肾移植后慢性戊型肝炎伴抗体反应提示再感染：病例报告。
Chronic hepatitis E after kidney transplantation with an antibody response suggestive of reinfection: a case report.
机构信息
Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hermann-Herder-Str, 11 79104, Freiburg, Germany.
Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
出版信息
BMC Infect Dis. 2019 Jul 30;19(1):675. doi: 10.1186/s12879-019-4307-6.
BACKGROUND
Hepatitis E virus (HEV) infection is now recognized as a major cause of acute hepatitis worldwide. HEV specific antibodies develop shortly after infection and are thought to confer protection.
CASE PRESENTATION
We report an immunocompromised patient who developed chronic HEV infection despite the presence of high level antibodies. HEV infection was detected using RT-PCR upon diagnostic evaluation due to increased liver enzymes. Upon retrospective analysis of stored serum samples we found that the patient was HEV RNA positive since 7 months. Chronic HEV infection was successfully treated with ribavirin.
CONCLUSIONS
In conclusion, the patient suffered from a chronic course of HEV infection, which was successfully treated with ribavirin. Our case underlines the importance of RT-PCR for HEV diagnostics in immunosuppressed patients and supports the notion that HEV antibodies do not confer universal protection. Counseling patients at risk for chronic HEV infection seems advisable. The role of the humoral and T-cell mediated immune response in cases of HEV reinfection deserves further study.
背景
戊型肝炎病毒（HEV）感染现已被认为是全球范围内急性肝炎的主要病因。HEV 特异性抗体在感染后不久即产生，并被认为可提供保护。
病例介绍
我们报告了一例免疫功能低下的患者，尽管存在高水平的抗体，但仍发生慢性 HEV 感染。由于肝酶升高，在诊断评估时通过 RT-PCR 检测到 HEV 感染。通过对存储的血清样本进行回顾性分析，我们发现该患者自 7 个月前起即呈 HEV RNA 阳性。慢性 HEV 感染用利巴韦林成功治疗。
结论
总之，该患者患有慢性 HEV 感染，用利巴韦林成功治疗。我们的病例强调了 RT-PCR 在免疫抑制患者中进行 HEV 诊断的重要性，并支持 HEV 抗体不能提供普遍保护的观点。对有发生慢性 HEV 感染风险的患者进行咨询似乎是合理的。在 HEV 再感染的情况下，体液和 T 细胞介导的免疫反应的作用值得进一步研究。
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