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Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A.

Hussain Z, Husain SA, Almajhdi FN, Kar P - Virol. J. (2011)

Bottom Line: The immunological helper/suppressor (CD4+/CD8+) ratio of fulminant hepatitis was significantly lower compared to acute cases.The average quantitative viral load of fulminant cases was significantly higher (P < 0.05).There was similar genotypic distribution in both acute and fulminant category, with predominance of genotype IIIA (70%) compared to IA (30%).

View Article: PubMed Central - HTML - PubMed

Affiliation: PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India. hussainzahep@gmail.com

ABSTRACT

Background: Hepatitis A virus is an infection of liver; it is hyperendemic in vast areas of the world including India. In most cases it causes an acute self limited illness but rarely fulminant. There is growing concern about change in pattern from asymptomatic childhood infection to an increased incidence of symptomatic disease in the adult population.

Objective: In-depth analysis of immunological, viral quantification and genotype of acute and fulminant hepatitis A virus.

Methods: Serum samples obtained from 1009 cases of suspected acute viral hepatitis was employed for different biochemical and serological examination. RNA was extracted from blood serum, reverse transcribed into cDNA and amplified using nested PCR for viral quantification, sequencing and genotyping. Immunological cell count from freshly collected whole blood was carried out by fluorescence activated cell sorter.

Results: Fulminant hepatitis A was mostly detected with other hepatic viruses. CD8+ T cells count increases in fulminant hepatitis to a significantly high level (P = 0.005) compared to normal healthy control. The immunological helper/suppressor (CD4+/CD8+) ratio of fulminant hepatitis was significantly lower compared to acute cases. The serologically positive patients were confirmed by RT-PCR and total of 72 (69.2%) were quantified and sequenced. The average quantitative viral load of fulminant cases was significantly higher (P < 0.05). There was similar genotypic distribution in both acute and fulminant category, with predominance of genotype IIIA (70%) compared to IA (30%).

Conclusions: Immunological factors in combination with viral load defines the severity of the fulminant hepatitis A. Phylogenetic analysis of acute and fulminant hepatitis A confirmed genotypes IIIA as predominant against IA with no preference of disease severity.

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A neighbor-joining phylogenetic tree of genetic relatedness among isolates of hepatitis A virus based on the sequencing of the VP1/2A region. Isolates DQ182500, DQ182498, DQ629076, DQ629075, DQ629088, DQ629094, DQ629086, DQ629078, DQ629087, DQ629084, DQ629077, DQ629100, DQ629090, DQ629081, DQ629096, DQ629083, DQ629095, DQ629085, DQ629093 and DQ629092 were collected during this study, in PCR Hepatitis Laboratory, MAM College and associated LNJ Hospital, New Delhi, India. The phylogenetic analysis revealed that the Indian isolates belong to genotypes IA and predominant III A.
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Figure 4: A neighbor-joining phylogenetic tree of genetic relatedness among isolates of hepatitis A virus based on the sequencing of the VP1/2A region. Isolates DQ182500, DQ182498, DQ629076, DQ629075, DQ629088, DQ629094, DQ629086, DQ629078, DQ629087, DQ629084, DQ629077, DQ629100, DQ629090, DQ629081, DQ629096, DQ629083, DQ629095, DQ629085, DQ629093 and DQ629092 were collected during this study, in PCR Hepatitis Laboratory, MAM College and associated LNJ Hospital, New Delhi, India. The phylogenetic analysis revealed that the Indian isolates belong to genotypes IA and predominant III A.

Mentions: Accommodating large number of sequenced samples (reference and studied sequences) in one phylogenetic tree lacks clarity, therefore for most accurate presentation 2 phylogenetic trees have been constructed as shown in Figure 4 and 5. The genotype of Indian HAV isolates was derived by neighbor-joining phylogenetic tree of hepatitis A virus sequences based on the VP1/2A region. According to phylogenetic analysis, acute cases were divided into genotype IA and IIIA. There was predominance of genotype IIIA with 74% of the total cases sequenced. In fulminant hepatitis A cases, genotype IIIA again was also prevalent (70%) as shown in Table 4. Between the groups the genotype was similarly distributed but within the two groups the prevalence was quite significant.


Immunological and molecular epidemiological characteristics of acute and fulminant viral hepatitis A.

