Laboratorio Nacional de Referencia de Hepatitis Virales, Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos G. Malbrán, Av. Vélez Sarsfield 563 (CP 1281), Buenos Aires, Argentina.
J Clin Virol. 2011 Oct;52(2):138-41. doi: 10.1016/j.jcv.2011.06.015. Epub 2011 Jul 27.
In recent years, an increasing number of infections with genotype 3 hepatitis E virus (HEV) have been reported in western countries. Data in South America, however, are still scarce. Swine and human variants previously described in Argentina are closely related to a human Austrian one.
To identify whether HEV is still circulating in Argentina.
Sera and stool samples from adults and children with unexplained acute liver disease referred to our center during the last six years were prospectively studied. Dual infection with hepatitis A was retrospectively studied in a group of children with fulminant hepatic failure.
Fifteen new cases (13 adults and 2 children), seven of whom required hospitalization, were diagnosed. Nine had detectable HEV RNA, and one had imported genotype 1. Subgenotype 3i HEV-related variants are still circulating. Five autochthonous sequences, related to European, American and Japanese ones, grouped in subgenotype 3a. One case had a subgenotype 3b variant.
The polyphyletic variants widespread in Argentina suggest multiple sources of infection. Whether or not their reservoir is swine merits further investigation. Since hepatitis E is still considered rare, differential laboratory testing in unexplained acute liver disease is not routinely performed in Argentina. Broadening awareness of this disease is important in light of the decrease in hepatitis A incidence since universal vaccination was implemented in 2005. The diagnosis of hepatitis E with a combination of serological and molecular tools is needed to better understand its epidemiology and impact on the clinical management of patients with unexplained increased transaminases.
近年来，越来越多的西方国家报告了基因型 3 型戊型肝炎病毒（HEV）感染。然而，南美洲的数据仍然很少。此前在阿根廷描述的猪和人类变异株与奥地利的一种人类变异株密切相关。
确定 HEV 是否仍在阿根廷流行。
在过去六年中，我们中心前瞻性研究了不明原因急性肝疾病的成人和儿童的血清和粪便样本。在一组暴发性肝衰竭的儿童中，回顾性研究了与甲型肝炎的双重感染。
诊断出 15 例新病例（13 例成人和 2 例儿童），其中 7 例需要住院治疗。9 例可检测到 HEV RNA，1 例为进口基因型 1。亚基因型 3i 与 HEV 相关的变异株仍在传播。5 个与欧洲、美洲和日本相关的本土序列，分为亚基因型 3a。1 例为亚基因型 3b 变异株。
阿根廷广泛存在的多系变异株提示存在多种感染源。其储主是否为猪值得进一步研究。由于戊型肝炎仍被认为罕见，因此在阿根廷，对不明原因急性肝疾病未进行常规的实验室检测。鉴于自 2005 年普遍接种疫苗以来甲型肝炎发病率下降，提高对这种疾病的认识很重要。通过血清学和分子工具联合诊断戊型肝炎，有助于更好地了解其流行病学和对不明原因转氨酶升高患者的临床管理的影响。
