Changing clinical and molecular characteristics of hepatitis E virus infection in Mie Prefecture, Japan: Disappearance of indigenous subtype 3e strains

AIM

To evaluate the clinical and molecular characteristics of hepatitis E virus (HEV) infection in Mie Prefecture, Japan, from 2004 through 2018.

METHODS

The clinical information of hepatitis E cases was collected from 21 medical institutions in Mie Prefecture. The nucleotide sequences of infecting HEV strains were determined for cases with available serum samples. The origins or transmission routes were inferred from phylogenetic analyses of the nucleotide sequences.

RESULTS

Fifty-three patients were diagnosed with HEV infection. The number of cases increased each year through 2012 and then decreased. Analyses of the clinical characteristics of the cases indicated that even mild cases were detected in the latter 10 years of the study. Nucleotide sequence analyses were undertaken on 38 of the 53 cases. The HEV subtype 3e (HEV-3e) strains identified for 13 cases were closely related to a swine HEV-3e strain that was isolated from the liver of a pig bred in Mie Prefecture. The number of cases infected with the indigenous Mie HEV-3e strains increased until 2012 but have not been reported since 2014. In the latter half of the study, cases involving various HEV strains of different genotypes and subtypes emerged.

CONCLUSIONS

The disappearance of indigenous Mie HEV-3e strains appeared to be the primary cause for the decrease in hepatitis E cases in Mie Prefecture. The disappearance might have been associated with improved hygienic conditions on pig farms or the closure of contaminated farms. The results suggest that indigenous HEV strains can be eradicated by appropriate management.

Synthesis and properties of polyimides containing hexaisobutyl-substituted T8 cages in their main chains

We prepared two types of polyimides containing T₈ cages in the main chains by polymerization of para-substituted bis(3-aminopropyl)hexaisobutyl-substituted T₈ cage, and studied their mechanical, thermal, and optical properties.

Characterization of sporadic acute hepatitis E and comparison of hepatitis E virus genomes in acute hepatitis patients and pig liver sold as food in Mie, Japan

AIM

To characterize hepatitis E in Mie prefecture and to investigate whether raw pig liver sold as food in Mie is contaminated with hepatitis E virus (HEV) strains similar to those recovered from patients.

METHODS

Seventeen patients with sporadic acute hepatitis E treated from 2004 to 2012 were studied. A total of 243 packages of raw pig liver from regional grocery stores were tested for the presence of HEV RNA. The partial genomic sequences of human and swine HEV isolates were determined and subjected to the phylogenetic analyses.

RESULTS

The HEV isolates recovered from the 17 patients segregated into genotype 3 (n = 15) and genotype 4 (n = 2), and 15 genotype 3 isolates further segregated into 3e (n = 11) and 3b (n = 4). Pig liver specimens from 12 (4.9%) of the 243 packages had detectable HEV RNA. All 12 swine HEV isolates were grouped into genotype 3 (3a or 3b). Although no 3e strains were isolated from pig liver specimens, two 3b swine strains were 99.5-100% identical to two HEV strains recovered from hepatitis patients, within 412-nt partial sequences.

CONCLUSION

The 3e HEV was prevalent among hepatitis E patients. HEV RNA was detected in approximately 5% of pig liver sold as food. The presence of identical HEV strains between hepatitis patients and pig liver indicated that pigs play an important role as reservoirs for HEV in humans in Mie. Further studies are needed to clarify the source of 3e HEV in the animal and environmental reservoirs.

Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis

Healthy adults who had not been exposed to antimicrobial agents for the preceding 4 weeks were examined for intestinal carriage of Clostridium difficile. The 1234 individuals examined were composed of seven groups: three classes of university students, hospital workers at two hospitals, employees of a company and self-defence force personnel at a local station. Overall, 94 (7.6%) individuals were positive for C. difficile by faecal culture but carriage rates among the study groups ranged from 4.2% to 15.3%. Typing by PCR ribotyping and pulsed-field gel electrophoresis demonstrated clusters of carriers colonised by a single type in each of three groups, indicating that cross-transmission of C. difficile can occur in community settings. Follow-up culture was performed on 38 C. difficile-positive individuals and C. difficile was isolated again from 12 (32%) of them 5-7 months after the initial culture; six (50%) of these 12 individuals had a new strain on repeat culture. Two or more family members were C. difficile-positive in five of 22 families examined. C. difficile with an identical type was isolated from persons within a family in only one family. These results suggest that intestinal carriage by healthy adults may play a role as a reservoir for community-acquired C. difficile-associated diarrhoea, but that cross-transmission of C. difficile does not occur frequently among family members at home.

