High prevalence of hepatitis A and E viruses in environmental and clinical samples from West Argentina

ABSTRACT Environmental surveillance of water sources is important to monitoring viral hepatitis transmission in clinical settings. This study investigated the circulation of hepatitis A (HAV) and E (HEV) viruses in sewage and clinical samples from Argentina. Between 2016 and 2017, 80 raw sewage samples and 86 clinical samples (stool and serum) from suspected cases of hepatitis A and hepatitis E were obtained. HAV and HEV were tested by both real-time and nested PCR. Positive samples were sequenced for genotype determination and phylogenetic analysis. Overall, HAV was recovered in 39% of sewage samples and 61.1% of clinical samples. HEV was detected in 22.5% of sewage samples and 15.9% of clinical samples. HAV was found more frequently in sewage during the winter and in clinical samples in spring; HEV was more prevalent in sewage during summer and in clinical samples in autumn. All HAV isolates belonged to genotype IA and HEV isolates belonged to genotype 3, the most prevalent genotypes in South America. High prevalence of HAV and HEV in environmental and clinical samples in Mendoza, Argentina was observed. These findings reinforce the importance of environmental surveillance and implementation of health strategies to control the spread of HAV and HEV in developing countries.

Prevalence of HEV infection markers in Chinese blood donors: a meta-analysis / 中国输血杂志

【Objective】 To analyze the serological markers and RNA prevalence of HEV infection in Chinese voluntary blood donors in different regions of China, so as to provide basis for the necessity of HEV screening and the formulation of screening strategies for voluntary blood donors. 【Methods】 Databases such as CNKI, Wanfang medicine and PubMed were searched for eligible literature, and the literature data meeting the inclusion criteria were extracted for meta-analysis using R4.1.3 software. 【Results】 A total of 26 studies were included, involving 97 928, 117 831 and 82 673 cases, respectively, for anti-HEV IgG, anti-HEV IgM and HEV RNA. The pooled estimated prevalence of anti-HEV IgG, anti-HEV IgM and HEV RNA among Chinese voluntary blood donors was 23.0% [95% CI (18%, 29%)] vs 1.13% [95% CI (0.94%, 1.36%)] vs 0.028%[95%CI(0.006%, 0.059%)], and there were significant differences among different cities and regions. 【Conclusion】 The past infection rate of HEV among voluntary blood donors in China was somewhat high and with significant regional differences. The current infection rate was relatively low and had decreased compared with that in the past decade, but there was still residual risk of blood transfusion. It is necessary to pay more attention to blood HEV screening of voluntary blood donors.

Demographic and Clinical Profile Analysis of Acute Viral Hepatitis

Background: Acute viral hepatitis (AVH) is a major health concern in developing countries like Bangladesh regarding morbidity as well as mortality. Usually, acute infections are caused by A, E, hepatitis viruses, and occasionally hepatitis B virus. Infection caused by the hepatitis C virus is usually asymptomatic. Prior knowledge of the demographic and clinical profile of acute viral hepatitis may be helpful for treatment professionals in the management of such patients. Aim of the study: The aim of this study was to assess the demographic and clinical profile of acute viral hepatitis patients in Bangladesh.Material & Methods:This prospective observational study was conducted in the Department of Gastroenterology, US-Bangla Medical College & Hospital during the period from March 2018 to February 2019, in Bangladesh. A total of 59 suspected patients with acute viral hepatitis were included as the study subjects for this study. Ethical approval of the study had been taken from the ethical committee of the mentioned hospital. A predesigned questionnaire was used in data collection. Collected data analyzed by using MS Office and SPSS version 23.0 programs as per need. A P-value, of <0.05 was considered significant.Results:Among 59 participants, the male-female ratio was 3.2:1 and the mean (±SD) age was 23.88±14.83 years. Analyzing hepatitis infection, we found hepatitis E was the highest in number 32(54.24%), followed by hepatitis E virus 20(33.9%), and hepatitis B virus 5(8.47%). In this study, we did not find any patients with hepatitis C virus, and 2 participants didn’t have any hepatotropic virus. The mean (±SD) Serum bilirubin (mg/dl) was 6.35±1.63, and the mean (±SD) serum alkaline phosphatase (IU/L), serum. creatinine (mg/dl), serum albumin (gm/dl) and plasma glucose random (mg/dl) were found 366.81±257.20, 6.97±14.96, 19.75±22.98 and 10.08±5.49 respectively. Considering dual viruses among the total of 5 patients along with hepatitis E & A viruses in this study, we found all were hepatitis B viruses. Among them, 3 with hepatitis E and the rest 2 were with hepatitis A virus consequently. Among them 3(60%) with hepatitis A and the rest 2(40%) with hepatitis E. In the issue of patients attended with clinical complaints, vomiting was the highest among hepatitis A patients 19(86.4%) followed by jaundice 8(36.4%) and fever8(36.4%). On the other hand, among hepatitis E patients’ jaundice was highest at 19(61.3%) followed by vomiting at 17(54.8%), and fever at 6(19.4%) respectively.Conclusions:The incidence of HEV is found as the most predominant among all the acute viral hepatitis patients and vomiting and jaundice were the most common presenting complaints.

