Emerging Infectious Diseases (Dec 2018)

Rat Hepatitis E Virus as Cause of Persistent Hepatitis after Liver Transplant

  • Siddharth Sridhar,
  • Cyril C.Y. Yip,
  • Shusheng Wu,
  • Jianpiao Cai,
  • Anna Jin-Xia Zhang,
  • Kit-Hang Leung,
  • Tom W.H. Chung,
  • Jasper F.W. Chan,
  • Wan-Mui Chan,
  • Jade L.L. Teng,
  • Rex K.H. Au-Yeung,
  • Vincent C.C. Cheng,
  • Honglin Chen,
  • Susanna K.P. Lau,
  • Patrick C.Y. Woo,
  • Ning-Shao Xia,
  • Chung-Mau Lo,
  • Kwok-Yung Yuen

DOI
https://doi.org/10.3201/eid2412.180937
Journal volume & issue
Vol. 24, no. 12
pp. 2241 – 2250

Abstract

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All hepatitis E virus (HEV) variants reported to infect humans belong to the species Orthohepevirus A (HEV-A). The zoonotic potential of the species Orthohepevirus C (HEV-C), which circulates in rats and is highly divergent from HEV-A, is unknown. We report a liver transplant recipient with hepatitis caused by HEV-C infection. We detected HEV-C RNA in multiple clinical samples and HEV-C antigen in the liver. The complete genome of the HEV-C isolate had 93.7% nt similarity to an HEV-C strain from Vietnam. The patient had preexisting HEV antibodies, which were not protective against HEV-C infection. Ribavirin was an effective treatment, resulting in resolution of hepatitis and clearance of HEV-C viremia. Testing for this zoonotic virus should be performed for immunocompromised and immunocompetent patients with unexplained hepatitis because routine hepatitis E diagnostic tests may miss HEV-C infection. HEV-C is also a potential threat to the blood product supply.

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