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von der Schulenburg P, Herting A, Harberts A, Lütgehetmann M, Jahnke‐Triankowski J, Pischke S, Piecha F, Drolz A, Jörg V, Hübener P, Wehmeyer M, Addo MM, Fischer L, Lohse AW, Schulze Zur Wiesch J, Sterneck M. High vaccination coverage and infection rate result in a robust SARS-CoV-2-specific immunity in the majority of liver cirrhosis and transplant patients: A single-center cross-sectional study. United European Gastroenterol J 2024; 12:339-351. [PMID: 38279837 PMCID: PMC11017769 DOI: 10.1002/ueg2.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/09/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND In the third year of the SARS-CoV-2 pandemic, little is known about the vaccine- and infection-induced immune response in liver transplant recipients (LTR) and liver cirrhosis patients (LCP). OBJECTIVE This cross-sectional study assessed the vaccination coverage, infection rate, and the resulting humoral and cellular SARS-CoV-2-specific immune responses in a cohort of LTR and LCP at the University Medical Center Hamburg-Eppendorf, Germany between March and May 2023. METHODS Clinical and laboratory data from 244 consecutive patients (160 LTR and 84 LCP) were collected via chart review and a patient survey. Immune responses were determined via standard spike(S)- and nucleocapsid-protein serology and a spike-specific Interferon-gamma release assay (IGRA). RESULTS On average, LTR and LCP were vaccinated 3.7 and 3.3 times, respectively and 59.4% of patients received ≥4 vaccinations. Altogether, 68.1% (109/160) of LTR and 70.2% (59/84) of LCP experienced a SARS-CoV-2 infection. Most infections occurred during the Omicron wave in 2022 after an average of 3.0 vaccinations. Overall, the hospitalization rate was low (<6%) in both groups. An average of 4.3 antigen contacts by vaccination and/or infection resulted in a seroconversion rate of 98.4%. However, 17.5% (28/160) of LTR and 8.3% (7/84) of LCP demonstrated only low anti-S titers (<1000 AU/ml), and 24.6% (16/65) of LTR and 20.4% (10/59) of LCP had negative or low IGRA responses. Patients with hybrid immunity (vaccination plus infection) elicited significantly higher anti-S titers compared with uninfected patients with the same number of spike antigen contacts. A total of 22.2% of patients refused additional booster vaccinations. CONCLUSION By spring 2023, high vaccination coverage and infection rate have resulted in a robust, mostly hybrid, humoral and cellular immune response in most LTR and LCP. However, booster vaccinations with vaccines covering new variants seem advisable, especially in patients with low immune responses and risk factors for severe disease.
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Affiliation(s)
- P. von der Schulenburg
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - A. Herting
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - A. Harberts
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - M. Lütgehetmann
- German Center for Infection Research (DZIF)Partner Site Hamburg‐Lübeck‐Borstel‐RiemsBraunschweigGermany
- Institute of Medical Microbiology, Virology and HygieneUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - J. Jahnke‐Triankowski
- Department of Visceral Transplant SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- University Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - S. Pischke
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Center for Infection Research (DZIF)Partner Site Hamburg‐Lübeck‐Borstel‐RiemsBraunschweigGermany
| | - F. Piecha
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - A. Drolz
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - V. Jörg
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - P. Hübener
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - M. Wehmeyer
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - M. M. Addo
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Center for Infection Research (DZIF)Partner Site Hamburg‐Lübeck‐Borstel‐RiemsBraunschweigGermany
- Department for Clinical Immunology of Infectious DiseasesBernhard‐Nocht‐Institute for Tropical MedicineHamburgGermany
- University Medical Center Hamburg‐EppendorfInstitute for Infection Research and Vaccine Development (IIRVD)HamburgGermany
| | - L. Fischer
- Department of Visceral Transplant SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- University Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - A. W. Lohse
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Center for Infection Research (DZIF)Partner Site Hamburg‐Lübeck‐Borstel‐RiemsBraunschweigGermany
| | - J. Schulze Zur Wiesch
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Center for Infection Research (DZIF)Partner Site Hamburg‐Lübeck‐Borstel‐RiemsBraunschweigGermany
