Sporadic cases of acute autochthonous hepatitis E virus infection in Southwest Germany

Brost, S.; Wenzel, J.J.; Ganten, T.M.; Filser, M.; Flechtenmacher, C.; Boehm, S.; Astani, A.; Jilg, W.; Zeier, M.; Schnitzler, P.

doi:10.1016/j.jcv.2009.10.011

« Previous Next »Journal of Clinical Virology
Volume 47, Issue 1 , Pages 89-92, January 2010

Sporadic cases of acute autochthonous hepatitis E virus infection in Southwest Germany

S. Brost
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
- These authors contributed equally to this work.
J.J. Wenzel
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- These authors contributed equally to this work.
T.M. Ganten
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
M. Filser
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
C. Flechtenmacher
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
S. Boehm
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
A. Astani
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
- Yazd Shahid Sadoghi University of Medical Science, Safaieh, Boali Street, Yazd, Iran
W. Jilg
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
M. Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
P. Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
- Corresponding author at: Department Infectious Diseases, Virology, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Tel.: +49 6221 56 50 16; fax: +49 6221 56 50 03.

Received 15 July 2009; received in revised form 5 October 2009; accepted 7 October 2009. published online 12 November 2009.

Abstract

Hepatitis E infection is usually a self-limiting disease and an important cause of acute hepatitis in tropical and subtropical regions where the virus is endemic. In industrialized countries, sporadic cases of acute hepatitis E virus (HEV) infections have been described and the number of documented autochthonous infections seems to be increasing. We report three sporadic cases of autochthonous hepatitis E infections in Southwestern Germany which presented at our university hospital within two years. All cases were men who presented with acute hepatitis, icterus and elevated liver. In case 1 and case 2, liver biopsy revealed acute hepatitis, both patients were positive for anti-HEV antibodies, case 1 was also positive for HEV RNA with a viral load of 3.0×10³copies/ml in serum. In case 3, anti-HEV antibodies were detectable and HEV RNA was detected in serum (4.3×10³copies/ml) and stool (1.4×10⁶copies/ml). None of the patients had a recent travel history outside Germany and close contact to animals has been denied. HEV sequence analysis of two patients revealed genotype 3 with homologies to other European isolates and isolates from swine. Thus the source of infection remains unclear. Hepatitis E should be considered in differential diagnosis in patients with unexplained hepatitis and patients with acute hepatitis, whatever their age or travel history might be, should be tested for HEV.