Short communicationHepatitis C virus transmission during colonoscopy evidenced by phylogenetic analysis
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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Present address: Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.