Virus de la hepatitis E

Resumen El virus de la hepatitis E (VHE) es uno de los principales agentes etiológicos de hepatitis entérica en el mundo. En países en vía de desarrollo, la seroprevalencia oscila entre 20 y 50% y en países desarrollados entre 4,4 y 21%. Clínicamente los casos de infección por VHE en individuos inmunocompetentes cursan como una hepatitis viral aguda auto limitada; por el contrario, en mujeres embarazadas, individuos receptores de trasplantes de órganos e individuos que conviven con el virus de la inmunodeficiencia humana (VIH), la infección puede manifestarse como una hepatitis crónica y grave. En América Latina, sólo Brasil y Argentina reportan cifras en individuos que conviven con el VIH. Se requieren más estudios en nuestra región que permitan determinar la prevalencia del VHE en individuos inmunosuprimidos, donantes de sangre y población general para adoptar medidas que garanticen un diagnóstico oportuno, acceso a la atención y el control de la transmisión.

Abstract The hepatitis E virus (HEV) is one of the main etiological agents of enteric hepatitis in the world. In developing countries its sero-prevalence ranges from 20 to 50% and in developed countries from 4.4% to 21%. Clinically, cases of HEV infection in immunocompetent individuals present as self-limited acute viral hepatitis; conversely, in pregnant women, transplanted individuals, and individuals living with the human immunodeficiency virus (HIV), the infection can manifest as chronic and severe hepatitis. In Latin America, only Brazil and Argentina report figures for individuals living with HIV. More studies are required in our region to determine the prevalence of HEV in immunosuppressed individuals, blood donors, and the general population to adopt measures that guarantee timely diagnosis, access to care, and control of transmission.

Assessment of hepatitis E seropositivity among HIV-infected patients in Bulgaria

Abstract It is debatable whether HIV-infected patients are at greater risk for hepatitis E virus (HEV) infection compared with healthy subjects. The reported anti-HEV seroprevalence among different groups in Bulgaria varied from 9.04% to 25.9%, but the information regarding the HIV population is still missing. The aim of the present study was to evaluate hepatitis E seroprevalence among HIV-infected patients in Bulgaria and to analyze demographic and immunological factors associated with HEV infection. Serum samples of 312 HIV-infected patients were analyzed retrospectively. Age, sex, residence and laboratory markers for HEV, HBV, HCV and HIV infection, and lymphocytes subpopulations were collected for all patients. None of the tested samples were positive for HEV RNA. HEV seroprevalence among HIV-infected patients was 10.9%. Males were more affected with the highest prevalence of positivity in the age group > 30 to ≤ 40 years. The documented HIV transmission routes in HIV/HEV co-infected group were heterosexual, homosexual, intravenous drug use (IDU), and vertical with predominace of the heterosexual route (z = 0.2; p = 0.804). There was a statistically significant trend of HIV mixed infection with routes of HIV transmission other than homosexual - heterosexual in HIV/HEV group and injection drug use in HIV/HBV/HCV co-infected group. The route of HIV transmission, in contexts of patients' behavior, was associated with HEV prevalence among HIV-infected patients.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31­40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007).