| | - M. Sterneck
- I. Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- University Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Schäfer G, Lübke R, Degen O, Mader M, Scheiter R, Wolski A, Addo MM, Schulze Zur Wiesch J, Pischke S. Lack of evidence of acute HEV infections as a sexually transmitted disease: Data from a German cohort of PrEP users. Braz J Infect Dis 2024; 28:103720. [PMID: 38365184 PMCID: PMC10885309 DOI: 10.1016/j.bjid.2024.103720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/26/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND While the sexual transmissibility of HAV in MSM has been extensively described, the potential for sexual transmission of HEV has not been definitively established. Although HEV has been detected in the ejaculate of chronically infected men, studies among MSM PrEP users in France did not observe an elevated anti-HEV seroprevalence as an indicator of increased exposure risk by sexual intercourse. PATIENTS AND METHODS A total of 111 unselected PrEP users and 111 age- and sex-matched blood donors were tested for anti-HEV IgG, IgM and HEV (PCR). Of the participants 79/111 (71 %) responded to a questionnaire covering topics as sexual preferences, previous sexually transmitted diseases, profession, food consumption, and pet ownership. RESULTS The anti-HEV IgG seroprevalence in PrEP users (22 %) did not differ significantly from the rate in controls (17 %). While one PrEP user and three controls tested positive for anti-HEV IgM, all PrEP users and controls tested PCR negative. CONCLUSION In immunocompetent individuals with frequent changes of sexual partners, the epidemiology of Hepatitis E Virus does not significantly involve the sexual transmission route.
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Affiliation(s)
- Guido Schäfer
- ICH Hamburg, Hamburg, Germany; Ambulanzentrum des UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rabea Lübke
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Degen
- Ambulanzentrum des UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Mader
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Scheiter
- Ambulanzentrum des UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Wolski
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Sven Pischke
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany.
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Pischke S, Ashouri MM, Peters U, Shiprov A, Schulze Zur Wiesch J, Sterneck M, Fischer F, Huebener P, Mader M, Fischer L, Fründt T, Aarabi G, Beikler T. High incidence of periodontitis in patients with ascitic decompensated cirrhosis. World J Hepatol 2023; 15:1325-1332. [PMID: 38223419 PMCID: PMC10784813 DOI: 10.4254/wjh.v15.i12.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/27/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Periodontitis has been associated with various liver diseases. However, the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive. In particular, it is unclear whether the common periodontitis pathogens, Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), can be detected not only in the oral mucosa but also in ascites and stool. AIM To investigate the significance of periodontitis, P. gingivalis, and A. actinomycetemcomitans in cirrhosis patients with ascitic decompensation. METHODS This prospective study was conducted at the University Hospital Hamburg-Eppendorf, a tertiary center in Northern Germany. A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis, as well as patient outcomes. PCR was used to test gingival samples, ascites, and stool for the presence of P. gingivalis and A. actinomycetemcomitans. Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab. RESULTS Periodontitis was diagnosed in 22 out of 27 (82%) ascite patients, which is significantly more common than in a control cohort of 100 unselected patients (59%, P = 0.04). P. gingivalis was detected in the gingiva of six patients, and one of them also had P. gingivalis in their stool. However, P. gingivalis was not found in the ascites of any patient. Five out of six patients with P. gingivalis had periodontitis (83%). A. actinomycetemcomitans was not detected in any sample. Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis, and survival (Kaplan-Meier analysis) was longer in patients with periodontitis (P = 0.02). Transplant-free survival was also more common in patients with periodontitis compared to those without (63% vs 0%, P = 0.02). CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis. However, there was no evidence of the translocation of P. gingivalis or A. actinomycetemcomitans into ascites. The survival of cirrhotic patients with periodontitis was not reduced.
