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Fatal course of an autochthonous hepatitis E virus infection in a patient with leukemia in Germany

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Abstract

An acute infection with hepatitis E virus (HEV) genotype 3 subtype c was diagnosed in a patient with chronic lymphatic B-cell leukemia 6 weeks after the infusion of donor lymphocytes. Despite intensive care the patient died 39 days after admission due to pericardial effusion that was related to acute liver failure. We suggest that diagnostic procedures for detection of HEV infection should be seriously considered for the immunocompromised patient with elevated liver enzymes in the absence of a travel history to HEV endemic countries.

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References

  1. Bächlein C, Grummer B. Hepatitis E—a new zoonotic disease in Germany? Berl Munch Tierarztl Wochenschr. 2010;123:198–204.

    PubMed  Google Scholar 

  2. Frickmann H, Gabriel M, Polywka S, Bonow I, Günther S, Schmidt-Chanasit J. An unusual cause of elevated liver function tests in an elderly female. J Clin Virol. 2011;51:93–5. doi:10.1016/j.jcv.2011.02.012.

    Article  PubMed  Google Scholar 

  3. Pischke S, Potthoff A, Hauröder B, Schlué J, Manns MP, Cornberg M, et al. Hepatitis E virus infection: a paradigm shift? Dtsch Med Wochenschr. 2010;135:1129–33.

    Article  PubMed  CAS  Google Scholar 

  4. Péron JM, Bureau C, Poirson H, Mansuy JM, Alric L, Selves J, et al. Fulminant liver failure from acute autochthonous hepatitis E in France: description of seven patients with acute hepatitis E and encephalopathy. J Viral Hepat. 2007;14:298–303.

    Article  PubMed  Google Scholar 

  5. Tamura A, Shimizu YK, Tanaka T, Kuroda K, Arakawa Y, Takahashi K, et al. Persistent infection of hepatitis E virus transmitted by blood transfusion in a patient with T-cell lymphoma. Hepatol Res. 2007;37:113–20.

    Article  PubMed  CAS  Google Scholar 

  6. Johne R, Plenge-Bönig A, Hess M, Ulrich RG, Reetz J, Schielke A. Detection of a novel hepatitis E-like virus in faeces of wild rats using a nested broad spectrum RT-PCR. J Gen Virol. 2010;91:750–8.

    Article  PubMed  CAS  Google Scholar 

  7. Lu L, Li C, Hagedorn CH. Phylogenetic analysis of global hepatitis E virus sequences: genetic diversity, subtypes and zoonosis. Rev Med Virol. 2006;16:5–36.

    Article  PubMed  CAS  Google Scholar 

  8. Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484–93.

    Article  PubMed  Google Scholar 

  9. Boxall E, Herborn A, Kochethu G, Pratt G, Adams D, Ijaz S, et al. Transfusion-transmitted hepatitis E in a ‘nonhyperendemic’ country. Transfus Med. 2006;16:79–83.

    Article  PubMed  CAS  Google Scholar 

  10. Lee CK, Chau TN, Lim W, Tsoi WC, Lai ST, Lin CK. Prevention of transfusion-transmitted hepatitis E by donor-initiated self exclusion. Transfus Med. 2005;15:133–5.

    Article  PubMed  CAS  Google Scholar 

  11. Matsubayashi K, Nagaoka Y, Sakata H, Sato S, Fukai K, Kato T, et al. Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan. Transfusion. 2004;44:934–40.

    Article  PubMed  Google Scholar 

  12. Mitsui T, Tsukamoto Y, Yamazaki C, Masuko K, Tsuda F, Takahashi M, et al. Prevalence of hepatitis E virus infection among hemodialysis patients in Japan: evidence for infection with a genotype 3 HEV by blood transfusion. J Med Virol. 2004;74:563–72.

    Article  PubMed  CAS  Google Scholar 

  13. Adlhoch C, Wolf A, Meisel H, Kaiser M, Ellerbrock H, Pauli G. High HEV prevalence in four different wild boar populations in East and West Germany. Vet Microbiol. 2009;139:270–8. doi:10.1016/j.vetmic.2009.06.032.

    Article  PubMed  Google Scholar 

  14. Ayoola EA, Want MA, Gadour MO, Al-Hazmi MsH, Hamza MK. Hepatitis E virus infection in haemodialysis patients: a case-control study in Saudi Arabia. J Med Virol. 2002;66:329–34.

    Article  PubMed  CAS  Google Scholar 

  15. Hosseini-Moghaddam SM, Zarei A, Alavian SM, Mansouri M. Hepatitis E virus infection: a general review with a focus on hemodialysis and kidney transplant patients. Am J Nephrol. 2010;31:398–407.

    Article  PubMed  Google Scholar 

  16. Myint KS, Gibbons RV. Hepatitis E: a neglected threat. Trans R Soc Trop Med Hyg. 2008;102:211–2.

    Article  PubMed  Google Scholar 

  17. Kamar N, Rostaing L, Abravanel F, Garrouste C, Lhomme S, Esposito L, et al. Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection. Gastroenterology. 2010;139:1612–8.

    Article  PubMed  CAS  Google Scholar 

  18. Mumtaz K, Azam Z, Hamid S, Abid S, Memon S, Ali Shah H, et al. Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation. Hepatol Int 2009;3:563–70.

    Google Scholar 

  19. Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ, et al. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet. 2010;376:895–902.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We acknowledge Petra Emmerich for helpful discussions and Insa Bonow, Marzena Domagalski, Alexandra Bialonski and Deborah Maus for technical assistance. The experiments comply with the current laws of Germany.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmühlen Strasse 5, 20099, Hamburg, Germany

    S. Pfefferle & N. Schmitz

  2. Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany

    H. Frickmann

  3. Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany

    M. Gabriel, S. Günther & J. Schmidt-Chanasit

Authors
  1. S. Pfefferle
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  2. H. Frickmann
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  3. M. Gabriel
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  4. N. Schmitz
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  5. S. Günther
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  6. J. Schmidt-Chanasit
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Corresponding author

Correspondence to J. Schmidt-Chanasit.

Additional information

Susanne Pfefferle and Hagen Frickmann contributed equally to this article.

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Pfefferle, S., Frickmann, H., Gabriel, M. et al. Fatal course of an autochthonous hepatitis E virus infection in a patient with leukemia in Germany. Infection 40, 451–454 (2012). https://doi.org/10.1007/s15010-011-0220-7

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  • DOI: https://doi.org/10.1007/s15010-011-0220-7

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