDV genotype 3 (HDV-3) was identified in cases of fulminant hepatitis from different countries of South America and has been associated with the co-infecting HBV genotype F (HBV-F), which is also indigenous to South America, suggesting that HDV-3 alone or in combination with HBV-F could be an important determinant of the particularly severe form of HDV-related disease in this region (Casey, 1996;Nakano et al., 2001a, b). Bensabath et al. (1987) carried out a 5 year protocol during 1979-1984 in the Brazilian western Amazon Basin to study the epidemiology of HDV infection and its role in the aetiology of fulminant hepatitis. In that study, the authors observed a high endemicity of HBV and HDV infection and confirmed the presence of HDV as a major factor forThe GenBank/EMBL/DDBJ accession numbers for the sequences reported in ...

Clonal analysis of hepatitis B viruses among blood donors from Joinville, Brazil: Evidence of dual infections, intragenotype recombination and markers of risk for hepatocellular carcinoma

“…HBV-D was represented by several subgenotypes (D1, D2, D3, D4, and D6), which are also common in European countries. Very few studies in Brazil showed subgenotypic data, all restricted to the Amazonian (Northern) region [Victoria Fda et al, 2008;Gomes-Gouvea et al, 2009;Santos et al, 2010], where genotype D is not the most prevalent and subgenotypes A1, F2, D1, D3, and D4 were also identified. The present study reports, for the first time, HBV subgenotypes in southern Brazil, a region of epidemiological relevance [Ministério da Saú de do Brasil, 2010].…”

“…While genotype A is the most prevalent in several Brazilian states, including those in the Amazon region where the HBV prevalence is highest, genotype D is predominant in Southern Brazil [Mello et al, 2007]. Several recent reports on HBV genotypes in Brazil [Gomes-Gouvea et al, 2009;Becker et al, 2010;Haddad et al, 2010;Santos et al, 2010] are restricted to specific regions (concentrated in capital cities) and have rarely investigated the presence of multiple HBV viral strains by genetic cloning.…”

Molecular identification of hepatitis B virus genotypes/subgenotypes: Revised classification hurdles and updated resolutions

“…Also, patients infected with genotype C progressed to end stage liver disease earlier than those infected by genotype B [91] . Interestingly, it has been shown that patients infected with genotype F have higher mortality rates than those infected with genotype A or D [92] . In India, genotype D is associated with more severe liver complications than other genotypes [93] .…”

Infecção oculta pelo vírus da hepatite B em comunidade amazônica submetida a intenso fluxo migratório, estado do Pará, Brasil

“…Segundo levantamento de diversos estudos sobre a distribuição dos genótipos e subgenótipos do VHB no mundo, o genótipo A apresenta tendência para cronicidade e é mais frequente na África Subsaariana, no Norte da Europa e na África Ocidental; os genótipos B e C são característicos da Ásia, e as mutações são mais frequentemente encontradas no genótipo C; o D predomina na África, na Europa, nos países do Mediterrâneo e na Índia, sendo frequente tanto a evolução para cronicidade como para o surgimento de mutações; o genótipo E foi descrito em estudos na África Central e na Arábia Saudita; o F em estudos na Tunísia, no Brasil e na Espanha; o genótipo G foi relatado na França, na Alemanha e nos EUA, em coinfecção com outros genótipos; o H é comumente encontrado nas Américas do Sul e Central, também relacionado a coinfecções; o genótipo I foi recentemente relatado no Vietnã e Laos, e o J foi identificado em ilhas do Japão 48 . 41 . Outro estudo desenvolvido entre indivíduos HBsAg+ de áreas urbana, rural e indígena do município de Lábrea, Amazônia Ocidental, mostrou que, em 86 amostras HBsAg+, 39 apresentaram VHB-DNA positivo, sendo detectada prevalência do genótipo A (60,0%) e presença dos genótipos D (35,0%) e F (5,0%) 57 .…”