Hepatitis E in Cuba: the case report of an infected pregnant woman

Abstract number: R2483

Montalvo Villalba M., Rodriguez Lay L., Chandra V., Bello Corredor M., Gutierrez Moreno A., Sariego Frometa S., Sanchez Wong M., Jameel S.

The HEV is transmitted primarily through the faecal–oral route in contaminated drinking water. It has been classified in the genus Hepevirus of the family Hepeviridae. Although there is only one serotype four major genotypes of HEV have so far been reported. Infection leads to high mortality rates among pregnant woman in their third trimester of pregnancy (20–25%). We report here the case of a 22 year-old Cuban pregnant woman with a gestational period of 35 weeks, admitted in 2005. She reported four days history of febrile episodes, asthenia, epigastric pain, nauseas, and vomiting. Her urine was dark-yellow and her faeces white. The patient had no previous jaundice, no international travel and no eats exotic food. Physical examination reveled icteric sclera, abdominal examination revealed an enlarged uterus according to gestational age and a fetal heart rate of 140 beats/min; the liver and spleen were not palpable. The results of biochemical indicators in blood showed 47.9 mmol/L creatinine, 358.1 mmol/L uric acid, 143.2 IU/L ASAT, 58.4 IU/L ALAT and 50 mmol/L of direct bilirubin. Coagulogram revealed a blood clotting time of 8 min, platelet counts 218×10⁹ cells/L and retraction of the blood clot. The clinical signs improved and enzymatic tests returned to normal levels 4 weeks after onset of symptoms. The hepatitis A virus IgM, HBsAg, HBc IgM and anti-HCV were all negative. Anti-HEV IgM was found to be positive, total anti-HEV showed increasing levels in several determinations, which was a strong evidence of acute HEV infection. Viral genomes were detected in stool samples using primers specific for the open reading frame1, described by Zhai. PCR amplification of an RNA dependent RNA polymerase was used as a consensus genomic region for HEV genotyping. A phylogenetic tree (Fig. 1) was constructed for this sequence and the four major genotypes were defined. The Cuban strain CUB2–2005 clustered within the Asian genotype I and was closely related to Indian HEV strains. It shared 98% nucleotide homology with Yam-67 isolated in Yamuna Nagar.. This molecular characterisation of an indigenous HEV strain from the Americas showed for the first time the presence of HEV genotype I in this region. It is noteworthy that HEV shows a global presence and the genotype distribution, while dominant in a given geographic area, is not limited to it. The case reported in this letter had a satisfactory clinical course of her pregnancy and successfully delivered at 39 weeks.

Phylogenetic tree constructed on the basis of 307 nucleotides (RdRp) from ORF1 region using the Neighbour Joining method. Bootstrap values for 1000 replicates that were above 70% are shown in the internal nodes. The major branches represent HEV genotypes.