title: First case report of an acute hepatitis E subgenotype 3c infection during pregnancy in Germany.
abstract: Hepatitis E is usually a self-limiting disease and an important cause of acute hepatitis in endemic countries in Asia and Africa. However, the mortality rate for pregnant women infected with hepatitis E virus (HEV) in this area is about 25%. In Germany, sporadic cases of acute hepatitis E infections have been described and the number of autochthonous infections is increasing. Here we report an autochthonous HEV subgenotype 3c infection in a 27-year old pregnant woman. This is the first documented case of a hepatitis E infection during pregnancy in Germany. The patient presented in week 26 of gestation with acute hepatitis and elevated transaminases. During follow-up, she tested positive for anti-HEV antibodies. HEV viral load during the acute hepatitis was 2.3×10(6) copies/ml serum, however viremia declined and cleared rapidly. Sequence analysis revealed a HEV subgenotype 3c closely related to European isolates. The patient had not travelled outside Germany, had regular contact to animals, but the source of infection remains unclear. The newborn was delivered in week 40 of gestation in good health, HEV was not transmitted and liver enzymes were normal. In conclusion, hepatitis E should be considered in differential diagnosis in patients with acute hepatitis especially during pregnancy, even without travel history to countries with high endemicity.
authors.affiliation: Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Tabatabai
authors.affiliation: Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Center, Regensburg, Germany.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wenzel
authors.affiliation: Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Soboletzki
authors.affiliation: Schwetzinger Str. 51, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Flux
authors.affiliation: Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
authors.forename: M Heidary
authors.initials: MH
authors.lastname: Navid
authors.affiliation: Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany. Electronic address: Paul_Schnitzler@med.uni-heidelberg.de.
authors.forename: P
authors.initials: P
authors.lastname: Schnitzler
mesh_terms: D000328:Adult; D005260:Female; D005838:Genotype; D005858:Germany; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*; D016752:Hepatitis E virus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*; D012367:RNA, Viral / Q000235:genetics; D000637:Transaminases / Q000097:blood; D019562:Viral Load; D014766:Viremia
chemical_list: D006508:Hepatitis Antibodies; D012367:RNA, Viral; D000637:Transaminases
keywords: Acute hepatitis; Autochthonous hepatitis E; Hepatitis E virus; Pregnancy