Transfusion-associated hepatitis E, France.

摘要: To the Editor: Hepatitis E virus (HEV) is a leading cause of acute and fulminant hepatitis in developing countries (1). In industrialized countries, HEV seroprevalence rates 0.4%–3% are common, evidence mounting that autochthonous transmission might account for substantial proportion infections (1–3). Whereas fecal-oral preponderant other routes have been demonstrated among them consumption pork or boar meat (1,4). Parenteral was first suggested but not (5,6). Because viruses cannot be fully inactivated blood products, recently emerged as transfusion-transmitted pathogen, with 6 reported cases, including 3 which comparative analysis sequences from donor recipient performed (7). We describe what is, to our knowledge, case France worldwide involving child recipient. A 7-year-old boy examined June 2006; he had erythematous-papulous skin an increased level alanine aminotransferase (ALT, 796 IU/L) 1 week’s duration. From October 2005 May 2006, received several courses combined chemotherapy rhabdoid tumor his kidney. Therapy included carboplatin, cyclophosphamide, etoposide, adriamycin, vincristine, and, because tumor’s hematotoxicity, 22 transfusions concentrated erythrocytes platelets. Peak levels ALT bilirubin were reached 4 weeks after onset (2,001 IU/L 49 μmol/L, respectively), returned normal range (8–45 later. During follow-up examination, boy’s prothrombin index remained >80%, clinical signs mostly consisted jaundice. diagnosis established by detection antibodies serum (EIAgen Kits, Adaltis Development Inc., Laval, Quebec, Canada) RNA in-house assays. Other infectious noninfectious causes excluded. immunoglobulin M (IgM) weakly positive 2006 (optical density ratio = 1.6), then strongly next month (ratio 10.8); IgG negative. detected samples collected real-time PCR targeted open reading frame 2 region genome. Sequences primers/probe follows: 5′-aattratttcgtcggcygg-3′; HevMrsRTRev: 5′acwgtcggctcgccattg-3′; HevMrsFam: 5′-FAM-actcycgccasgtygtctca-TAMRA-3′. Serum taken 12 U packed erythroctyes received, at time, during 3-months period before tested RNA; sample positive. Concentrated (310 mL) this donation transfused collection developed. IgM donation, indicates occurred prodromic phase disease. nucleotide identical. Phylogenetic showed they clustered together closely related genotype 3f, prevalent Europe (Figure [8]). Figure Outline phylogenetic tree (complete figure available online, http://www.cdc.gov/EID/13/4/zzz-T.htm) constructed neighbor-joining method on basis partial (ORF) ... The 24-year-old man. He did travel outside metropolitan 8 months donating blood. Anti-HEV seroconversion observed 24 whereas anti-HEV within values time No any time. products donor. Our data show transmitted child. On retrospective detection, infections, all adult recipients, HEV-hyperendemic Transfusion-transmitted strains belonged different genotypes/subtypes corresponded those found same geographic areas (Figure). In France, neither nor systematically donors, donations currently ALT. absence systematic testing, may hampered viremia seroconversion, possible short persistence antibodies, high frequency subclinical (1,2,5). these data, improved knowledge epidemiology general population donors needed guide screening policy products. Another concern potential severity E. Previously cases contamination through transfusion spontaneous recovery. However, although typically self-limited, potentially life-threatening mortality 0.2%–4%, reaching 20% pregnant women Fatal outcome has also described children (10). summary, HEV-contaminated challenge safety transfusion, countries.