Infecção pelo vírus da Hepatite e entre pacientes com níveis alterados de Alanina Aminotransferase

• Ano de defesa: 2020
• Autor(a) principal: Conte, Danielle Dias [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Hepatitis E; Alanine Aminotransferase; VHE; Brazil; Hepatite E; Alanina Aminotransferase; Brasil
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9854121; https://hdl.handle.net/11600/64715

Introduction: Hepatitis E virus (VHE) infection affects about 20 million people worldwide annually, with 3 million cases of acute infection and 56,000 deaths. The route of transmission is fecal-oral, and there is evidence of zoonotic transmission. The infection is asymptomatic in 50% of cases but can cause self-limited acute hepatitis. Symptomatic manifestation is commonly reported in men over 50 years of age. In women who acquire VHE during late pregnancy, 20% develop severe forms with fulminant liver failure. There are reports of chronic infection in immunocompromised patients, especially in solid organ transplant recipients or with pre-existing liver disease. Recent studies have shown that in VHE infections, without other viral hepatitis, there is a three-fold increase in the level of alanine aminotransferase (ALT) compared to the upper limit (56 IU/L). This elevation may be a predictive factor of VHE infection. Objective: To evaluate the increase in levels of alanine aminotransferase (ALT) with VHE infection in patients of the emergency care service of two hospitals in the city of São Paulo (Hospital Beneficência Portuguesa and Hospital São Paulo). Casuistic: Cross-sectional study with 400 serological samples of mischaracterized patients who presented increased ALT levels. Method: Serum samples with ALT elevation (> 200 IU/L) were submitted to enzymatic immunoassay for qualitative detection of IgM and IgG antibodies (Commercial Kit- Beijing Wantai Biological Pharmacy Enterprise, Beijing, China). The samples that presented "reactive" results for anti-VHE IgM were submitted to viral RNA extraction for real-time RT-PCR VHE-RNA. Results: In total, 400 patients (200 from each HBP) were tested for VHE by real-time RT-PCR (RT-qPCR), from serum samples. Among these patients, 90 (45 of each BP) were randomly selected for the detection of IgM anti-VHE antibodies by ELISA. In addition, the 200 HSP patients were investigated for the presence of anti-hepatitis A IgM (HAV), B (HBV), and C (IgG-HCV) by ELISA. The age of the patients ranged from 0.8 to 91 years (mean = 46.29±24.47, median = 48). In the RT-qPCR VHE tests, 16 patients were positive (4.1%), 9 HSP and 7 HBP. In the Anti-VHE IgM ELISA test, 2 BPH patients were reactive (2.22%). In the latter, alt values were 1505 and 3831 IU/L, a 77-year-old male patient, and a 39-year-old female, respectively. In the latter, alt values were 1505 and 3831 IU/L, a 77-year-old male patient, and a 39-year-old female, respectively. In positive RT-qPCR, the ALT mean was 441.87 IU/L (range 299 to 698). In the 200 HSP patients, they were reagents for HAV, B, and C, 9%, 4.5%, and 3.5%, respectively. Two RT-qPCR-positive patients for VHE were reagents for HAV and B separately. Conclusion: Hepatitis E remains underreported and neglected in Brazil, with a higher frequency than normally researched. Since this research was conducted in the population of two hospitals of the Unified Health System, which usually serves low-income people and may eventually have poor hygiene conditions. Thus, it is important to establish a routine diagnosis of HEV that allows early intervention and improve the prognosis of patients.