title: First report of an autochthonous hepatitis E virus genotype 3 infection in a 5 month old female child in Germany.
abstract: Hepatitis E virus (HEV) is well-known to cause endemic outbreaks of hepatitis in tropical countries, mostly caused by HEV genotypes 1 or 2 and transmitted from humans to humans via the fecal-oral route. In contrast, HEV genotypes 3 or 4 are commonly encountered as sporadic cases in a non-endemic setting; these autochthonous cases are transmitted from animals to humans and commonly affect elderly male subjects. We report a five-month-old caucasian girl presenting with diarrhea, emesis, and elevated ALT. Surprisingly, acute infection with Hepatitis E virus (HEV) genotype 3 was laboratory-confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) and sequencing. Thirteen months later, RT-PCR for HEV from stool tested negative whereas anti-HEV IgG in serum tested positive. Neither HEV RNA nor anti-HEV antibodies could be detected in stool or serum of the parents. To our knowledge, this is the first pediatric case of a HEV infection in Germany. Thus, HEV should be included into the differential diagnosis of pediatric infectious liver and bowel disease.
authors.affiliation: Division of Virology, Department of Medical Microbiology, University Hospital Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Krüttgen
authors.forename: S
authors.initials: S
authors.lastname: Scheithauer
authors.forename: M
authors.initials: M
authors.lastname: Häusler
authors.forename: M
authors.initials: M
authors.lastname: Kleines
mesh_terms: D001483:Base Sequence; D005243:Feces / Q000821:virology; D005260:Female; D005838:Genotype; D005858:Germany; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis* / Q000821:virology; D016752:Hepatitis E virus / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D012367:RNA, Viral / Q000032:analysis / Q000097:blood* / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D012367:RNA, Viral