Hepatitis E virus prevalence among blood donors in Wuhan / 中国输血杂志

【Objective】 To investigate the prevalence and risk factor of hepatitis E virus(HEV) infection among blood donors in Wuhan. 【Methods】 A total of 1 302 serum samples (including 1 076 with normal ALT and 226 with elevated ALT) from blood donors were randomly collected from January to December 2021 in Wuhan Blood Center. Anti-HEV IgG, IgM and HEV antigen (Ag) were examined by enzyme-linked immunosorbent assay (ELISA). The IgM or Ag positive and elevated ALT samples were subjected to real time-PCR to detect HEV RNA. Multivariable logistic regression modeling was used to examine the risk factors associated with HEV prevalence. 【Results】 Overall, the positive rates of anti-HEV IgG, IgM, and Ag were 16.44%, 1.0% and 0.08%, respectively. However, none of the serum samples were HEV RNA positive. The prevalence of anti-HEV IgG and anti-HEV IgM was similar in samples with increased ALT and normal ALT (IgG 13.72% vs 17.01%, P>0.05; IgM 1.33% vs 0.93%, P>0.05). Multivariate analysis revealed a strong statistical association between age and HEV IgG seroprevalence. The prevalence increased with increasing age, from 5.4% (18~25 years old) to 68.7%(the highest) in blood donors above 46 years (P<0.05). 【Conclusion】 HEV showed a seroprevalence among blood donors in Wuhan, some of whom were recent infections, suggesting a threat to the safety of blood transfusions. A low anti-HEV prevalence in young adults (18~25 years) is indicative of a susceptible population and implicates a higher risk of HEV infections in this age group in the future.

ELISA detection method for IgG, IgM and IgA antibodies against hepatitis E virus: Establishment and preliminary application / 中国输血杂志

【Objective】 To establish an indirect ELISA method for detecting IgG, IgM and IgA antibodies against Hepatitis E virus (HEV). 【Methods】 Tn-5 cells were infected with recombinant HEV baculovirus, and HEV-like particles (VLP) were collected and purified for coating antigen. The reaction conditions and methodology of indirect ELISA method were established and evaluated. The prevalence of HEV antibody among blood donors in Xishuangbanna were detected. 【Results】 The collected and purified VLP showed HEV antigenicity. The positive rates of anti-HEV IgG, IgM and IgA in blood donors in Xishuangbanna Prefecture were 18%(90/500), 5.6%(28/500) and 2.6%(13/500), respectively. The recent HEV infection rate was 1.8 % (9/500), and the seroprevalence of hepatitis E was 19.8% (99/500). Of the 13 anti-HEV IgA positive samples, 2 were both anti-HEV IgG and IgM negative. 【Conclusion】 HEV antibody positive is common among blood donors in Xishuangbanna, some of which are recent infections, posing a threat to the safety of blood transfusion. HEV IgA antibody indirect ELISA combined with human HEV IgM antibody detection can improve the detection rate of recent HEV infection.

Prevalence of hepatitis E virus infection among blood donors / 中国输血杂志

【Objective】 To investigate the prevalence of hepatitis E virus (HEV) among voluntary blood donors, and the viability and practicability of nucleic acid testing (NAT) in Jinhua area. 【Methods】 Blood samples from 1 017 voluntary blood donors at Jinhua Blood Center from April to May 2021 were collected, and HEV RNA was detected by CHURAS BSS1200 blood nucleic acid detection system. The reactive samples were re-tested for IgM and IgG antibodies by ELISA, and HEV genotyping by gene sequencing. 【Results】 The yield rate of HEV RNA out of voluntary blood donors in Jinhua was 0.98 ‰ (1 / 017). The individual was negative for IgM and IgG antibodies, but was confirmed to be HEV RNA genotype 4 by sequencing. 【Conclusion】 HEV RNA positive donors have been found in this study. HEV RNA blood screening can effectively enhance the safety of blood transfusion.

