Case Report
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World J Gastroenterol. Mar 21, 2014; 20(11): 3044-3049
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.3044
Acute hepatitis B of genotype H resulting in persistent infection
Norie Yamada, Ryuta Shigefuku, Ryuichi Sugiyama, Minoru Kobayashi, Hiroki Ikeda, Hideaki Takahashi, Chiaki Okuse, Michihiro Suzuki, Fumio Itoh, Hiroshi Yotsuyanagi, Kiyomi Yasuda, Kyoji Moriya, Kazuhiko Koike, Takaji Wakita, Takanobu Kato
Norie Yamada, Ryuichi Sugiyama, Takaji Wakita, Takanobu Kato, Department of Virology II, National Institute of Infectious Diseases, Shinjyuku-Ku, Tokyo 162-8640, Japan
Norie Yamada, Minoru Kobayashi, Kiyomi Yasuda, Department of Internal Medicine, Center for Liver Diseases, Kiyokawa Hospital, Suginami, Tokyo 166-0004, Japan
Norie Yamada, Ryuta Shigefuku, Minoru Kobayashi, Hiroki Ikeda, Hideaki Takahashi, Chiaki Okuse, Michihiro Suzuki, Fumio Itoh, Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
Hiroshi Yotsuyanagi, Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Kyoji Moriya, Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Shigefuku R, Kobayashi M, Ikeda H, Takahashi H, Okuse C, Suzuki M and Itoh F were the patient’s attending physicians; Yotsuyanagi H, Yasuda K, Moriya K, Koike K, Wakita T and Kato T organized the study; Yamada N, Sugiyama R and Kato T performed the research; Yamada N and Kato T wrote the manuscript.
Supported by Japan Society for the Promotion of Science and the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology of Japan
Correspondence to: Takanobu Kato, MD, PhD, Department of Virology II, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjyuku-Ku, Tokyo 162-8640, Japan. takato@nih.go.jp
Telephone: +81-3-52851111 Fax: +81-3-52851161
Received: October 3, 2013
Revised: November 18, 2103
Accepted: December 5, 2013
Published online: March 21, 2014
Processing time: 165 Days and 21.4 Hours
Abstract

A 47-year-old man presented with general fatigue and dark urine. The laboratory data showed increased levels of hepatic transaminases. The patient was positive for hepatitis B virus (HBV) markers and negative for anti-human immunodeficiency virus. The HBV-DNA titer was set to 7.7 log copies/mL. The patient was diagnosed with acute hepatitis B. The HBV infection route was obscure. The serum levels of hepatic transaminases decreased to normal ranges without any treatment, but the HBV-DNA status was maintained for at least 26 mo, indicating the presence of persistent infection. We isolated HBV from the acute-phase serum and determined the genome sequence. A phylogenetic analysis revealed that the isolated HBV was genotype H. In this patient, the elevated peak level of HBV-DNA and the risk alleles at human genome single nucleotide polymorphisms s3077 and rs9277535 in the human leukocyte antigen-DP locus were considered to be risk factors for chronic infection. This case suggests that there is a risk of persistent infection by HBV genotype H following acute hepatitis; further cases of HBV genotype H infection must be identified and characterized. Thus, the complete determination of the HBV genotype may be essential during routine clinical care of acute hepatitis B outpatients.

Keywords: Acute hepatitis; Chronic hepatitis; Genotyping; Hepatitis B virus; Single nucleotide polymorphisms

Core tip: Hepatitis B virus (HBV) genotype H infection is rare in Asia, particularly in Japan. Here, we report a case of acute hepatitis B caused by a genotype H strain with persistent infection, although most adult cases of acute hepatitis B are self-limiting in Japan. This case suggests that the HBV genotype H infection can be a risk factor for persistent infection. Therefore, it is necessary to investigate the characteristics of genotype H infection in an accumulation of cases. Thus, the complete determination of the HBV genotype may be essential in the routine clinical care of acute hepatitis B patients.