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Affiliation(s)
- Sven Pischke
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany.
| | - Mohamad Motee Ashouri
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
- Periodontics, Preventive and Restorative Dentistry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Ulrike Peters
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Anita Shiprov
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
- Periodontics, Preventive and Restorative Dentistry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Martina Sterneck
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Frank Fischer
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Peter Huebener
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Maria Mader
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Thorben Fründt
- First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - G Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Gömer A, Klöhn M, Jagst M, Nocke MK, Pischke S, Horvatits T, Schulze zur Wiesch J, Müller T, Hardtke S, Cornberg M, Wedemeyer H, Behrendt P, Steinmann E, Todt D. Emergence of resistance-associated variants during sofosbuvir treatment in chronically infected hepatitis E patients. Hepatology 2023; 78:1882-1895. [PMID: 37334496 PMCID: PMC10653298 DOI: 10.1097/hep.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/21/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND AND AIMS Chronic HEV infections remain a serious problem in immunocompromised patients, as specifically approved antiviral drugs are unavailable. In 2020, a 24-week multicenter phase II pilot trial was carried out, evaluating the nucleotide analog sofosbuvir by treating nine chronically HEV-infected patients with sofosbuvir (Trial Number NCT03282474). During the study, antiviral therapy reduced virus RNA levels initially but did not lead to a sustained virologic response. Here, we characterize the changes in HEV intrahost populations during sofosbuvir treatment to identify the emergence of treatment-associated variants. APPROACH AND RESULTS We performed high-throughput sequencing on RNA-dependent RNA polymerase sequences to characterize viral population dynamics in study participants. Subsequently, we used an HEV-based reporter replicon system to investigate sofosbuvir sensitivity in high-frequency variants. Most patients had heterogenous HEV populations, suggesting high adaptability to treatment-related selection pressures. We identified numerous amino acid alterations emerging during treatment and found that the EC 50 of patient-derived replicon constructs was up to ~12-fold higher than the wild-type control, suggesting that variants associated with lower drug sensitivity were selected during sofosbuvir treatment. In particular, a single amino acid substitution (A1343V) in the finger domain of ORF1 could reduce susceptibility to sofosbuvir significantly in 8 of 9 patients. CONCLUSIONS In conclusion, viral population dynamics played a critical role during antiviral treatment. High population diversity during sofosbuvir treatment led to the selection of variants (especially A1343V) with lower sensitivity to the drug, uncovering a novel mechanism of resistance-associated variants during sofosbuvir treatment.
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Affiliation(s)
- André Gömer
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Mara Klöhn
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Michelle Jagst
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maximilian K. Nocke
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Sven Pischke
- Medical Clinic and Polyclinic, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg Lübeck-Borstel-Riems, Germany
| | - Thomas Horvatits
- Medical Clinic and Polyclinic, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg Lübeck-Borstel-Riems, Germany
- Gastromedics Health Center, Eisenstadt, Austria
| | - Julian Schulze zur Wiesch
- Medical Clinic and Polyclinic, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg Lübeck-Borstel-Riems, Germany
| | - Tobias Müller
- Department of Gastroenterology and Hepatology, Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Svenja Hardtke
- German Center for Infection Research (DZIF); HepNet Study-House/German Liver Foundation (DLS), Hannover, Germany
- Institute for Infections Research and Vaccine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - Markus Cornberg
- German Center for Infection Research (DZIF); HepNet Study-House/German Liver Foundation (DLS), Hannover, Germany
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Germany
- German Center for Infection Research (DZIF); Partner Site Hannover Braunschweig, Germany
- Center for Individualized Infection Medicine (CiiM), Hannover, Germany
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF); HepNet Study-House/German Liver Foundation (DLS), Hannover, Germany
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Germany
- German Center for Infection Research (DZIF); Partner Site Hannover Braunschweig, Germany
| | - Patrick Behrendt
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Germany
- German Center for Infection Research (DZIF); Partner Site Hannover Braunschweig, Germany
- Institute of Experimental Virology, TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
- German Centre for Infection Research (DZIF), Bochum, Germany
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
- European Virus Bioinformatics Center (EVBC), Jena, Germany
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Pischke S, Knoop EV, Mader M, Kling L, Wolski A, Wagner A, Mueller K, Horvatits T, Stiller J, Wisnewski K, Kohn B, Schulze Zur Wiesch J, Groschup MH, Eiden M. Author Correction: Anti-HEV seroprevalence and rate of viremia in a German cohort of dogs, cats, and horses. Sci Rep 2023; 13:20651. [PMID: 38001248 PMCID: PMC10673996 DOI: 10.1038/s41598-023-47523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Affiliation(s)
- S Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany.