Hepatitis E virus seroprevalence among blood donors in Liuzhou, China / 中国输血杂志

【Objective】 To investigate the hepatitis E virus(HEV) infection among voluntary blood donors in Liuzhou, Guangxi. 【Methods】 Qualified blood donations in Liuzhou from October to November 2019 were tested for anti-HEV IgG and IgM and.HEV antigen. HEV RNA test was performed on samples positive for HEV antigen and/or anti-HEV IgM. and the test results were analyzed statistically. 【Results】 The seroprevalence rates of HEV antigen and anti-HEV IgG and IgM among 5 751 qualified donations were 0, 26.03% (1497/5 751), and 1.67% (96/5 751), respectively.None of the 91 anti-HEV IgM positive samples was positive for HEV RNA, whereas 60.41% of anti-HEV IgM positive samples were anti-HEV IgG positive. The HEV antibody prevalence varied significantly by gender, age, and nationality (P<0.05). 【Conclusion】 The prevalence of anti-HEV IgG / IgM among blood donors in Liuzhou was higher than that in other domestic regions. Significant increase in HEV antibody prevalence was observed among ethnic minorities, such as Miao and Dong, and age group of more than 45 years.Follow-up studies with larger sample size could be conducted to estimate potential risks of HEV transmission by blood transfusion, which may provide references for selective screening of HEV infection marker among high-endemic population.

Prevalence of hepatitis A virus and hepatitis E virus in the patients presenting with acute viral hepatitis in Rohtak, Haryana, India

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV) cause acute hepatitis in humans and are transmitted mainly through the fecal-oral route. They pose major health problems in developing countries. This study was done to determine prevalence of HAV and HEV in patients presenting with AVH and the co-infection of HAV and HEV in these patients.Methods: The study was conducted in the virology research and diagnostic laboratory, PGIMS Rohtak during the study period of August 2017-December 2018. The study population included sera of individuals from all age group who were suspected of acute viral hepatitis (AVH). All the sera were screened for IgM antibody to HEV and HAV using IgM capture ELISA.Results: HEV IgM ELISA test   was performed in 307 patients (mean age 34 years;), with an overall seroprevalence rate of 138(44.9%). HAV antibodies were detected in 109 subjects, with a median age of 9.5 years the seroprevalence of HAV was 34 (31.1%). HEV seropositivity was highest in the age group 20-30 years. Mean age was 34 years whereas the interquartile range was from 14-71 years. HAV infection was positive mainly in the age group <10 years. With interquartile range from 6-16 years. Out of total 34 patients positive for HAV infection males were 20 (58.8%), whereas females were 14(41.1%). HEV IgM was positive in 138 patients, out of which male were 96 (69.56%) and females were 42 (30.43%). HEV IgM was positive in 138 patients, out of which male were 96 (69.56%) and females were 42 (30.43%). HAV and HEV seen to be prevalent all with highest predominance seen towards the end of monsoons (August and September) and beginning of winters.Conclusions: The present study also points toward HEV being the prime etiological agent for outbreaks of acute hepatitis in the studied region of Haryana (Rohtak), India. A comparatively lower HAV prevalence may be the consequence of an overall declining trend due to improved living standards and environmental hygiene.

