Limits...
Re-infection following sustained virological response with a different hepatitis C virus genotype: implications for infection control policy.

O'Shaughnessy MM, O'Regan JA, Murray FE, Connell JA, Duffy MP, Francis VM, Dwyer S, Thornton LM, Conlon PJ - Clin Kidney J (2012)

Bottom Line: He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a.Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection.This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.

ABSTRACT
We report the case of a 45-year-old haemodialysis patient who achieved a sustained virological response (SVR) following pegylated interferon therapy for hepatitis C virus (HCV) genotype 2 infection. He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a. Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection. This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

No MeSH data available.


Related in: MedlinePlus

Phylogenetic tree demonstrating closely related HCV genotype 3a subtypes of index patient and Patient X. Unrooted neighbour-joining (NJ) tree HCV nucleotide sequences in the E1/E2 region (300 bp) with outgroup D26556 (genotype 3b). The nucleotide sequences of index patient and X1, X2 and X3 of Patient X are indicated (see arrow). The NJ tree generated by heuristic search using PAUP [8]. The tree was constructed using the GTR + G + I model of nucleotide substitution selected by jModeltest with 1000 bootstrap replicates. The bootstrap values >700 are displayed as percentage values.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4400513&req=5

fig2: Phylogenetic tree demonstrating closely related HCV genotype 3a subtypes of index patient and Patient X. Unrooted neighbour-joining (NJ) tree HCV nucleotide sequences in the E1/E2 region (300 bp) with outgroup D26556 (genotype 3b). The nucleotide sequences of index patient and X1, X2 and X3 of Patient X are indicated (see arrow). The NJ tree generated by heuristic search using PAUP [8]. The tree was constructed using the GTR + G + I model of nucleotide substitution selected by jModeltest with 1000 bootstrap replicates. The bootstrap values >700 are displayed as percentage values.

Mentions: A detailed epidemiological and molecular investigation was initiated. There was no evidence to support HCV transmission outside the dialysis unit or within the patient's holiday dialysis unit. A review of the genotypes of all HCV viraemic patients within the unit identified two additional patients with HCV genotype 3a infection. One patient (Patient X) had received dialysis alongside the index patient (i.e. same shift, room and nurse but different dialysis machine) throughout the month of December, at which time his HCV viral load was >69 000 000 IU/mL. Phylogenetic analysis of fragments of the E1/E2 region, including the hypervariable region, of HCV RNA from Patient X and the index patient demonstrated that there was a strong possibility that both viruses were genetically related (see Figure 2). We concluded that the index patient had been infected with HCV genotype 3a from Patient X while they were being cohorted together for dialysis.


Re-infection following sustained virological response with a different hepatitis C virus genotype: implications for infection control policy.

O'Shaughnessy MM, O'Regan JA, Murray FE, Connell JA, Duffy MP, Francis VM, Dwyer S, Thornton LM, Conlon PJ - Clin Kidney J (2012)

Phylogenetic tree demonstrating closely related HCV genotype 3a subtypes of index patient and Patient X. Unrooted neighbour-joining (NJ) tree HCV nucleotide sequences in the E1/E2 region (300 bp) with outgroup D26556 (genotype 3b). The nucleotide sequences of index patient and X1, X2 and X3 of Patient X are indicated (see arrow). The NJ tree generated by heuristic search using PAUP [8]. The tree was constructed using the GTR + G + I model of nucleotide substitution selected by jModeltest with 1000 bootstrap replicates. The bootstrap values >700 are displayed as percentage values.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400513&req=5

fig2: Phylogenetic tree demonstrating closely related HCV genotype 3a subtypes of index patient and Patient X. Unrooted neighbour-joining (NJ) tree HCV nucleotide sequences in the E1/E2 region (300 bp) with outgroup D26556 (genotype 3b). The nucleotide sequences of index patient and X1, X2 and X3 of Patient X are indicated (see arrow). The NJ tree generated by heuristic search using PAUP [8]. The tree was constructed using the GTR + G + I model of nucleotide substitution selected by jModeltest with 1000 bootstrap replicates. The bootstrap values >700 are displayed as percentage values.
Mentions: A detailed epidemiological and molecular investigation was initiated. There was no evidence to support HCV transmission outside the dialysis unit or within the patient's holiday dialysis unit. A review of the genotypes of all HCV viraemic patients within the unit identified two additional patients with HCV genotype 3a infection. One patient (Patient X) had received dialysis alongside the index patient (i.e. same shift, room and nurse but different dialysis machine) throughout the month of December, at which time his HCV viral load was >69 000 000 IU/mL. Phylogenetic analysis of fragments of the E1/E2 region, including the hypervariable region, of HCV RNA from Patient X and the index patient demonstrated that there was a strong possibility that both viruses were genetically related (see Figure 2). We concluded that the index patient had been infected with HCV genotype 3a from Patient X while they were being cohorted together for dialysis.

Bottom Line: He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a.Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection.This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.

ABSTRACT
We report the case of a 45-year-old haemodialysis patient who achieved a sustained virological response (SVR) following pegylated interferon therapy for hepatitis C virus (HCV) genotype 2 infection. He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a. Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection. This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

No MeSH data available.


Related in: MedlinePlus