| | | | - M Mader
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Kling
- SYNLAB.Vet GmbH, Berlin, Germany
| | - A Wolski
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Wagner
- Vetambulanz Hamburg, Hamburg, Germany
| | - K Mueller
- Small Animal Clinic, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - T Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Stiller
- Small Animal Clinic, University of Leipzig, Leipzig, Germany
| | - K Wisnewski
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - B Kohn
- Small Animal Clinic, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - J Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
| | - M H Groschup
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - M Eiden
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
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Pischke S, Knoop EV, Mader M, Kling L, Wolski A, Wagner A, Mueller K, Horvatits T, Stiller J, Wisnewski K, Kohn B, Schulze Zur Wiesch J, Groschup MH, Eiden M. Anti-HEV seroprevalence and rate of viremia in a German cohort of dogs, cats, and horses. Sci Rep 2023; 13:19240. [PMID: 37935733 PMCID: PMC10630430 DOI: 10.1038/s41598-023-46009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Hepatitis E virus (HEV) genotype 3 infections in Germany are mainly transmitted zoonotically through the consumption of swine meat. Furthermore, there is evidence that pets might come into contact with HEV, but the relevance of companion animals as possible sources of HEV transmission in Germany still needs to be defined. A monitoring study was therefore carried out on dogs, cats, and horses from Germany. In total 365 serum samples from pets (124 dogs, 119 cats, and 122 horses) were tested for HEV by PCR and for anti-HEV antibodies by a commercial ELISA. The HEV seroprevalence determined by the sero-assay varied significantly between dogs (10%), cats (6%), and horses (2%). Liver injury-related enzymes, alanine transaminase (ALT), and aspartate transaminase (AST) showed no differences between HEV-positive or negative animals. None of the pet serum samples tested positive for PCR. This serological study suggests that dogs and cats are significantly exposed to HEV in Germany, while horses are of minor relevance.
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Affiliation(s)
- S Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany.
| | | | - M Mader
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Kling
- SYNLAB.Vet GmbH, Berlin, Germany
| | - A Wolski
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Wagner
- Vetambulanz Hamburg, Hamburg, Germany
| | - K Mueller
- Small Animal Clinic, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - T Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Stiller
- Small Animal Clinic, University of Leipzig, Leipzig, Germany
| | - K Wisnewski
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - B Kohn
- Small Animal Clinic, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - J Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
| | - M H Groschup
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - M Eiden
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Hamburg, Germany
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
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7
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Hermanussen L, Lampalzer S, Bockmann JH, Ziegler AE, Piecha F, Dandri M, Pischke S, Haag F, Lohse AW, Lütgehetmann M, Weiler-Normann C, zur Wiesch JS. Non-organ-specific autoantibodies with unspecific patterns are a frequent para-infectious feature of chronic hepatitis D. Front Med (Lausanne) 2023; 10:1169096. [PMID: 37387781 PMCID: PMC10300640 DOI: 10.3389/fmed.2023.1169096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/18/2023] [Indexed: 07/01/2023] Open
Abstract