Hepatitis E virus prevalence in Egyptian children with transfusion-dependent thalassemia

ABSTRACT Hepatitis E virus (HEV) infection is one of the major public health problems in developing countries. HEV can cause chronic infections in immunocompromised individuals e.g. thalassemic patients with increased risk of morbidity and mortality. In addition there is possibility of HEV transmission through blood transfusion. Therefore, the present study aimed to investigate the seroprevalence and risk factors of HEV infection in β-thalassemic children. Methods: This cross-sectional study was conducted on 140 Egyptian children suffering from β-thalassemia, attending the hematology outpatient clinic from April to October 2016. Serum samples from patients were collected and anti-HEV antibodies; Immunoglobulin G (IgG) and Immunoglobulin M (IgM)were measured by enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of HEV in β-thalassemic chidren was relatively high (27.15%). Anti-HEV IgG prevalence was 24.29% while that of IgM was 2.86%. There was significant association between HEV infection and age, residence, liver enzymes and amount of blood transfusion per year. Conclusions: Thalasemic patients are vulnerable to chronicity and increased risk of morbidity and mortality from HEV infection. Frequent assessment of liver enzymes in thalassemic patients to monitor subclinical HEV is recommended. Close monitoring and HEV screening of blood donations should be taken in consideration. Public awareness about HEV endemicity, modes of transmission, and risk hazards especially in high risk group should be done to reduce the disease burden.

Serological and molecular retrospective analysis of hepatitis E suspected cases from the Eastern Brazilian Amazon 1993-2014

Abstract INTRODUCTION We evaluated the anti-hepatitis E virus (HEV) antibody prevalence and HEV-RNA in archived serum samples of non-A-C hepatitis, or suspected cases of HEV infection from the Eastern Brazilian Amazon from 1993 to 2014. METHODS Serum samples (n = 318) were tested using ELISA and immunoblotting, and screened for HEV-RNA by RT-qPCR. RESULTS Anti-HEV IgM and IgG were detected in 3.4% (11/318) and 5.9% (19/318) of the samples, respectively. All samples were HEV-RNA negative. CONCLUSIONS HEV was detected at a low prevalence. Broader serological and molecular evaluation of HEV infection in the Amazon region should be carried out.

Protein from Hevea brasiliensis "Hev b 13" latex attenuates systemic inflammatory response and lung lesions in rats with sepsis / Proteína do latex de Hevea brasiliensis "Hev b 13" atenua resposta inflamatória sistêmica e lesão pulmonar de ratos com sepse

Abstract Sepsis induces a severe systemic inflammatory response that may result in multiple organ dysfunction and death. Studies using a protein derived from natural Hevea brasiliensis (rubber tree) latex, denominated Hev b 13, have demonstrated important anti-inflammatory effects, but no data have been published regarding its effects on sepsis. The aim of this study was to investigate the effects of Hev b 13 on the inflammatory response and lung lesions of septal rats. Male Wistar rats were submitted to cecal ligation and puncture (CLP), randomized into groups and treated with subcutaneously administered doses of 0.5/2.0/3.0 mg/Kg of Hev b 13. Next, animals were subdivided into three different points in time (1, 6 and 24 hours after treatments) for collection of blood samples and euthanasia accompanied by organ removal. Total and differential leukocyte counts, cytokine dosage and histological assessment were analyzed. Treatment with Hev b 13 resulted in a significant decline in total and differential leukocytes as well as suppression of TNF-α and IL-6 production, associated with the increase in IL-10 and IL-4 in plasma and lung tissue. Moreover, it reduced morphological and pathological changes found in the lungs, including neutrophil infiltration, edema and alveolar thickening. The present study concluded that Hev b 13 exerts anti-inflammatory effects and attenuates lung lesions in septal rats, showing potential for clinical application.

