Kuno Akiko, Ido Kenichi, Isoda Norio, Satoh Yoshiaki, Ono Kazunori, Satoh Shin, Inamori Hideaki, Sugano Kentaro, Kanai Nobuyuki, Nishizawa Tsutomu, Okamoto Hiroaki
Department of Gastroenterology, Jichi Medical School, 329-0498, Tochigi-Ken, Japan
Hepatol Res. 2003 Jul;26(3):237-242. doi: 10.1016/s1386-6346(03)00197-9.
We encountered a patient with sporadic acute hepatitis E who had not traveled to areas endemic for hepatitis E virus (HEV) infection and may have been infected in Japan. The patient was a 47-year-old male who had no history of blood transfusion or contact with travelers to hepatitis E-endemic regions or unspecified individuals. The disease presented with general malaise, fever, and brown urine as chief complaints in April 2002. Various hepatitis virus markers were negative, but IgM class antibodies to hepatitis E virus (anti-HEV) and HEV RNA were positive, and the patient was diagnosed with acute hepatitis E. The entire nucleotide sequence (7240 bases) of HEV (HE-JK4) isolated from this patient was determined and compared with known HEV strains. HE-JK4 belonged to genotype IV and exhibited higher similarities to genotype IV HEV strains previously isolated in Japan than to those isolated in China, Taiwan, and Vietnam. The patient's family members living with him were negative for anti-HEV IgG and IgM, but their pet cat was anti-HEV IgG-positive. This finding suggests a potential route of infection of sporadic cases of hepatitis E in Japan. Since the presence of HEV indigenous to Japan is predicted, HEV infection should be considered in the diagnosis of acute hepatitis of unknown cause, even for patients who have not traveled abroad.
我们遇到了一名散发性急性戊型肝炎患者，他未曾前往戊型肝炎病毒（HEV）感染的流行地区，可能是在日本感染的。该患者为一名47岁男性，无输血史，也未与前往戊型肝炎流行地区的旅行者或身份不明的个体接触过。2002年4月，该疾病以全身乏力、发热和茶色尿为主诉发病。各种肝炎病毒标志物均为阴性，但戊型肝炎病毒IgM类抗体（抗-HEV）和HEV RNA呈阳性，患者被诊断为急性戊型肝炎。测定了从该患者分离出的HEV（HE-JK4）的完整核苷酸序列（7240个碱基），并与已知的HEV毒株进行了比较。HE-JK4属于IV型基因型，与先前在日本分离出的IV型基因型HEV毒株的相似性高于在中国、台湾和越南分离出的毒株。与该患者共同生活的家庭成员抗-HEV IgG和IgM均为阴性，但其宠物猫抗-HEV IgG呈阳性。这一发现提示了日本散发性戊型肝炎病例的潜在感染途径。由于预计日本存在本土HEV，即使对于未出过国的患者，在诊断病因不明的急性肝炎时也应考虑HEV感染。
