Autochthone Hepatitis-E-Virus-Infektion als Ursache der akuten Hepatitis in Deutschland – eine Kasuistik

Zusammenfassung

Während das Hepatitis-E-Virus (HEV) als Auslöser akuter Hepatitiden in tropischen und subtropischen Regionen Asiens, Afrikas und Amerikas mit niedrigem hygienischen Standard bekannt ist, werden in hoch entwickelten Industriestaaten zunehmend häufig autochthon erworbene Infektionen beobachtet. Bei 2 Patienten aus Thüringen ohne entsprechende Reiseanamnese wurden nach Ausschluss häufiger Hepatitis-Ursachen HEV-Infektionen diagnostiziert. Während beide Patienten einen ausgeprägten Transaminasenanstieg zeigten, war nur bei einem Patienten ein passagerer Ikterus nachweisbar. Bei beiden Patienten kam es im Verlauf zu einer vollständigen Restitutio ad integrum. Sowohl die Ergebnisse der phylogenetischen Analyse von Virusisolaten als auch epidemiologische Daten des Robert Koch-Instituts und der Gesundheitsämter zeigen, dass die Hepatitis E in Deutschland als Zoonose aufzufassen ist. Die Übertragung auf den Menschen erfolgt am wahrscheinlichsten über ungenügend gegartes Fleisch und Innereien von Hausschweinen und Wildtieren. Die Hepatitis E stellt eine wesentliche Differenzialdiagnose der akuten Non-A, B, C-Virus-Hepatitis dar. Wissenschaftliche Bemühungen sollten neben der exakten Erfassung von Erregerreservoirs und Transmissionswegen auf Konzepte zur Prophylaxe – insbesondere für Risikogruppen wie chronisch Leberkranke und Transplantierte – fokussieren.

Abstract

There is an increasing body of evidence that hepatitis E virus (HEV) triggers acute hepatitis not only in tropical and subtropical regions of Asia, Africa, and America with low sanitary standards but also in highly industrialized countries. We here report on two patients from Thuringia (Germany) with a HEV infection without a recent stay abroad. All other common causes of hepatitis were excluded. Transaminases were significantly incresed in both cases, while icterus could be proven in one patient, only. Both patients fully recovered in the long-term course. Epidemiological and phylogenetic data from viral analyses suggest that HEV infection has to be considered as a zoonosis. It is likely that viral transmission from animals to humans occurs through insufficiently cooked meat or entrails, e. g., from pigs or wild animals. In summary, HEV infection is a relevant differential diagnosis in acute non-A/B/C viral hepatitis. Further studies are required for the identification of other transmission pathways, pathogen reservoirs as well as novel concepts for prophylaxis, especially for patients at risk for hepatic diseases.

Schlüsselwörter

Hepatitis E - Deutschland - autochthone Hepatitis - akute Hepatitis

Key words

hepatitis E - Germany - autochthonous hepatitis - acute hepatitis

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