Resumo Sepse induz uma resposta inflamatória sistêmica grave podendo resultar em disfunção de múltiplos órgãos e morte. Pesquisas utilizando uma proteína derivada do látex natural de Hevea brasiliensis (seringueira), denominada Hev b 13 tem demonstrado importantes efeitos anti-inflamatórios, mas nenhum dado foi publicado dos seus efeitos na sepse. O objetivo deste estudo foi investigar os efeitos da Hev b 13 na resposta inflamatória e na lesão pulmonar de ratos com sepse. Ratos machos da linhagem Wistar foram submetidos a ligação e perfuração do ceco (LPC), randomizados em grupos e tratados com as doses 0,5/2,0/3,0 mg/Kg de Hev b 13 subcutâneo. Após subdividiu-se os animais em três pontos diferentes de tempo (1, 6 e 24 horas após os tratamentos) para coleta de amostras sanguíneas e eutanásia com remoção dos órgãos. Contagem total e diferencial de leucócitos, dosagem de citocinas e avaliação histológica foram analisadas. O tratamento com a Hev b 13 resultou em diminuição significativa de leucócitos totais e diferenciais bem como suprimiu a produção de TNF-α e IL-6, associado ao aumento de IL-10 e IL-4 no plasma e tecido pulmonar. Além disso, reduziu as alterações morfológicas e patológicas encontradas nos pulmões, incluindo infiltrado de neutrófilos, edema e espessamento alveolar. Este estudo concluiu que a Hev b 13 tem efeitos anti-inflamatórios e atenua lesões pulmonares em ratos com sepse, apresentando potencialidades para aplicabilidade clínica.

Infectivity of hepatitis E virus in SPF rabbit urine / 中华微生物学和免疫学杂志

Objective@#To investigate the presence of hepatitis E virus (HEV) RNA and HEV antigen (HEV-Ag) and to evaluate the infectivity of HEV in urine through a SPF rabbit model of HEV infection.@*Methods@#Serum, fecal and urine samples collected from SPF rabbits with HEV infection were tested for viral and biochemical markers using real-time RT-PCR and ELISA. Liver and kidney biopsies were performed for observing histopathological changes and immunohistochemical staining. Rabbits were challenged with HEV isolated in urine samples to evaluate the infectivity.@*Results@#Rabbit R1# that was injected with rabbit HEV presented viremia, fecal shedding of HEV, high serum level of HEV-Ag, elevated aspartate transaminase (AST) and alanine transaminase (ALT) and typical symptoms of hepatitis. Urine samples of rabbit R1# continued to be positive for HEV RNA and HEV-Ag. Ratios of HEV-Ag to RNA in urine samples of rabbit R1# were significantly higher than those in serum and feces samples. The parameters quantified in routine urinalysis remained within the normal ranges in rabbit R1#. However, pathological changes and the presence of HEV-Ag were observed in kidney tissues. Furthermore, serum and fecal samples that were collected from one of the two rabbits injected with rabbit R1# urine-derived HEV were HEV positive and the virus strains isolated form feces remained infective to rabbits.@*Conclusion@#HEV infection may result in kidney injury and the urine may pose a risk of transmission. HEV-Ag detection in urine may be valuable for the diagnosis of ongoing HEV infection.

Immunomodulating effects of the purified hev b 13 fraction on septic rats / Efeitos imunomoduladores da fração purificada hev b 13 em ratos com sepse

ABSTRACT Background: Sepsis is a potentially life-threatening complication of an infection that occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body, especially in the acute phase of the disease, producing excessive pro-inflammatory cytokines, leading to multiple organ injury and death. The Hev b 13 fraction has demonstrated biological activity capable of inducing IL-10 production and shrinking inflammatory disease lesions. Aim: To investigate the immunomodulating effects of the Hev b 13 fraction on septic rats. Methods: Acinetobacter baumannii was injected into the peritoneal cavity of the animals after sustaining a lesion in the pancreas, with the stomach as an entry point. After 10 h of infection, they were euthanized for blood and lung collection, followed by total and differential leukocyte count, determination of cytokine level and histopathological analysis. Results: Administering a single dose of the Hev b 13 fraction 2 h after sepsis induction significantly decreased total leukocyte count. Higher IL-10 and IL-4 and lower IL-6 production shrank the lung tissue lesions compared to the control groups. Conclusion: The Hev b 13 fraction exhibits an anti-inflammatory tendency, with potential for sepsis treatment.

