Summary
- Circoviruses are a family of DNA virus and very little is known about them in terms of human health but the most well studied one, porcine circovirus 2 (PCV2) causes hepatitis among pigs.
- A 66-year-old woman with severe liver disease and chronic infection associated a new human circovirus (HCirV-1) following long-term immunosuppression due to treatment for rheumatoid arthritis.
- The patient resided in the countryside of Switzerland and did not have direct animal contact nor a recent travel history, but reported sporadic consumption of raw calf liver.
- The virus has been identified in the liver of the patient, with high viral loads found over 21 months.
- HCirV-1 replicated in liver tissue and had persisted owing to an antibody deficiency of the patient, as well as a prolonged absence B cells due years of immunosuppressive therapy.
Circoviruses, a class of DNA virus, have been making grabbed the attention of medical societies because it affects human health in an ambiguous manner. Little is known about the human consequences of such viruses, although they have been tied to infections in animals. Porcine circovirus 2, a type of circovirus that can infect pigs and causes hepatitis
In a recent report from China, a novel human circovirus (Designated as HCirV-1) has been isolated from an immunosuppressed patient with chronic infection associated damage to liver. This was a 66-year-old woman from Switzerland who presented with elevated liver enzymes. While testing negative for common hepatitis viruses, the patient’s liver enzymes further increased making a diagnosis of cytolytic hepatitis.
Based on the patient medical history, the patient had been treated for a long time because of rheumatoid arthritis requiring immunosuppressive drugs. Furthermore, the immune system was already impaired due to a hospital stay for the treatment of complications occurring in course of SARS-CoV-2. A liver biopsy was performed, and the patient’s results were consistent with acute/subacute hepatitis showing inflammatory changes compatible with an infectious etiology.
Further analysis on the liver biopsy demonstrates the presence of HCirV-1 -specific reads. The same was confirmed with specific PCR tests, high levels of the virus were detected in the liver tissue.
Interestingly, the virus remained in the body of the patient for more than 21 months without any major changes detected within its genome. The weak immune system, due to prolonged immunosuppressive therapy, likely contributed to the persistence of the virus.
In conclusion, the detection of HCirV-1 in a patient with long-term infection and ongoing liver damage points towards a possible contribution of circovirus to human illness, particularly in immunocompromised individuals. A long-term persistence of the virus in infected hosts indicate that more research is needed to investigate pathogenicity and impact on human health. It is an illustrative case that shows the relevance of studying viral pathology in high-risk patient populations, and demonstrates a personalized therapeutic approach depending on what was causing clinical decompensation.
Infectious Diseases, Internal Medicine, Immunocompromised Patient, Switzerland