CLINICAL-EPIDEMIOLOGICAL AND MOLECULAR-GENETIC CHARACTERISTICS OF THE FIRST CASE OF ACUTE HEPATITIS E IN THE GRODNO REGION

Abstract

Background. The emergence of hepatitis E virus (HEV) in developed countries is driven by improved diagnostic tools, increased clinician awareness of the autochthonous nature of transmission and the potential for life-threatening acute and chronic liver damage. Objective. To present the first confirmed case of acute hepatitis E (AHE) caused by the E virus of the first genotype (HEV-1) in the Grodno region, registered in 2022. Material and methods. The patient is a native of Pakistan, who has been living and working in Grodno for recent years. He visited Italy and Pakistan several times within last six months, returned to Grodno 2 weeks before the onset of clinical manifestations of the disease. The patient was hospitalized in the Regional infectious diseases hospital. The methods for laboratory and etiological diagnosis of hepatitis included: general clinical methods, serological and molecular genetic ones (ELISA - IgM, IgG HEV; PCR - RNA HEV, genotyping and sequencing of the HEV genome). Results. Epidemiological, clinical and laboratory methods made it possible to exclude viral hepatitis A, B, C, D and establish the diagnosis of AHE of icteric (bilirubin at the height of the disease - 209.1 μmol/l, ALT - 1795 U/l), moderate form with a favorable outcome. IgM and IgG to HEV were detected in the patient's blood. HEV RNA was isolated from the patient's biological material. The isolated sequence in 100% bootstrap replications was assigned to HEV genotype 1. The insignificant value of the evolutionary distance between the "Grodno" sequence and the sequence isolated from a patient's body in Pakistan indicated a high degree of their homology, which made it possible to conclude that this case of AHE was imported. Conclusions. For the first time in the Grodno region, there was registered an imported case of AHE acquired during travel to HEV hyperendemic territory. The identified sequence is 100% HEV-1 genotype and 94.3% homologous to the sequence obtained from a patient in Pakistan. Under favourable conditions, HEV-1, which has a significant epidemic potential, can cause the development of HEV outbreaks.