RESUMO Racional: Sepse se correlaciona com a ruptura do complexo equilíbrio entre os mediadores inflamatórios, que principalmente na fase aguda da doença, produz exacerbadamente citocinas pró-inflamatórias levando a lesão de múltiplos órgãos e morte. A fração Hev b 13 tem demonstrado atividade biológica capaz de induzir a produção de IL-10 e regredir lesões de doenças inflamatórias. Objetivo: Investigar os efeitos imunomoduladores da fração Hev b 13 em ratos com sepse. Métodos: Foi injetado Acinetobacter baumannii na cavidade peritoneal dos animais após lesão no pâncreas e estômago como porta de entrada. Após 10 h de infecção, foi realizada eutanásia para coleta de sangue e pulmões, em seguida, contagem total e diferencial de leucócitos, dosagem de citocinas e histopatologia para análise. Resultados: A administração de dose única da fração Hev b 13, 2 h após a indução de sepse, diminuiu significativamente a contagem total de leucócitos. Associado a maior produção de IL-10 e IL-4, e menor de IL-6, atenuou as lesões nos tecidos pulmonares em comparação com os grupos controles. Conclusão: A fração Hev b 13 apresenta tendência anti-inflamatória, com potencialidades no tratamento da sepse.

Acute Hepatitis E Mimicking a Flare of Disease in a Patient with Chronic Autoimmune Hepatitis

Abstract: Acute hepatitis E is becoming increasingly recognised in Europe with up to 40% of the population in Southern France being exposed to the virus, which is harboured in pigs. Patients with known liver disease may present with acute hepatitis E and present a diagnostic challenge. For example patients with autoimmune hepatitis (AIH) who are immunosuppressed and contract hepatitis E may be at increased risk of developing chronicity due to concurrent immunosuppression. Importantly, the diagnosis may be missed with the infection misdiagnosed as an autoimmune flare, and immunosuppression increased by the attending physician, thus enhancing the risk of chronicity of infection leading to progressive liver injury in immunocompromised patients. We report a case of acute hepatitis E in a patient with AIH and discuss the features that helped us differentiating it from an autoimmune flare.

High Clinical Manifestation Rate in an Imported Outbreak of Hepatitis E Genotype 1 Infection in a German Group of Travellers Returning from India

Abstract: Background. There are only few reports about travel-associated, imported tropical hepatitis E virus (HEV) genotype 1 infections within Western travellers. We describe the clinical course of a single outbreak of hepatitis E in a German travellers group returning from India and compare the results of two commercial HEV-seroassays. Material and methods. After identifying hepatitis E in an index patient returning from a journey to India all 24 members of this journey were tested for anti-HEV-IgG and IgM using two commercial seroassays (Wantai and Mikrogen), for HEV-RNA by PCR and HEV-Ag by an antigen-assay (Wantai). Results. 5/24 (21%) individuals were viraemic with viral loads between 580-4,800,000 IU/mL. Bilirubin and ALT levels in these patients ranged from 1.3-14.9 mg/dL (mean 7.3 mg/dL, SD 5.6 mg/dL) and 151-4,820 U/L (mean 1,832U/L, SD 1842U/L), respectively and showed significant correlations with viral loads (r = 0.863, p < 0.001; r = 0.890, p < 0.001). No risk factor for food-borne HEV-transmission was identified. All viraemic patients (5/5) tested positive for anti-HEV-IgG and IgM in the Wantai-assay but only 4/5 in the Mikrogen-assay. Wantai-HEV-antigen-assay was negative in all patients. Six months later all previously viraemic patients tested positive for anti-HEV-IgG and negative for IgM in both assays. However, two non-viremic individuals who initially tested Wantai-IgM-positive stayed positive indicating false positive results. Conclusions. Despite the exact number of exposed individuals could not be determined HEV genotype 1 infections have a high manifestation rate of more than 20%.The Wantai-antigen-test failed, the Wantai-IgMrapid-test and the Mikrogen-IgM-recomblot showed a better performance but still they cannot replace real-time PCR for diagnosing ongoing HEV-infections.

