Rat Hepatitis E in an Immunocompromised Patient
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Rat Hepatitis E in an Immunocompromised Patient
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circulates in rats in Hong Kong [3].
We recently managed a teenage patient in whom rat hepatitis E virus (HEV) was detected in blood by a real-time RT-PCR assay during investigation of worsening cholestasis. The patient developed cholestasis in the course of a very complicated history of acute myeloid leukemia including relapse after failed hematopoietic system cell transplant, graft versus host disease, cytomegalovirus infection, and staphylococcal septicemia. The pediatricians had no experience in managing this infection. To aid understanding, management and counseling, we performed a PubMed search using the keywords “Rat hepatitis E” and noted only three publications describing rat HEV infection in humans [1,2]. Two of these publications were from Hong Kong and one from Canada. According to the latest epidemiological data from the Hong Kong Center for Health protection, there have been 14 confirmed cases of rat HEV in Hong Kong between the years 2017 and 2020, including the current case. Rat HEV is an underrecognized cause of hepatitis infection, which is missed by commonly performed molecular diagnostic assays for hepatitis E. Serological assays may cross-react between human and rat HEV, but have been known to miss cases of rat HEV, especially in immunocompromised persons [3]. The source of rat HEV infection in our patient is uncertain at the time of writing but screening of archived rodent samples showed that rat HEV
INDIAN PEDIATRICS
SUJOY NEOGI* AND SHASANKA SHEKHAR PANDA Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India. *[email protected] REFERENCES
Viral hepatitis, including HEV is a notifiable disease in Hong Kong. Sanitation is the most important measure in prevention of hepatitis E, consisting of proper treatment and disposal of human waste, higher standards for public water supplies, improved personal hygiene procedures, sanitary food preparation and pest control [4]. Cooking meat at 71°C for five minutes kills the hepatitis E virus. Zoonotic HEV is also a potential threat to the blood product supply [4,5]. The viral load in blood products required to cause transfusion-transmitte
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