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Autochthonous sporadic acute hepatitis E caused by two distinct subgenotype 3b hepatitis E virus strains with only 90% nucleotide identity

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Abstract

Hepatitis E, which is caused by hepatitis E virus (HEV), is a public health concern in Japan, where the zoonotic food-borne transmission of HEV from domestic pigs and wild boars plays an important role. A 44-year-old Japanese man with autochthonous sporadic acute hepatitis E was admitted with general fatigue and moderate liver dysfunction. In the present study, two distinct HEV strains were recovered from the patient, who had consumed the raw or undercooked pig liver and intestine two or three times per week for 3 months before the disease onset. The recovered HEV strains were segregated into two clusters within subgenotype 3b, the open reading frame (ORF)1 and ORF2 sequences of which each showed ~10% difference, indicating HEV mixed infection. Because most notified patients with clinical HEV infection in Japan are diagnosed based on the detection of IgA-class HEV antibodies and because serum samples from only a limited number of HEV-infected patients are subjected to HEV RNA detection and nucleotide sequencing, it is very likely that patients with HEV mixed infection remain largely overlooked. The identification of sources of autochthonous HEV infection remains an important goal. Continued efforts to trace the sources of acute or chronic autochthonous HEV infection are warranted.

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Acknowledgments

This study was supported in part by the Research Program on Hepatitis from the Japan Agency for Medical Research and Development, AMED (16fk0210201h0002) and a MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2013–2017 (S1311030).

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Authors and Affiliations

  1. Department of Gastroeterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka-Shi, Gunma, 375-0024, Japan

    Yasuko Yamaguchi, Hitoshi Takagi, Yuhei Suzuki, Kyoko Maruhashi & Takashi Kosone

  2. Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-Shi, Gunma, 371-8511, Japan

    Satoru Kakizaki, Ken Sato & Masanobu Yamada

  3. Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan

    Shigeo Nagashima, Masaharu Takahashi & Hiroaki Okamoto

Authors
  1. Yasuko Yamaguchi
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  2. Hitoshi Takagi
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  3. Yuhei Suzuki
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  4. Kyoko Maruhashi
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  5. Takashi Kosone
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  6. Satoru Kakizaki
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  7. Ken Sato
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  8. Masanobu Yamada
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  9. Shigeo Nagashima
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  10. Masaharu Takahashi
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  11. Hiroaki Okamoto
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Corresponding authors

Correspondence to Hitoshi Takagi or Hiroaki Okamoto.

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Conflict of interest:

The authors declare no conflicts of interest in association with the present study.

Human/Animal Rights:

All of the experimental procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation and the 2008 revision of the Helsinki Declaration of 1975.

Informed Consent:

Informed consent for the publication of this report was obtained from the patient.

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Yamaguchi, Y., Takagi, H., Suzuki, Y. et al. Autochthonous sporadic acute hepatitis E caused by two distinct subgenotype 3b hepatitis E virus strains with only 90% nucleotide identity. Clin J Gastroenterol 10, 168–173 (2017). https://doi.org/10.1007/s12328-017-0718-3

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  • DOI: https://doi.org/10.1007/s12328-017-0718-3

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