Zeytinoğlu A, Erensoy S, Abacioğlu H, Sayiner A A, Ozacar T, Başçi A, Kaplan H, Simmonds P, Bilgiç A
Department of Microbiology and Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey.
Clin Microbiol Infect. 2002 Nov;8(11):741-4. doi: 10.1046/j.1469-0691.2002.00442.x.
Nosocomial hepatitis C virus (HCV) infections were recorded in the renal transplantation unit of the university hospital. There were cases of acute HCV infection with aggressive clinical courses diagnosed from a positive HCV RNA test in the early post-transplantation period and which remained anti-HCV negative. Their anti-HCV seronegativity was attributed to them having acquired HCV under intense immunosuppressive therapy and suggested that the aggressive clinical course could be due to the deficient immune response resulting in an inability to limit viral replication. There were also donors diagnosed as having acute HCV infection in the early post-operative period. Genotyping and sequence analysis for HCV were performed on the isolates of eight of these patients who were consecutively transplanted and of three donors whose recipients were infected with HCV prior to transplantation, and who acquired acute HCV infection after transplantation. Of the eight recipients in the first group three were genotype 1a, three were genotype 1b, one was genotype 3a, and the last one was genotype 4 according to Simmond's classification. Of the three donor-recipient couples both the HCV isolates from one couple were genotyped as 1b and the phylogenetic analysis indicated that the patients were infected with a common variant of HCV, but the genotypes of HCV isolates from the other couples were different. Recipients were genotype 1b and the donors were genotype 1a in these couples. Genotype results of the first group and donor-recipient couples, and sequence analysis of genotype 1b and 1a isolates, showed that the source of infection was not a unique strain and there were multiple breaks in universal precautions while managing these patients.
大学医院的肾移植科记录到了医院内丙型肝炎病毒（HCV）感染病例。有一些急性HCV感染病例，其临床病程较为凶险，这些病例在移植后早期通过HCV RNA检测呈阳性而被诊断出来，且抗-HCV检测一直为阴性。它们的抗-HCV血清学阴性被归因于在强化免疫抑制治疗下感染了HCV，这表明这种凶险的临床病程可能是由于免疫反应不足导致无法限制病毒复制。也有供体在术后早期被诊断为急性HCV感染。对连续接受移植的8例患者以及3例供体（其受体在移植前已感染HCV且移植后又感染了急性HCV）的分离株进行了HCV基因分型和序列分析。根据西蒙兹分类法，第一组的8例受体中，3例为1a基因型，3例为1b基因型，1例为3a基因型，最后1例为4基因型。在3对供体-受体组合中，其中一对的HCV分离株均被基因分型为1b，系统发育分析表明患者感染的是HCV的一个共同变体，但其他组合的HCV分离株基因型不同。在这些组合中，受体为1b基因型，供体为1a基因型。第一组和供体-受体组合的基因型结果，以及1b和1a基因型分离株的序列分析表明，感染源并非单一毒株，在治疗这些患者时普遍预防措施存在多处漏洞。