Infections with hepatotropic viruses are associated with various immune phenomena. Hepatitis D virus (HDV) causes the most severe form of viral hepatitis. However, few recent data are available on non-disease-specific and non-organ-specific antibody (NOSA) titers and immunoglobulin G (IgG) levels in chronic hepatitis D (CHD) patients. Here, we examined the NOSA titers and IgG levels of 40 patients with CHD and different disease courses and compared them to 70 patients with chronic hepatitis B (CHB) infection. 43% of CHD patients had previously undergone treatment with pegylated interferon-α (IFN-α). The antibody display of 46 untreated patients diagnosed with autoimmune hepatitis (AIH) was used as a reference. The frequency of elevated NOSA titers (CHD 69% vs. CHB 43%, p < 0.01), and the median IgG levels (CHD 16.9 g/L vs. CHB 12.7 g/L, p < 0.01) were significantly higher in CHD patients than in patients with CHB, and highest in patients with AIH (96%, 19.5 g/L). Also, the antinuclear antibody pattern was homogeneous in many patients with AIH and unspecific in patients with viral hepatitis. Additionally, f-actin autoantibodies were only detectable in patients with AIH (39% of SMA). In CHD patients, IgG levels correlated with higher HDV viral loads, transaminases, and liver stiffness values. IgG levels and NOSA were similar in CHD patients irrespective of a previous IFN-α treatment. In summary, autoantibodies with an unspecific pattern are frequently detected in CHD patients with unclear clinical relevance.
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Affiliation(s)
- Lennart Hermanussen
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sibylle Lampalzer
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jan-Hendrik Bockmann
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Annerose E. Ziegler
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Felix Piecha
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Maura Dandri
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W. Lohse
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Weiler-Normann
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze zur Wiesch
- Department of Medicine (Gastroenterology, Hepatology, Infectious diseases, and Tropical Medicine), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Westphal T, Mader M, Karsten H, Cords L, Knapp M, Schulte S, Hermanussen L, Peine S, Ditt V, Grifoni A, Addo MM, Huber S, Sette A, Lütgehetmann M, Pischke S, Kwok WW, Sidney J, Schulze zur Wiesch J. Evidence for broad cross-reactivity of the SARS-CoV-2 NSP12-directed CD4 + T-cell response with pre-primed responses directed against common cold coronaviruses. Front Immunol 2023; 14:1182504. [PMID: 37215095 PMCID: PMC10196118 DOI: 10.3389/fimmu.2023.1182504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction The nonstructural protein 12 (NSP12) of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has a high sequence identity with common cold coronaviruses (CCC). Methods Here, we comprehensively assessed the breadth and specificity of the NSP12-specific T-cell response after in vitro T-cell expansion with 185 overlapping 15-mer peptides covering the entire SARS-CoV-2 NSP12 at single-peptide resolution in a cohort of 27 coronavirus disease 2019 (COVID-19) patients. Samples of nine uninfected seronegative individuals, as well as five pre-pandemic controls, were also examined to assess potential cross-reactivity with CCCs. Results Surprisingly, there was a comparable breadth of individual NSP12 peptide-specific CD4+ T-cell responses between COVID-19 patients (mean: 12.82 responses; range: 0-25) and seronegative controls including pre-pandemic samples (mean: 12.71 responses; range: 0-21). However, the NSP12-specific T-cell responses detected in acute COVID-19 patients were on average of a higher magnitude. The most frequently detected CD4+ T-cell peptide specificities in COVID-19 patients were aa236-250 (37%) and aa246-260 (44%), whereas the peptide specificities aa686-700 (50%) and aa741-755 (36%), were the most frequently detected in seronegative controls. In CCC-specific peptide-expanded T-cell cultures of seronegative individuals, the corresponding SARS-CoV-2 NSP12 peptide specificities also elicited responses in vitro. However, the NSP12 peptide-specific CD4+ T-cell response repertoire only partially overlapped in patients analyzed longitudinally before and after a SARS-CoV-2 infection. Discussion The results of the current study indicate the presence of pre-primed, cross-reactive CCC-specific T-cell responses targeting conserved regions of SARS-CoV-2, but they also underline the complexity of the analysis and the limited understanding of the role of the SARS-CoV-2 specific T-cell response and cross-reactivity with the CCCs.
