Klink Patrycja, Harms Dominik, Altmann Britta, Dörffel Yvonne, Morgera Ulrike, Zander Steffen, Bock C Thomas, Hofmann Jörg
Department of Infectious Diseases, Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, 13353 Berlin, Germany.
Outpatient Clinic, Charité, Universitätsmedizin Berlin, Berlin, Germany.
One Health. 2023 Mar 22;16:100528. doi: 10.1016/j.onehlt.2023.100528. eCollection 2023 Jun.
In immunocompromised individuals persisting viremia frequently leads to a chronic hepatitis E virus (HEV) infection. Zoonotic transmission of HEV from pigs and wild boar to humans is proven and sporadic infections with rabbit HEV (raHEV) have recently been reported. Here, the molecular characterisation of a raHEV strain isolated from an immunocompromised, chronically HEV-infected, heart-transplanted patient is described. After successful ribavirin (RBV) treatment of a HEV infection in 2019, the patient was again tested HEV positive in 2021 and received a second RBV therapy cycle. Full-length HEV genome amplification and next generation sequencing was performed on a plasma sample taken between first and second cycle of RBV therapy and a stool sample taken two months after starting the second cycle. The sequence of plasma (raHEV-83) and stool (raHEV-99) derived virus showed the highest nucleotide sequence identity to a Chinese raHEV and a phylogenetic relationship to a raHEV strain isolated from a French patient. Furthermore, sequence analysis revealed the presence of RBV-associated substitutions V1479I and G1634K in the HEV sequences from plasma and additionally K1398R from stool. The results underline the role of rabbits as putative sources of HEV infection and emphasize the need of a one health concept for a better understanding of HEV epidemiology and to develop tools for prevention and control of HEV infection.
在免疫功能低下的个体中，持续性病毒血症常导致慢性戊型肝炎病毒（HEV）感染。已证实HEV可从猪和野猪人畜共患传播给人类，最近还报告了零星的兔HEV（raHEV）感染病例。在此，描述了从一名免疫功能低下、慢性感染HEV的心脏移植患者中分离出的一株raHEV毒株的分子特征。2019年该患者的HEV感染经利巴韦林（RBV）成功治疗后，于2021年再次检测出HEV呈阳性，并接受了第二个RBV治疗周期。在RBV治疗的第一个和第二个周期之间采集的一份血浆样本以及开始第二个周期两个月后采集的一份粪便样本上进行了全长HEV基因组扩增和二代测序。血浆（raHEV-83）和粪便（raHEV-99）来源的病毒序列与一株中国raHEV的核苷酸序列同一性最高，并且与从一名法国患者分离出的一株raHEV毒株存在系统发育关系。此外，序列分析显示血浆HEV序列中存在与RBV相关的替代V1479I和G1634K，粪便中还存在K1398R。这些结果强调了兔子作为HEV潜在感染源的作用，并强调需要一个“同一健康”概念，以便更好地理解HEV流行病学，并开发预防和控制HEV感染的工具。
