Geographic Variation of Indigenous Hepatitis C Virus Subtypes 6g and 6w in an Endemic Area of Southern Taiwan

Background and Aims: Hepatitis C virus (HCV) genotype (GT) 6 is the most genetically diverse GT and mainly distributed in Southeast Asia and south China but not Taiwan. Earlier studies showed the major GTs in Taiwan were GT 1b and GT 2 with very rare GT6 except in injection drug user and subtype 6a is the main GT 6 subtype among IDUs. Recently we reported a much higher prevalence (18.3%) of GT 6 in Tainan City, southern Taiwan. This study was designed to clarify the subtypes of GT 6 in this endemic area. Materials and Methods: A total 3022 (1343 men and 1679 women) HCV patients were enrolled. GT 6 subtypes were determined by sequencing of core/E1 and nonstructural protein 5B (NS5B) in 322 of 518 GT 6 patients. Results: The overall GT6 prevalence rate was 17.1% (518/3022) with higher prevalence districts located in northern Tainan. The major GT6 subtypes in Tainan were 6g (81.0%), followed by 6w (10.8%), 6a (7.5%), and 6n (0.7%).Conclusions: The high GT 6 prevalence in Tainan was mainly due to subtype 6g and 6w with characteristic geographic distribution, suggesting subtypes 6g and 6w could be indigenous in Tainan for centuries.

First Report of “Munchausen Syndrome by Proxy Variant” in an Injection Drug User with 12 New Organisms in Blood Cultures 17 Days after Admission to the Hospital

The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the hospital around this time was suspected to have injected a solution of drugs brought from home directly into the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New onset of unexpected symptoms should alert caregivers of the possibility of such abuse.