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Affiliation(s)
- Tim Westphal
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Maria Mader
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Karsten
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leon Cords
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Knapp
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Schulte
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Hermanussen
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Peine
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa Ditt
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, United States
| | - Marylyn Martina Addo
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Department for Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute of Infection Research and Vaccine Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samuel Huber
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, United States
| | - Marc Lütgehetmann
- German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - William W. Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
| | - John Sidney
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, United States
| | - Julian Schulze zur Wiesch
- Infectious Diseases Unit I, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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9
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Pischke S, Shiprov A, Peters U, Schulze Zur Wiesch J, Kluwe J, Westphal T, Fischer F, Mader M, Fründt T, Horvatits K, Horvatits T, Aarabi G, Beikler T. High prevalence of periodontal disease in patients with NASH- possible association of poor dental health with NASH severity. Ann Hepatol 2023; 28:100887. [PMID: 36646168 DOI: 10.1016/j.aohep.2022.100887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/28/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recent translational research indicated a bidirectional relationship between NASH (non-alcoholic steatohepatitis) and periodontitis; however, few clinical cohorts have studied this in detail. Thus we investigated this assumed association in a well-defined cohort. MATERIALS AND METHODS Data were generated prospectively for 132 patients (32 patients with NASH and 100 unselected, consecutively collected, anonymized controls from a local dental practice): detailed periodontal parameters, i.e., pocket-probing-depths (PPD), bleeding-on-probing (BOP), plaque-index, and utilization of dental care were assessed and correlated with relevant hepatic parameters (liver stiffness via fibroscan, AST, ALT, bilirubin, and MELD-score). Gingiva samples were tested for Porphyromonas gingvalis (P.g.) and Actinobacillus actinomyctemcomitans (A.a.) by PCR. RESULTS 87.5% of NASH patients and 47% of controls suffered from moderate to severe periodontitis (p=0.01). Liver stiffness was significantly correlated with elevated PPD (p=0.02) and BOP (p=0.03). 34 % of the NASH patients did not make use of regular dental health care. In these patients, AST (p=0.04), MELD score (p<0.01), and liver stiffness (p=0.01) were significantly elevated compared to those who see a dentist regularly. The severity of NASH was not associated with the intraoral detection of P.g. and A.a. CONCLUSIONS The present study suggests that NASH might be associated with periodontitis, irrespective of the intraoral presence of P.g. and A.a. Moreover, regular dental care utilization might mitigate the course of NASH, and patients should be reminded by their hepatologists of the importance of regular dental visits. Future studies should investigate the role of regular dental care and additional anti-inflammatory treatments of the oral cavity.
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Affiliation(s)
- Sven Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Germany.
