Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt

Jason T. Blackard, Susan D. Rouster, Soad Nady, Gehan Galal, Naglaa Marzuuk, Marwaa M. Rafaat, Enas Daef, Salwa Seif El Din, Robert H. Purcell, Suzanne U. Emerson, Kenneth E. Sherman, M. Tarek Shata

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in many developing countries. In Egypt, HEV seroprevalence is among the highest in the world; however, only a very limited number of Egyptian HEV sequences are currently available. Objectives: The objectives were to determine the HEV genotype(s) currently circulating in Egypt. Study design: AVH patients without serologic evidence of hepatitis A, B, and C viruses were evaluated for possible HEV infection using serologic assays for anti-HEV IgM and anti-HEV IgG and real-time PCR for HEV RNA. Stool suspensions from suspected cases were inoculated into rhesus macaques to confirm the presence of HEV. Sequence analysis was utilized to determine HEV genotype. Results: Of 287 subjects with AVH enrolled, 58 had serologic evidence of acute HEV infection. Stool samples for two of these patients were repeatedly positive for HEV RNA by real-time PCR. Macaques experimentally inoculated with these human stools also developed viremia. Sequence analysis of open reading frame (ORF) 1 demonstrated that these isolates belonged to HEV genotype 1 and were 3.9-9.5% divergent from other genotype 1 isolates. ORF2 was 5.3-8.7% divergent from previously reported Egyptian isolates. Conclusions: This study strongly suggests that genotype 1 HEV related to other North African isolates is circulating in acute symptomatic patients in Egypt. Further evaluation of genotypic variability is underway in this highly endemic cohort and is considered an important component of our increased understanding of HEV pathogenesis.

Original languageEnglish
Pages (from-to)140-144
Number of pages5
JournalJournal of Clinical Virology
Volume46
Issue number2
DOIs
Publication statusPublished - 1 Oct 2009

Fingerprint

Hepatitis E virus
Egypt
Virus Diseases
Genotype
Hepatitis
Sequence Analysis
Real-Time Polymerase Chain Reaction
RNA
Hepatitis A virus
Viremia
Seroepidemiologic Studies
Macaca

Keywords

  • Diversity
  • Egypt
  • Genotype
  • Hepatitis E virus (HEV)
  • Symptomatic

Cite this

Blackard, J. T., Rouster, S. D., Nady, S., Galal, G., Marzuuk, N., Rafaat, M. M., ... Shata, M. T. (2009). Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt. Journal of Clinical Virology, 46(2), 140-144. https://doi.org/10.1016/j.jcv.2009.07.007
Blackard, Jason T. ; Rouster, Susan D. ; Nady, Soad ; Galal, Gehan ; Marzuuk, Naglaa ; Rafaat, Marwaa M. ; Daef, Enas ; El Din, Salwa Seif ; Purcell, Robert H. ; Emerson, Suzanne U. ; Sherman, Kenneth E. ; Shata, M. Tarek. / Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt. In: Journal of Clinical Virology. 2009 ; Vol. 46, No. 2. pp. 140-144.
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abstract = "Background: Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in many developing countries. In Egypt, HEV seroprevalence is among the highest in the world; however, only a very limited number of Egyptian HEV sequences are currently available. Objectives: The objectives were to determine the HEV genotype(s) currently circulating in Egypt. Study design: AVH patients without serologic evidence of hepatitis A, B, and C viruses were evaluated for possible HEV infection using serologic assays for anti-HEV IgM and anti-HEV IgG and real-time PCR for HEV RNA. Stool suspensions from suspected cases were inoculated into rhesus macaques to confirm the presence of HEV. Sequence analysis was utilized to determine HEV genotype. Results: Of 287 subjects with AVH enrolled, 58 had serologic evidence of acute HEV infection. Stool samples for two of these patients were repeatedly positive for HEV RNA by real-time PCR. Macaques experimentally inoculated with these human stools also developed viremia. Sequence analysis of open reading frame (ORF) 1 demonstrated that these isolates belonged to HEV genotype 1 and were 3.9-9.5{\%} divergent from other genotype 1 isolates. ORF2 was 5.3-8.7{\%} divergent from previously reported Egyptian isolates. Conclusions: This study strongly suggests that genotype 1 HEV related to other North African isolates is circulating in acute symptomatic patients in Egypt. Further evaluation of genotypic variability is underway in this highly endemic cohort and is considered an important component of our increased understanding of HEV pathogenesis.",
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Blackard, JT, Rouster, SD, Nady, S, Galal, G, Marzuuk, N, Rafaat, MM, Daef, E, El Din, SS, Purcell, RH, Emerson, SU, Sherman, KE & Shata, MT 2009, 'Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt', Journal of Clinical Virology, vol. 46, no. 2, pp. 140-144. https://doi.org/10.1016/j.jcv.2009.07.007

Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt. / Blackard, Jason T.; Rouster, Susan D.; Nady, Soad; Galal, Gehan; Marzuuk, Naglaa; Rafaat, Marwaa M.; Daef, Enas; El Din, Salwa Seif; Purcell, Robert H.; Emerson, Suzanne U.; Sherman, Kenneth E.; Shata, M. Tarek.

In: Journal of Clinical Virology, Vol. 46, No. 2, 01.10.2009, p. 140-144.

Research output: Contribution to journalArticle

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T1 - Genotypic characterization of symptomatic hepatitis E virus (HEV) infections in Egypt

AU - Blackard, Jason T.

AU - Rouster, Susan D.

AU - Nady, Soad

AU - Galal, Gehan

AU - Marzuuk, Naglaa

AU - Rafaat, Marwaa M.

AU - Daef, Enas

AU - El Din, Salwa Seif

AU - Purcell, Robert H.

AU - Emerson, Suzanne U.

AU - Sherman, Kenneth E.

AU - Shata, M. Tarek

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N2 - Background: Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in many developing countries. In Egypt, HEV seroprevalence is among the highest in the world; however, only a very limited number of Egyptian HEV sequences are currently available. Objectives: The objectives were to determine the HEV genotype(s) currently circulating in Egypt. Study design: AVH patients without serologic evidence of hepatitis A, B, and C viruses were evaluated for possible HEV infection using serologic assays for anti-HEV IgM and anti-HEV IgG and real-time PCR for HEV RNA. Stool suspensions from suspected cases were inoculated into rhesus macaques to confirm the presence of HEV. Sequence analysis was utilized to determine HEV genotype. Results: Of 287 subjects with AVH enrolled, 58 had serologic evidence of acute HEV infection. Stool samples for two of these patients were repeatedly positive for HEV RNA by real-time PCR. Macaques experimentally inoculated with these human stools also developed viremia. Sequence analysis of open reading frame (ORF) 1 demonstrated that these isolates belonged to HEV genotype 1 and were 3.9-9.5% divergent from other genotype 1 isolates. ORF2 was 5.3-8.7% divergent from previously reported Egyptian isolates. Conclusions: This study strongly suggests that genotype 1 HEV related to other North African isolates is circulating in acute symptomatic patients in Egypt. Further evaluation of genotypic variability is underway in this highly endemic cohort and is considered an important component of our increased understanding of HEV pathogenesis.

AB - Background: Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in many developing countries. In Egypt, HEV seroprevalence is among the highest in the world; however, only a very limited number of Egyptian HEV sequences are currently available. Objectives: The objectives were to determine the HEV genotype(s) currently circulating in Egypt. Study design: AVH patients without serologic evidence of hepatitis A, B, and C viruses were evaluated for possible HEV infection using serologic assays for anti-HEV IgM and anti-HEV IgG and real-time PCR for HEV RNA. Stool suspensions from suspected cases were inoculated into rhesus macaques to confirm the presence of HEV. Sequence analysis was utilized to determine HEV genotype. Results: Of 287 subjects with AVH enrolled, 58 had serologic evidence of acute HEV infection. Stool samples for two of these patients were repeatedly positive for HEV RNA by real-time PCR. Macaques experimentally inoculated with these human stools also developed viremia. Sequence analysis of open reading frame (ORF) 1 demonstrated that these isolates belonged to HEV genotype 1 and were 3.9-9.5% divergent from other genotype 1 isolates. ORF2 was 5.3-8.7% divergent from previously reported Egyptian isolates. Conclusions: This study strongly suggests that genotype 1 HEV related to other North African isolates is circulating in acute symptomatic patients in Egypt. Further evaluation of genotypic variability is underway in this highly endemic cohort and is considered an important component of our increased understanding of HEV pathogenesis.

KW - Diversity

KW - Egypt

KW - Genotype

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