Fulminant hepatitis B and acute hepatitis B due to intrafamilial transmission of HBV after chemotherapy for non-Hodgkin's lymphoma in an HBV carrier
Fulminant hepatitis B and acute hepatitis B due to intrafamilial transmission of HBV after chemotherapy for non-Hodgkin's lymphoma in an HBV carrier
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DOI：
10.1007/s00431-009-1000-6
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发表时间：
2010-02-01
影响因子：
3.6
通讯作者：
Tamai, Hiroshi
中科院分区：
文献类型：
--
作者：
Aomatsu, Tomoki;Komatsu, Haruki;Tamai, Hiroshi
化疗后乙型肝炎病毒 (HBV) 再激活已被研究，但对于 HBV 再激活的免疫功能低下宿主的水平传播风险知之甚少。我们分别治疗了两名患有暴发性乙型肝炎和急性乙型肝炎的儿童，他们的祖母是乙型肝炎病毒携带者，一直在接受利妥昔单抗加环磷酰胺、阿霉素、长春新碱和泼尼松 (R+CHOP) 治疗淋巴瘤。当两个孩子患病时，祖母也患有暴发性肝炎。三个家庭成员的完整 HBV DNA 序列相同。乙型肝炎病毒的全基因组序列分析为乙型肝炎病毒的家庭内传播提供了有力的证据。引起免疫抑制的治疗，例如针对淋巴瘤的 R+CHOP 治疗，如果给予 HBV 携带者，可能会增加血清 HBV DNA 水平以及家庭内 HBV 感染的风险。总之，特异性抗病毒预防对于预防接受化疗的 HBV 携带者中 HBV 的水平传播和再激活是必不可少的。
Hepatitis B virus (HBV) reactivation after chemotherapy has been investigated, but little is known about the risk of horizontal transmission from an immunocompromised host with HBV reactivation. We treated two children with fulminant hepatitis B and acute hepatitis B, respectively, whose grandmother, an HBV carrier, had been undergoing rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R+CHOP) therapy for lymphoma. The grandmother was also suffering from fulminant hepatitis when both children became ill. The complete HBV DNA sequences of the three family members were identical. The full genome sequence analysis of HBV provided strong evidence of intrafamilial transmission of HBV. Treatments that cause immunosuppression, such as R+CHOP therapy for lymphoma, can increase the levels of serum HBV DNA and the risk of intrafamilial HBV infection when given to HBV carriers. In conclusion, specific antiviral prophylaxis is indispensable for preventing horizontal transmission as well as reactivation of HBV in chemotherapy-treated HBV carriers.