| | - Anita Shiprov
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Periodontics, Preventive and Restorative Dentistry, University Medical Centre Hamburg-Eppendorf, Germany
| | - Ulrike Peters
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Centre Hamburg-Eppendorf, Germany
| | - Julian Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner Sites, Germany
| | - Johannes Kluwe
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Westphal
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Fischer
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Centre Hamburg-Eppendorf, Germany
| | - Maria Mader
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorben Fründt
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karoline Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Centre Hamburg-Eppendorf, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Centre Hamburg-Eppendorf, Germany
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10
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Dammermann W, von Menges A, Singethan K, Pischke S, Ritter O, Lüth S, Ullrich S. Increased Seroprevalence of Campylobacter jejuni, but not HEV, in healthcare workers in gastroenterological endoscopy. Z Gastroenterol 2022; 60:1763-1769. [PMID: 35697063 DOI: 10.1055/a-1833-8917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The exposure of healthcare workers (HCW) to fecal-orally transmitted pathogens like hepatitis E Virus (HEV), Campylobacter jejuni or Helicobacter pylori is still not known. The potential risk for employees or patients to acquire these infections through asymptomatic infected healthcare personnel has not yet been studied. Physicians and nurses in gastroenterology working in endoscopic workspaces were recruited. Employees from cardiology, presumed to possess a lower exposure, served as controls. The cytomegalovirus (CMV) seroprevalence was analyzed as a control pathogen without fecal-oral route of transmission. This study provides an objective view onto the potential exposure risk for HCW and patients in endoscopic workspaces. We hypothesize that HCW in gastroenterological endoscopy show a higher seroprevalence for fecal-oral pathogens like HEV, C. jejuni and H. pylori compared to HCW in cardiology. OBJECTIVE Primary objective was the assessment of antibody titers against HEV, C. jejuni and H. pylori in serum of HCW from gastroenterological endoscopy as well as cardiology. As a secondary objective we analyzed the seroprevalence against CMV. METHODS 65 HCW were from gastroenterological endoscopy (n=42) and cardiology (n=23) in three medical centers in the German federal states of Brandenburg, Hamburg and Schleswig-Holstein and were prospectively studied. Antibody titers were determined via ELISA in serum. RESULTS HCW in gastroenterological endoscopy showed a significantly higher C. jejuni seroprevalence for IgG (19.1 %) compared to HCW from the field of cardiology (8.7 %; p=0.04). IgA titers against C. jejuni were negligible. HEV seroprevalence for IgG did not differ significantly between HCW in gastroenterological endoscopy (7.1 %) and cardiology (8.7 %), respectively. IgA and IgM titers against HEV were also negligible. All other antibody titers against CMV and H. pylori showed no significant difference. CONCLUSIONS Only the C. jejuni seroprevalence was significantly increased in HCW from the field of gastroenterological endoscopy. HEV seroprevalence showed no differences. The results for CMV and H. pylori were without pathological findings. However, there is no elevated risk for HEV exposure in medical staff working at an endoscopy unit, but for C. jejuni the protective measures might need to be improved.
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Affiliation(s)
- Werner Dammermann
- Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.,Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea von Menges
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Singethan
- Bundeswehr Institute of Microbiology, München, Germany.,Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Sven Pischke
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Ritter
- Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.,Center for Internal Medicine I, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stefan Lüth
- Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Kemming J, Gundlach S, Panning M, Huzly D, Huang J, Lütgehetmann M, Pischke S, Schulze Zur Wiesch J, Emmerich F, Llewellyn-Lacey S, Price DA, Tanriver Y, Warnatz K, Boettler T, Thimme R, Hofmann M, Fischer N, Neumann-Haefelin C. Mechanisms of CD8+ T-cell failure in chronic hepatitis E virus infection. J Hepatol 2022; 77:978-990. [PMID: 35636577 DOI: 10.1016/j.jhep.2022.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS In immunosuppressed patients, persistent HEV infection is common and may lead to cirrhosis and liver failure. HEV clearance depends on an effective virus-specific CD8+ T-cell response; however, the knowledge gap around HEV-specific CD8+ T-cell epitopes has hindered analysis of the mechanisms of T-cell failure in persistent infection. METHODS We comprehensively studied HEV-specific CD8+ T-cell responses in 46 patients with self-limiting (n = 34) or chronic HEV infection (n = 12), by epitope-specific expansion, functional testing, ex vivo peptide HLA class I tetramer multi-parametric staining, and viral sequence analysis. RESULTS We identified 25 HEV-specific CD8+ T-cell epitopes restricted by 9 different HLA class I alleles. In self-limiting HEV infection, HEV-specific CD8+ T cells were vigorous, contracted after resolution of infection, and formed functional memory responses. In contrast, in chronic infection, the HEV-specific CD8+ T-cell response was diminished, declined over time, and displayed phenotypic features of exhaustion. However, improved proliferation of HEV-specific CD8+ T cells, increased interferon-γ production and evolution of a memory-like phenotype were observed upon reduction of immunosuppression and/or ribavirin treatment and were associated with viral clearance. In 1 patient, mutational viral escape in a targeted CD8+ T-cell epitope contributed to CD8+ T-cell failure. CONCLUSION Chronic HEV infection is associated with HEV-specific CD8+ T-cell exhaustion, indicating that T-cell exhaustion driven by persisting antigen recognition also occurs in severely immunosuppressed hosts. Functional reinvigoration of virus-specific T cells is at least partially possible when antigen is cleared. In a minority of patients, viral escape also contributes to HEV-specific CD8+ T-cell failure and thus needs to be considered in personalized immunotherapeutic approaches. LAY SUMMARY Hepatitis E virus (HEV) infection is usually cleared spontaneously (without treatment) in patients with fully functioning immune systems. In immunosuppressed patients, chronic HEV infection is common and can progress rapidly to cirrhosis and liver failure. Herein, we identified the presence of HEV-specific CD8+ T cells (a specific type of immune cell that can target HEV) in immunosuppressed patients, but we show that these cells do not function properly. This dysfunction appears to play a role in the development of chronic HEV infection in vulnerable patients.
