It could be unsafe medical procedures, nonmedical percutaneous exposures or other infrequent transmission mode, but most likely we shall never learn about the conclusive evidence. In the developed countries, the rapid improvement of healthcare conditions and the introduction of anti-HCV screening for blood donors have led to a sharp decrease in the incidence of iatrogenic hepatitis C, but the epidemic continues to spread in developing countries. grouped ZEN-3219 with the strain “type”:”entrez-nucleotide”,”attrs”:”text”:”KC967476″,”term_id”:”509263120″KC967476 from Denmark, then clustered with the elder sisters virus. Both their partial did not clustered the top BLAST hits (GZ215 for the elder sisters and BJ665 for the youngers) (Fig.?1B). As shown in the phylogenetic tree of and gene of HCV. A. Phylogenetic tree based on partial gene. B. Detail of the sequence relationships in the red rectangle area in A. C. Phylogenetic tree based on partial gene. D. Detail of the sequence relationships in the red rectangle ZEN-3219 area in C. The tree is mid-point rooted for clarity. Bootstrap values? ?50% are shown at relevant nodes. Branches are colored according to their geographic origins, indicated at the bottom. The meaning represented by symbol , and were also indicates at the bottom. Sequences reported in this study have been submitted to GenBank and assigned the accession numbers “type”:”entrez-nucleotide-range”,”attrs”:”text”:”MH463463-MH463466″,”start_term”:”MH463463″,”end_term”:”MH463466″,”start_term_id”:”1574153597″,”end_term_id”:”1574154341″MH463463-MH463466. To better understand their disease histories, epidemiologic investigation was performed. Members of the immediate family of the two sisters including their parents, husbands and children were screened for HCV by quantitative PCR and serologic tests (IgM and IgG), none of them was HCV-positive. Finally, the younger sister had surgery for subarachnoid hemorrhage in 2015, yet both sisters denied a history of blood transfusion, intravenous drug use and experience of unprotected sex other than with a spouse. Unfortunately, the attempts to dissect the transmission route were failed. The only significant risk factor of the younger sister was the surgery. However, infrequent exposure could not be ruled out. As for the elder sister, it most likely not to be infected through the high-risk factors. Both sisters received antiviral treatment starting the day after admission (day 2). They were treated with peginterferon alpha-2a 180?g subcutaneous?injection once a week plus ribavirin 900?mg oral daily for 24?weeks. On day 7, another routine blood and liver function test were performed. The ALP and TBA of the elder sister dropped slightly toward the normal range; the youngers ALP also dropped slightly and Rabbit Polyclonal to GAS1 the TBA increased a little though still within the normal range. The high TBIL and IBIL of the younger sister had returned to normal (Table?1). The results suggested that their liver function ZEN-3219 had gradually improved. Both sisters were discharged from the hospital on day 12. The anti-viral medication continued, and they were monitored on an outpatient basis after discharge. At the end of treatment, HCV viral RNA was not detected by real-time PCR test from their blood samples. Also, they were arranged follow-up every 6?months for 3 years, HCV viral RNA was not detected by real-time PCR test every time. Although hepatitis, jaundice and even fulminant hepatic failure can occur in the early stage of HCV infection (Hoofnagle 1997; Cox em et al /em . 2005; Villano em et al. /em 1999; Mosley em et al /em . 2005), overall, one-third of patients with acute infection are symptomatic (Hoofnagle 1997; Cox em et al. /em 2005). In our study, two sisters claimed no discomfort until 1?week ZEN-3219 before hospitalized they felt fatigue. Hence, like most HCV-infected persons, they were unaware of their status, although they are at risk for life-threatening diseases such as cirrhosis and hepatocellular carcinoma (HCC) (Hoofnagle 1997). The two sisters have never donated their blood so most likely they were not the direct victims of the illegal blood donation campaign. Also they claimed not to be intravenous drug users and have no experience of.