Hussain Z, Husain SA, Almajhdi FN, Kar P - Virol. J. (2011)

A neighbor-joining phylogenetic tree of genetic relatedness among isolates of hepatitis A virus based on the sequencing of the VP1/2A region. Isolates DQ182500, DQ182498, DQ629076, DQ629075, DQ629088, DQ629094, DQ629086, DQ629078, DQ629087, DQ629084, DQ629077, DQ629100, DQ629090, DQ629081, DQ629096, DQ629083, DQ629095, DQ629085, DQ629093 and DQ629092 were collected during this study, in PCR Hepatitis Laboratory, MAM College and associated LNJ Hospital, New Delhi, India. The phylogenetic analysis revealed that the Indian isolates belong to genotypes IA and predominant III A.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117845&req=5

Figure 4: A neighbor-joining phylogenetic tree of genetic relatedness among isolates of hepatitis A virus based on the sequencing of the VP1/2A region. Isolates DQ182500, DQ182498, DQ629076, DQ629075, DQ629088, DQ629094, DQ629086, DQ629078, DQ629087, DQ629084, DQ629077, DQ629100, DQ629090, DQ629081, DQ629096, DQ629083, DQ629095, DQ629085, DQ629093 and DQ629092 were collected during this study, in PCR Hepatitis Laboratory, MAM College and associated LNJ Hospital, New Delhi, India. The phylogenetic analysis revealed that the Indian isolates belong to genotypes IA and predominant III A.
Mentions: Accommodating large number of sequenced samples (reference and studied sequences) in one phylogenetic tree lacks clarity, therefore for most accurate presentation 2 phylogenetic trees have been constructed as shown in Figure 4 and 5. The genotype of Indian HAV isolates was derived by neighbor-joining phylogenetic tree of hepatitis A virus sequences based on the VP1/2A region. According to phylogenetic analysis, acute cases were divided into genotype IA and IIIA. There was predominance of genotype IIIA with 74% of the total cases sequenced. In fulminant hepatitis A cases, genotype IIIA again was also prevalent (70%) as shown in Table 4. Between the groups the genotype was similarly distributed but within the two groups the prevalence was quite significant.

Bottom Line: The immunological helper/suppressor (CD4+/CD8+) ratio of fulminant hepatitis was significantly lower compared to acute cases.The average quantitative viral load of fulminant cases was significantly higher (P < 0.05).There was similar genotypic distribution in both acute and fulminant category, with predominance of genotype IIIA (70%) compared to IA (30%).

View Article: PubMed Central - HTML - PubMed

Affiliation: PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India. hussainzahep@gmail.com

ABSTRACT

Background: Hepatitis A virus is an infection of liver; it is hyperendemic in vast areas of the world including India. In most cases it causes an acute self limited illness but rarely fulminant. There is growing concern about change in pattern from asymptomatic childhood infection to an increased incidence of symptomatic disease in the adult population.

Objective: In-depth analysis of immunological, viral quantification and genotype of acute and fulminant hepatitis A virus.

Methods: Serum samples obtained from 1009 cases of suspected acute viral hepatitis was employed for different biochemical and serological examination. RNA was extracted from blood serum, reverse transcribed into cDNA and amplified using nested PCR for viral quantification, sequencing and genotyping. Immunological cell count from freshly collected whole blood was carried out by fluorescence activated cell sorter.

Results: Fulminant hepatitis A was mostly detected with other hepatic viruses. CD8+ T cells count increases in fulminant hepatitis to a significantly high level (P = 0.005) compared to normal healthy control. The immunological helper/suppressor (CD4+/CD8+) ratio of fulminant hepatitis was significantly lower compared to acute cases. The serologically positive patients were confirmed by RT-PCR and total of 72 (69.2%) were quantified and sequenced. The average quantitative viral load of fulminant cases was significantly higher (P < 0.05). There was similar genotypic distribution in both acute and fulminant category, with predominance of genotype IIIA (70%) compared to IA (30%).

Conclusions: Immunological factors in combination with viral load defines the severity of the fulminant hepatitis A. Phylogenetic analysis of acute and fulminant hepatitis A confirmed genotypes IIIA as predominant against IA with no preference of disease severity.

Show MeSH
Related in: MedlinePlus