title: Sporadic cases of acute autochthonous hepatitis E virus infection in Southwest Germany.
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 x 10(3)copies/ml in serum. In case 3, anti-HEV antibodies were detectable and HEV RNA was detected in serum (4.3 x 10(3)copies/ml) and stool (1.4 x 10(6)copies/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.
authors.affiliation: Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Brost
authors.forename: J J
authors.initials: JJ
authors.lastname: Wenzel
authors.forename: T M
authors.initials: TM
authors.lastname: Ganten
authors.forename: M
authors.initials: M
authors.lastname: Filser
authors.forename: C
authors.initials: C
authors.lastname: Flechtenmacher
authors.forename: S
authors.initials: S
authors.lastname: Boehm
authors.forename: A
authors.initials: A
authors.lastname: Astani
authors.forename: W
authors.initials: W
authors.lastname: Jilg
authors.forename: M
authors.initials: M
authors.lastname: Zeier
authors.forename: P
authors.initials: P
authors.lastname: Schnitzler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D019353:Endemic Diseases; D005858:Germany; D016751:Hepatitis E / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood
chemical_list: D012367:RNA, Viral