[Effects of bofu-tsusho-san, a traditional Chinese medicine, on body fat accumulation in fructose-loaded rats]

The effects of Bofu-tsusho-san (BOF), a traditional Chinese medicine, on fructose-induced hypertriglyceridemia and body fat accumulation were investigated in female SD rats. Rats were allowed to drink ad libitum 25% (w/w) fructose solution for 6 weeks. BOF was administered to the rats as an experimental diet containing 1.5% or 4.5% (w/w) of BOF during the fructose-loading period. BOF suppressed body weight gain and prevented the elevation of serum triglyceride levels and body fat accumulation in fructose-loaded rats without affecting food and fructose intake. Furthermore, BOF prevented the increase of triglyceride content in the liver and the reduction of mitochondrial cytochome c oxidase activity in the brown adipose tissue induced by fructose. From these results, it has been suggested that BOF has a preventive effect against the body fat accumulation caused by excess intake of sugar or other fructose-containing foods. The inhibition of triglyceride synthesis in the liver, and the enhancement of lipolysis in adipocytes and of thermogenesis in brown adipose tissue have been presumed as the mechanisms of action of BOF.

Genetic analysis of type E botulinum toxin-producing Clostridium butyricum strains

Type E botulinum toxin (BoNT/E)-producing Clostridium butyricum strains isolated from botulism cases or soil specimens in Italy and China were analyzed by using nucleotide sequencing of the bont/E gene, random amplified polymorphic DNA (RAPD) assay, pulsed-field gel electrophoresis (PFGE), and Southern blot hybridization for the bont/E gene. Nucleotide sequences of the bont/E genes of 11 Chinese isolates and of the Italian strain BL 6340 were determined. The nucleotide sequences of the bont/E genes of 11 C. butyricum isolates from China were identical. The deduced amino acid sequence of BoNT/E from the Chinese isolates showed 95.0 and 96.9% identity with those of BoNT/E from C. butyricum BL 6340 and Clostridium botulinum type E, respectively. The BoNT/E-producing C. butyricum strains were divided into the following three clusters based on the results of RAPD assay, PFGE profiles of genomic DNA digested with SmaI or XhoI, and Southern blot hybridization: strains associated with infant botulism in Italy, strains associated with food-borne botulism in China, and isolates from soil specimens of the Weishan lake area in China. A DNA probe for the bont/E gene hybridized with the nondigested chromosomal DNA of all toxigenic strains tested, indicating chromosomal localization of the bont/E gene in C. butyricum. The present results suggest that BoNT/E-producing C. butyricum is clonally distributed over a vast area.

Novel catalytic asymmetric sulfoxidation in water using the hypervalent iodine reagent iodoxybenzene

A new catalytic asymmetric oxidation of sulfides to sulfoxides in water using the hypervalent iodine(V) reagent iodoxybenzene (PhIO2) has been developed. This methodology is distinctly different from the previously reported use of cyclodextrins or biological catalysts and provides a new route to asymmetric sulfoxidation in water.

Deletions in the repeating sequences of the toxin A gene of toxin A-negative, toxin B-positive Clostridium difficile strains

The repeating sequences of the toxin A gene from toxin A-negative, toxin B-positive (toxin A-, toxin B+) strains of Clostridium difficile which were isolated in geographically separated facilities in Japan and Indonesia were determined. All six strains tested had identical repeating sequences with two deletions (1548 and 273 nucleotides in size) in the toxin A gene. A PCR method was designed to detect the deletions and the deletions were confirmed in all 50 toxin A-, toxin B+ strains examined by this method. Western immunoblot analysis revealed that polyclonal antiserum against native toxin A did not react with the concentrated culture filtrates of the toxin A-, toxin B+ strains. These results may suggest that toxin A-, toxin B+ strains have deletions of the two thirds of the repeating regions of the toxin A gene, which encodes the epitopes fully responsible for the reaction with the polyclonal antiserum.

