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Hepatitis C virus transmission during colonoscopy evidenced by phylogenetic analysis

https://doi.org/10.1016/j.jcv.2013.03.007Get rights and content

Abstract

Background

Nosocomial transmission events still play an important role in hepatitis C virus (HCV) spreading. Among most reported medical procedures involved in nosocomial transmission, endoscopy procedures remain controversial and might be underestimated.

Objective

The aim of the study was to investigate a case of nosocomial person-to-person transmission of HCV in an endoscopy unit.

Study design

An acute HCV infection was detected in a person that had undergone a colonoscopy after an HCV-infected patient. Serum samples from both persons were subjected to a molecular epidemiology study. The HCV NS5B genetic region was amplified and directly sequenced and the E1–E2 region was amplified, cloned and sequenced (20 clones per specimen). All sequences were subjected to phylogenetic analyses. A conventional epidemiological investigation was performed to determine the most likely cause of HCV transmission.

Results

NS5B sequence analysis revealed that both persons were infected with closely related HCV-1b strains. Furthermore, phylogenetic analysis of E1–E2 sequences evidenced a direct transmission between patients. The epidemiological investigation pointed out to anesthetic procedures as the most likely source of HCV transmission. The index case, not having spontaneously cleared the infection 10 months after infection, required antiviral treatment, which resulted in a sustained virological response.

Conclusions

The molecular epidemiology study performed provided evidence of a person-to-person transmission of HCV during a colonoscopy procedure, and the anesthetic procedure was the most likely source of HCV transmission. This study highlights the importance of strictly following standard precautions by healthcare workers in order to prevent nosocomial HCV transmission.

Section snippets

Background

Although rarely reported, nosocomial transmission of hepatitis C virus (HCV) continues occurring in developed countries.1, 2 Several medical procedures have been associated with HCV transmission, being haemodialysis the most frequently reported one.3, 4, 5 Transmission during colonoscopy procedures has also been reported.6, 7, 8, 9, 10 However, the direct transmission by the use of a contaminated colonoscope remains controversial and might be underestimated.

Objectives

The aim of the study was to investigate a case of nosocomial person-to-person transmission of HCV in an endoscopy unit by conventional and molecular epidemiology analyses.

Study design

An acute HCV infection was diagnosed in February 2010 in a person that had undergone a colonoscopy in a Spanish hospital. The Hospital Director and the Preventive Medicine Group initiated an investigation. The suspicion of nosocomial transmission was reported to the Public Health Authority.

Medical records of the patient were reviewed and data on risk factors, serological status, diagnosis, diagnostic procedures, surgical interventions, medications and other treatments were collected. A

Results

HCV NS5B sequence analysis revealed that both persons were infected with subtype 1b, and that both viral strains were closely related (data not shown). Additionally, the phylogenetic analysis of the more variable HCV genetic region E1–E2 evidenced that the viral sequences obtained from the source and the index patients were more closely related to each other than to the rest of sequences obtained from other patients (Fig. 1). Since the sequences from both patients formed a well-supported

Discussion

The molecular epidemiology study performed provided evidence of a person-to-person transmission of HCV during a colonoscopy procedure. The sequences from both patients formed a well-supported monophyletic group in the phylogenetic tree of the HCV E1–E2 genomic region. Sequences from the source case showed a high degree of genetic heterogeneity, which is a typical pattern observed in chronic infections,6 while sequences from the index case showed a lower genetic variability; this observed

Authorship/contributors

VS, ME, IC, VA and EM contributed to the study conception and design, data acquisition, analysis and interpretation. VS, ME and EM drafted the article and IC and VA critically revised it. All authors approved the final version to be published.

Funding

This study was funded by Hospital Universitari Germans Trias i Pujol, and was carried out with the support of grant CP09/00044 from “Ministerio de Economía y Competitividad”, within the “Plan Nacional de Investigación científica, Desarrollo e Innovación Tecnológica (I+D+I)” (EM).

Competing interests

None declared.

Ethical approval

Not required.

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There are more references available in the full text version of this article.

Cited by (0)

1

Present address: Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.

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