Picchi Giovanna, Ricciardi Alessandra, Marola Lara, Di Norcia Monica, D'alessandro Margherita, Mariani Rinalda, Cacciatore Pierluigi, Sozio Federica, Necozione Stefano, Cofini Vincenza, Parruti Giustino, Villano Umbertina, Madonna Elisabetta, Marcantonio Cinzia, Bruni Roberto, Mataj Elida, Grimaldi Alessandro, Ciccaglione Anna Rita
Infectious Diseases Department, Ospedale Regionale "San Salvatore", L'Aquila, Italy.
Infectious Diseases Department, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy.
Infez Med. 2023 Mar 1;31(1):70-78. doi: 10.53854/liim-3101-10. eCollection 2022.
HEV-3 and HEV-4 are emerging cause of zoonotic acute hepatitis in high-income countries. In Europe the disease is underdiagnosed but hyperendemic areas have been identified. We describe a population with acute non-ABC (n-ABC) hepatitis in Abruzzo, the Italian region with the highest seroprevalence reported. The study was included in the surveillance of acute hepatitis E by the Italian Institute of Public Health started in 2004 and implemented in 2015.
Patients with n-ABC hepatitis during 2004-2018 in all Abruzzo Infectious Disease Departments were tested for HEV-IgM (Wantai) and HEV-RNA (ORF3). Positive samples were sequenced (Beckman Coulter) and phylogenetic tree (MEGA 6.06 software) obtained. Clinical data were retrospectively collected and an alimentary risk factors-questionnaire was administered. Categorical and quantitative variables were compared (Chi square test or Fisher test and Wilcoxon test).
97 hospitalized patients were tested, most cases (91.7%) after 2015. Overall, HEV-IgM resulted positive in 36% and HEV-RNA detectable in 33.3%. All 24 sequences obtained were HEV-3, with two small groups of closely related strands. L'Aquila was the Province with higher positivity rate (44%). Retrospective clinical data were acquired in 86.5% of patients, no one having liver failure. Higher ALT-levels (1282.34 vs 893.25, p=0.0139) and extrahepatic symptoms (OR 16.69, p=0.0018) were strongly associated with HEV-IgM presence. Two small outbreaks are described.
More than one third of n-ABC hepatitis in all Abruzzo are HEV-related. Extrahepatic symptoms correlate with HEV aetiology. Implementing surveillance is mandatory to really understand the extent of the disease.
戊型肝炎病毒3型（HEV-3）和4型（HEV-4）在高收入国家正成为人畜共患急性肝炎的病因。在欧洲，该病诊断不足，但已确定了高流行地区。我们描述了意大利血清阳性率最高的阿布鲁佐地区一群患有急性非ABC型（n-ABC）肝炎的人群。该研究纳入了意大利公共卫生研究所于2004年启动并于2015年实施的戊型肝炎急性监测。
对2004年至2018年期间阿布鲁佐所有传染病科的n-ABC肝炎患者进行戊型肝炎IgM（万泰）和戊型肝炎RNA（ORF3）检测。对阳性样本进行测序（贝克曼库尔特公司）并构建系统发育树（MEGA 6.06软件）。回顾性收集临床数据并进行饮食风险因素问卷调查。比较分类变量和定量变量（卡方检验或费舍尔检验以及威尔科克森检验）。
对97名住院患者进行了检测，大多数病例（91.7%）在2015年之后。总体而言，戊型肝炎IgM检测呈阳性的占36%，可检测到戊型肝炎RNA的占33.3%。获得的所有24个序列均为HEV-3，有两组密切相关的毒株。拉奎拉省的阳性率较高（44%）。86.5%的患者获得了回顾性临床数据，无一例发生肝衰竭。较高的丙氨酸转氨酶水平（1282.34对893.25，p=0.0139）和肝外症状（比值比16.69，p=0.0018）与戊型肝炎IgM的存在密切相关。描述了两起小规模疫情。
阿布鲁佐所有n-ABC肝炎中超过三分之一与戊型肝炎有关。肝外症状与戊型肝炎病因相关。必须开展监测以真正了解该病的范围。
