Prolonged Fecal Excretion of Hepatitis A Virus in Adult Patients With Hepatitis A As Determined by Polymerase Chain Reaction

Abstract

the most sensitive method for the detection of nucleic acids. 14 In hepatitis A virus (HAV) infection, fecal excretion ofA recent report on an outbreak of hepatitis A in a neonatal the virus has been reported to cease shortly after sympintensive care unit reported the occurrence of prolonged extoms occur. Although there have been several reports cretion of HAV RNA in stool (as long as 6 months) much on detection of HAV in feces using polymerase chain longer than previously reported. 15 However, neonates may reaction (PCR), the duration of fecal HAV shedding in excrete HAV in stool for longer than adults because of their human adult hepatitis A has not been well described. In underdeveloped immunity.15 the present study, we applied the reverse-transcription In the present study, we determined HAV RNA in stools (RT)-PCR system to the detection of fecal HAV RNA in from adult patients using the two-stage reverse-transcription 10 patients with sporadic hepatitis A. The viral genomic (RT)-PCR method 16 and found that fecal shedding of HAV RNA was detected in the stools from five patients after continued for up to 3 months after onset of illness, and even the onset of clinical symptoms. All stool samples colafter the normalization of the serum ALT levels. ied by several methods. Immunoelectron microscopy has dis-sera as described previously.16 RNA pellets from 100 mL of sera were closed that HAV antigen is detectable in the stool before the dissolved in 25 mL of distilled water and subjected to PCR. Stool development of jaundice and peaking of serum alanine trans-RNA was extracted by the same method from 400 mL of 10% stool suspension in phosphate-buffered saline (pH 7.4).aminase (ALT) levels. Taq under the same conditions as used for the first amplification.Address reprint requests to: Kazuhiko Koike, M.D., First Department of Internal MediAliquots of the resulting samples were electrophoresed in 6% polycine,

Clinical features and molecular characterization of hepatitis A virus outbreak in a child care center in Thailand

“…Therefore, the detection of HAV-RNA in sera is practical and useful to study the molecular epidemiology of HAV infection. Nonetheless, HAV concentration in feces is usually higher than in sera and fecal shedding can persist for months after resolution of hepatitis (Yotsuyanagi et al, 1996). In fact, delayed fecal excretion of HAV is predominantly observed in neonates or young children, reflecting the importance of cell-mediated immunity in resolving the infection (Rosenblum et al, 1991).…”

Molecular epidemiology of hepatitis A virus in metropolitan areas in Japan

“…15 In developed countries, a substantial number of patients with hepatitis A acquired HAV through homosexual activity (www.cdc.gov/nciod/diseases/hepatitis/ h96surve.htm). Recent studies using PCR analysis have shown that the fecal excretion of HAV continues even after recovery, 16 which suggests that hepatitis A patients may transmit the virus even after recovery. This is in accordance with the fact that positivity for anti-HAV among homosexual people is very high.…”

Recurrence of clinically significant hepatitis A following liver transplantation for fulminant hepatitis A

“…It has been shown that HAV viremia regularly paralleled the clinical and biochemical course of the disease even in cases of relapsing disease (Sagnelli et al, 2003). Viremia was detectable for up to 490 days after the onset of icterus and was correlated with elevated transaminases but not with anti-HAV (Normann et al, 2004) RNA was detected in stools up to 3 months after the onset of clinical symptoms, in one case even after alanine aminotransferase (ALT) levels fell to normal (Yotsuyanagi et al, 1996).…”