Protein from Hevea brasiliensis Hev b 13 latex attenuates systemic inflammatory response and lung lesions in rats with sepsis

Abstract Sepsis induces a severe systemic inflammatory response that may result in multiple organ dysfunction and death. Studies using a protein derived from natural Hevea brasiliensis (rubber tree) latex, denominated Hev b 13, have demonstrated important anti-inflammatory effects, but no data have been published regarding its effects on sepsis. The aim of this study was to investigate the effects of Hev b 13 on the inflammatory response and lung lesions of septal rats. Male Wistar rats were submitted to cecal ligation and puncture (CLP), randomized into groups and treated with subcutaneously administered doses of 0.5/2.0/3.0 mg/Kg of Hev b 13. Next, animals were subdivided into three different points in time (1, 6 and 24 hours after treatments) for collection of blood samples and euthanasia accompanied by organ removal. Total and differential leukocyte counts, cytokine dosage and histological assessment were analyzed. Treatment with Hev b 13 resulted in a significant decline in total and differential leukocytes as well as suppression of TNF- and IL-6 production, associated with the increase in IL-10 and IL-4 in plasma and lung tissue. Moreover, it reduced morphological and pathological changes found in the lungs, including neutrophil infiltration, edema and alveolar thickening. The present study concluded that Hev b 13 exerts anti-inflammatory effects and attenuates lung lesions in septal rats, showing potential for clinical application.

Resumo Sepse induz uma resposta inflamatória sistêmica grave podendo resultar em disfunção de múltiplos órgãos e morte. Pesquisas utilizando uma proteína derivada do látex natural de Hevea brasiliensis (seringueira), denominada Hev b 13 tem demonstrado importantes efeitos anti-inflamatórios, mas nenhum dado foi publicado dos seus efeitos na sepse. O objetivo deste estudo foi investigar os efeitos da Hev b 13 na resposta inflamatória e na lesão pulmonar de ratos com sepse. Ratos machos da linhagem Wistar foram submetidos a ligação e perfuração do ceco (LPC), randomizados em grupos e tratados com as doses 0,5/2,0/3,0 mg/Kg de Hev b 13 subcutâneo. Após subdividiu-se os animais em três pontos diferentes de tempo (1, 6 e 24 horas após os tratamentos) para coleta de amostras sanguíneas e eutanásia com remoção dos órgãos. Contagem total e diferencial de leucócitos, dosagem de citocinas e avaliação histológica foram analisadas. O tratamento com a Hev b 13 resultou em diminuição significativa de leucócitos totais e diferenciais bem como suprimiu a produção de TNF- e IL-6, associado ao aumento de IL-10 e IL-4 no plasma e tecido pulmonar. Além disso, reduziu as alterações morfológicas e patológicas encontradas nos pulmões, incluindo infiltrado de neutrófilos, edema e espessamento alveolar. Este estudo concluiu que a Hev b 13 tem efeitos anti-inflamatórios e atenua lesões pulmonares em ratos com sepse, apresentando potencialidades para aplicabilidade clínica.

Establishment of a real time quantitative reverse-transcription PCR method for detection of hepatitis E virus based on standard plasmid / 中华微生物学和免疫学杂志

Objective To establish a real-time quantitative reverse-transcription PCR ( qRT-PCR) method for detection of hepatitis E virus ( HEV) of different genotypes based on standard HEV DNA plasmid in order to promote its application in clinical laboratory. Methods Specific primers and probe of HEV were designed based on the conserved open reading frame 3 (ORF3) regions. HEV DNA plasmids were construc-ted and 10-fold serial dilutions of the plasmids were prepared and used as standards to establish one-step qRT-PCR. The established method was compared with HEV antigen, antibody and RT-nPCR assays. Some positive samples were sequenced and analyzed by evolutionary tree. Results The one-step qRT-PCR meth-od for HEV detection in serum or feces samples was successfully establish. It could reach a sensitivity of 25 copies/test and 77. 8% of its results were consistent with those by HEV antigen assay. Nine patients were infected with HEV of genotypes 4a, 4d or 4n as indicated by evolutionary tree. Conclusion The HEV qRT-PCR method based on its standard plasmid is successfully established, which paves the way for commercial-ization of clinical applications.