Molecular and serologic tracing of a transfusion-transmitted hepatitis A virus

BACKGROUND: The transmission of hepatitis A virus (HAV) via blood transfusion has not been evidenced by molecular tracing so far. CASE REPORT: A 33-year-old asymptomatic female volunteer made a whole-blood donation. Thirteen days later an acute HAV infection was diagnosed. Retrospectively, a high viral load was measured by quantitative reverse transcription polymerase chain reaction (RT-PCR) in the quarantine fresh-frozen plasma (1.4 x 10(6) geq/mL), whereas immunoglobulin M (IgM) and G (IgG)/IgM anti-HAV were not detectable and the alanine aminotransferase levels not elevated. The red blood cells have just been transfused on Day 14. The 63-year-old male recipient already was HAV seropositive. He did not develop clinical symptoms of HAV and anti-HAV IgM was not detected. Seventy-five days later, a 25-fold increase in the anti-HAV IgG/IgM titer was observed. Demonstrable HAV ribonucleic acid (RNA) in the recipient by means of RTPCR on Day 6, but not on Days 1 and 75, suggests that a transient reinfection did occur. Analyzed sequences of the HAV RNA in the donor and recipient were identical. CONCLUSION: For the first time, transfusion-transmitted HAV was evidenced by molecular and serologic tracing. The transmitted HAV can survive and replicate for a limited period despite the presence of anti-HAV IgG.