Laboratory diagnosis of toxigenic Clostridium difficile by polymerase chain reaction: presence of toxin genes and their stable expression in toxigenic isolates from Japanese individuals

Clostridium difficile causes pseudomembranous colitis and antibiotic-associated diarrhea. The definitive diagnosis of C. difficile infection is finally accomplished by the isolation of toxigenic C. difficile. However, only a small number of Japanese clinical laboratories are able to reach a definitive diagnosis of C. difficile infection, probably because simple reliable assays for toxins in the isolates are not available. In this study, we examined the compatibility of a polymerase chain reaction (PCR) assay and tissue culture assay to identify toxigenic C. difficile, in toxigenic and nontoxigenic C. difficile isolates from Japanese patients and healthy carriers. The specificity of PCR primers was demonstrated by restriction endonuclease digestion and seminested PCR in C. difficile VPI 10463 strain. No PCR product was amplified in the eight other clostridial species used to check the specificity of the PCR assay. The detection limit was 10(3) cells. Both toxin A and toxin B genes (the genes encoding the major virulence factors of C. difficile) were detected in 58 toxigenic C. difficile isolates, which showed a wide range of cytotoxic activity in tissue culture assays. Neither of the toxin genes was carried by 40 nontoxigenic strains of C. difficile. The results of this study strongly suggest that a definitive diagnosis of C. difficile infection can be accomplished by PCR detection of the toxin genes rather than by tissue culture assay of isolates.

Effect of arginine on toxin production by Clostridium difficile in defined medium

Twenty strains of Clostridium difficile were examined for the effect of arginine on toxin production in a defined medium. In three strains, the production of toxins A and B was greatly enhanced in the absence of arginine. These strains showed distinctively poorer growth in the absence of arginine in comparison with the remaining 17 strains, indicating that the presence of arginine is required for good growth among the three strains. From the present results, test strains were divided into two groups: a group in which arginine insufficiency caused distinctly poor growth and enhanced toxin production, and another group in which there was neither distinctly poor growth nor enhanced toxin production. The phenomenon is discussed in relation to the biosynthesis and catabolism of arginine.

[An epidemiological study on Bordetella pertussis infection in Fukui Prefecture from 1986 to 1991--especially observation on the patients of culture-confirmed pertussis]

In order to clarify the epidemiological situation of whooping cough in Fukui prefecture, 478 nasopharyngeal swabs from patients with pertussis-like symptoms were submitted to bacterial isolation. Laboratory data of these patients with clinical informations at the departments of pediatrics of 6 hospitals in Fukui city from June 1986 to May 1991 were also examined in relation to the above bacterial isolation. The results observed in culture positive patients were as follows: 1) B. pertussis were isolated from 83 patients (41 men and 42 women). 2) Isolates were classified into 3 serotypes. Most dominant type was 1.3.6 (80 strains, 96.4%), and followed by 1 (2 strains) and 1.4.5 (1 strain). 3) Most of the patients were non-vaccinees less than 3 years of age (69 of 83 (83.1%). This evidence suggested strongly that pertussis vaccine was highly effective to prevent pertussis. 4) The patients under 3 years of age whose leucocyte counts were > or = 15000/mm3 and lymphocyte rate to total leucocyte were > or = 70% in their peripheral blood at the time of nasopharyngeal swabs sampling were only 49.3% (33 of 67). Therefore, diagnosis of pertussis by leucocyte findings alone were considered to be inadequate. 5) The area of the patient's residence covered 7 regions of 8 health center districts in Fukui prefecture. The areal distribution of the number of patients from June 1986 to May 1991 was relatively proportional to the population of each district.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on somatomedin C in diabetic pregnancies]

Somatomedins have been shown to have potent mitogenic activities in cultured cells and also promote individual growth. We studied the concentrations of somatomedin C in diabetic pregnant women and rats. Serum and liver somatomedin C were measured by RIA double antibody method, after extraction with an ODS silica column. Serum somatomedin C concentrations were 20.45 +/- 5.14 nM/l (mean +/- S.D.) in nonpregnant normal women. In nonpregnant diabetic women, these were 16.96 +/- 4.37 nM/l, which were significantly lower than those of normal nonpregnant women. The concentrations of pregnant normal and diabetic women were similar to those of nonpregnant normal women. Maternal concentrations of somatomedin C significantly correlated with infant weight (r = 0.41, p less than 0.05, n = 41). Serum somatomedin C concentrations in the normal infants were 6.45 +/- 1.97 nM/l, which were considerably lower than those of their mothers. In the infants from diabetic mothers, these were 9.17 +/- 3.28 nM/l, which were significantly higher than those of normal infants. Rat serum somatomedin C concentrations which were 15.86 +/- 2.37 nM/l in nonpregnant normal rats, tended to increase during pregnancy. The mother's concentration significantly correlated with fetus weight (r = 0.491). Liver somatomedin C levels decreased in diabetic and pregnant states. Fetal rats had lower hepatic somatomedin C, which was about 10% of the mother's levels. These were higher in the fetuses from diabetic mothers. These finding suggested that the mother's somatomedins might contribute to fetal growth.