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A man from Hong Kong is the first human to become infected with a type of hepatitis E infection that has only been observed in the rat.
The 56-year-old man received a liver transplant at the Queen Mary Hospital of the University of Hong Kong in May 2017, according to the South China Morning Post. Several months after the transplant, he began to have liver problems and in September of the same year, a test revealed that he was suffering from the hepatitis E version of the rat. (Hepatitis is an inflammation of the liver.)
Doctors do not think that the man has received the virus from another human. the liver donor and the people who donated blood to the man were all tested negative for the virus.
Yet, we do not know how the virus has gone from a rat to a human. One possibility is that the man has eaten food contaminated with rat excrement. The man lives next to a garbage chute, where conditions are unhygienic, the Post said. [10 Deadly Diseases That Hopped Across Species]
However, when the investigators tested the mice in the area, as well as drainage water samples, they found no signs of the virus. It was only when they tested frozen samples of a 2012 rat that had once roamed the region that they found a potential source: the rat had the virus, according to the Post. This finding, however, is far from being a clear answer.
How did it happen?
"Infectious diseases … can easily spread from rats to humans," said Dr. Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security, who was not involved in the patient's case. This is thanks to "a lot of similarities between rats and humans," he said.
But the infection of a man is not necessarily the sign of a rat-mediated hepatitis attack. "It's important to remember that this patient was a transplant patient from the liver, so he was probably more likely [to the virus] that an ordinary person would be, says Adalja.
Organ transplant recipients must take medication to suppress their immune system so that the body does not reject the new organ. This makes them more susceptible to infection. Indeed, the combination of compromised human immune system and exposure to rat feces could have caused this singular case, said Adalja.
Simply because it is the first case of documented hepatitis E infection in humans in a human, Adalja said: "This does not mean that it is the first time that it has occurred in history. " There are many infections that go "undiagnosed or misdiagnosed," he added.
Hepatitis E in rats has a different genetic signature than the human strain, so this is probably not what routine tests can detect, says Adalja. But because the rat strain is present in rats around the world, it may be time to change the diagnostic tests used for hepatitis to include these strains to determine if this can resolve "cases of Unexplained hepatitis ".
Many people clearly have hepatitis, based on their symptoms, but they are negative on all known human strains, said Adalja.
The researchers ventured into another hypothesis: the genetic signature of the virus could also have changed, giving it the ability to infect humans. But Adalja said that he thought that the suppressed immune system of the man was more likely the explanation of this case.
"If it happened in a person who was not a liver transplant, you may have more reason to speculate" on the mutations of the virus, he added. The next steps in the investigation could be to test people in the same area – especially those who are not immunosuppressed – who may have been exposed to rats, he said.
This patient has completely recovered after being treated with an antiviral drug used to treat the human strain of hepatitis E, according to the Post.
Hepatitis can be caused by various factors including viruses or alcohol. According to the Centers for Disease Control and Prevention (CDC), the human strain of hepatitis E is usually transmitted through dirty water.
The symptoms of hepatitis are usually mild and may include fever, abdominal pain and jaundice (yellowing of the skin), says the CDC. Most cases resolve themselves, according to the CDC.
Originally published on Live Science.
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