RESUMO
Purpose: Hepatitis E virus infection mainly presents with liver-related symptoms, and multiple studies have shown that hepatitis E virus infection can also induce extrahepatic-related symptoms. Thrombotic thrombocytopenic purpura is an uncommon and fatal thrombotic microangiopathy characterized by severe thrombocytopenia, organ damage, and microangiopathic haemolytic anaemia. We report the first case in which acute hepatitis E induced the first episode of immune-mediated thrombotic thrombocytopenic purpura. Patients and Methods: A 53-year-old male was admitted to our emergency department with fever, thrombocytopenia, and abnormal liver function. Laboratory tests revealed significant bilirubin, AST, and ALT elevations, renal impairment, positive anti-HEV IgM and IgG antibody results, schistocytes on the blood smear, 0% ADAMTS-13 activity, and positive ADAMTS13 inhibitor results. He was diagnosed with acute hepatitis E, which induced the first episode of immune-mediated thrombotic thrombocytopenic purpura. Results: After receiving treatment with plasmapheresis, glucocorticoid medication, rituximab, and other supportive medicines, the patient's physiological circumstances and laboratory indicators improved, and a 4-month follow-up revealed no abnormalities. Conclusion: This is a unique case report of an acute hepatitis E-induced immune-mediated thrombotic thrombocytopenic purpura initial episode. This case report offers evidence that hepatitis E virus infection can cause thrombotic thrombocytopenic purpura. In patients with abnormal liver function and thrombocytopenia, we advise screening for hepatitis E or thrombotic thrombocytopenic purpura.
RESUMO
The surveillance of schistosomiasis in Shicheng Village, a national schistosomiasis surveillance site in Yangzhong City from 2005 to 2010 showed that snail areas were 16.43 hm2, the occurrence rates of frames with living snails and mean densities of living snails exhibited a declining trend year by year, and the infected snails were only found in 2007. The sero-positive rates in residents were 1.81%, 0.98%, 0.29%, 0.28%, 0.47% and 0.51%, respectively from 2005 to 2010. However, no stool-examination -positive persons were detected. During the period, no acute infections occurred, and no advanced cases and infected animals were detected. It is indicated that schistosomiasis has been effectively controlled in the surveillance site. However, snails remain present, so comprehensive control and surveillance of infectious sources should be further strengthened.
