Sikora C, Tipples G, Pang X-L, Andonov A
Alberta Health Services, Edmonton, AB.
University of Alberta, Edmonton, AB.
Can Commun Dis Rep. 2017 Nov 2;43(11):245-246. doi: 10.14745/ccdr.v43i11a07.
We identified a case of acute Hepatitis A virus (HAV) infection linked to cannabis use. The local Public Health department received report of a man in his mid-20s with a classic presentation of hepatitis - jaundice, abdominal pain, vomiting, general malaise, and dark urine - as well as elevated serum aminotransferase levels and a positive anti-HAV IgM. Upon questioning, he reported no contact with ill individuals, or travel outside his metropolitan area. His exclusive source of water was the local municipal supply. He reported consuming mainly pre-packaged lower risk foods from large chain-style supermarket stores and eating at several local restaurants. While administering the questionnaire, the investigator identified that the patient smoked cannabis. Upon request, the patient agreed to provide a sample of cannabis for testing purposes. A viral elution of fresh cannabis leaves was completed. The sequences derived from the patient's serum sample and the eluate from the cannabis leaves were identical, but did not match any other HAV sub-genotype 1B sequences from Canadian isolates within the National Microbiology Laboratory database. Hepatitis A virus can survive >60 days when dried and kept at room temperature and low humidity; HAV can remain infectious in water at room temperature for 300 days. It cannot be concluded with certainty that the cannabis was the source of the hepatitis A; however, as other sources were excluded, or were of lesser probability, the association of cannabis with his disease acquisition remains strong.
我们发现了一例与使用大麻相关的急性甲型肝炎病毒（HAV）感染病例。当地公共卫生部门收到报告，一名25岁左右的男子出现了典型的肝炎症状——黄疸、腹痛、呕吐、全身不适和深色尿液——同时血清转氨酶水平升高且抗HAV IgM呈阳性。经询问，他报告称没有与患病个体接触，也没有离开其所在大都市区旅行。他唯一的水源是当地市政供水。他报告说主要食用大型连锁超市预包装的低风险食品，并在当地几家餐馆就餐。在填写问卷时，调查人员发现该患者吸食大麻。经请求，患者同意提供一份大麻样本用于检测。对新鲜大麻叶进行了病毒洗脱。从患者血清样本和大麻叶洗脱液中获得的序列相同，但与国家微生物实验室数据库中加拿大分离株的任何其他HAV 1B亚基因型序列均不匹配。甲型肝炎病毒在干燥并保存在室温及低湿度环境下时可存活超过60天；HAV在室温水中可保持传染性300天。虽然不能确定大麻就是甲型肝炎的来源；然而，由于其他来源已被排除或可能性较小，大麻与他感染疾病之间的关联仍然很强。
