Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany.
J Clin Virol. 2010 Jan;47(1):89-92. doi: 10.1016/j.jcv.2009.10.011. Epub 2009 Nov 11.
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.
戊型肝炎感染通常是一种自限性疾病，是病毒流行的热带和亚热带地区急性肝炎的重要病因。在工业化国家，已描述了散发性急性戊型肝炎病毒（HEV）感染病例，并且有记录的本地感染病例似乎在增加。我们报告了德国西南部的三例散发性本地戊型肝炎感染病例，这些病例在两年内在我们的大学医院就诊。所有病例均为男性，表现为急性肝炎、黄疸和肝酶升高。在病例 1 和病例 2 中，肝活检显示为急性肝炎，两例患者均抗-HEV 抗体阳性，病例 1 还存在 HEV RNA 阳性，血清病毒载量为 3.0 x 10(3)拷贝/ml。在病例 3 中，可检测到抗-HEV 抗体，血清（4.3 x 10(3)拷贝/ml）和粪便（1.4 x 10(6)拷贝/ml）中均检测到 HEV RNA。这些患者均无德国境外近期旅行史，否认与动物有密切接触。对两名患者的 HEV 序列分析显示基因型 3，与其他欧洲分离株和猪分离株具有同源性。因此，感染源仍不清楚。对于不明原因的肝炎患者和急性肝炎患者，无论其年龄或旅行史如何，都应考虑进行戊型肝炎的鉴别诊断，并且应检测 HEV。