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Affiliation(s)
- Janine Kemming
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Swantje Gundlach
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marcus Panning
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jiabin Huang
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Sven Pischke
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Schulze Zur Wiesch
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sian Llewellyn-Lacey
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom; Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Yakup Tanriver
- Department of Medicine IV (Nephrology and Primary Care), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Fischer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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12
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Ghandili S, Lindhauer C, Pischke S, zur Wiesch JS, von Kroge PH, Polywka S, Bokemeyer C, Fiedler W, Kröger N, Ayuk F, Adjallé R, Modemann F. Clinical features of hepatitis E infections in patients with hematologic disorders. Haematologica 2022; 107:2870-2883. [PMID: 35770534 PMCID: PMC9713558 DOI: 10.3324/haematol.2022.280853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Indexed: 12/14/2022] Open
Abstract
Hepatitis E virus is increasingly being reported to cause chronic infection in immunocompromised patients. However, less is known about patients with an underlying hematologic disease. In particular, the impact of hepatitis E infection on oncological therapy has been poorly described. In this retrospective single-center study, we analyzed 35 hematologic patients with hepatitis E, including 20 patients under active oncological treatment and 15 patients who were in the posttreatment follow-up or under active surveillance. The primary aim was to describe the clinical courses with particular focus on any hepatitis E-related therapy modifications of cancer-directed therapy. In the majority (60%) of patients who were under active oncological treatment, hepatitis E-related therapy modifications were made, and 25% of deaths were due to progression of the hematologic disease. In patients receiving concomitant oncological treatment, no hepatitis Erelated deaths occurred. In contrast, two patients in the follow-up group died from hepatitis E-associated acute-onchronic liver failure. Chronic hepatitis E was observed in 34% of all cases and 43% received ribavirin therapy; of those, 27% achieved a sustained virological response. CD20-directed therapy was the only independent risk factor for developing chronic hepatitis E. We conclude that CD20-directed treatment at any time point is a risk factor for developing chronic hepatitis E. Nevertheless, since mortality from the progression of hematologic disease was higher than hepatitis E-related mortality, we suggest careful case-by-case decisions on modifications of cancer treatment. Patients in the posttreatment follow-up phase may also suffer from severe courses and hepatitis E chronicity occurs as frequently as in patients undergoing active therapy.
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Affiliation(s)
- Susanne Ghandili
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf,*SG and CL contributed equally as co-first authors
| | - Cecilia Lindhauer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf,*SG and CL contributed equally as co-first authors
| | - Sven Pischke
- The I. Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf
| | - Julian Schulze zur Wiesch
- The I. Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf
| | - Philipp H. von Kroge
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf
| | - Susanne Polywka
- The Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf and
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf and
| | - Raissa Adjallé
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf and ,RA and FM contributed equally as co-last authors
| | - Franziska Modemann
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf,Mildred Scheel Cancer Career Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,RA and FM contributed equally as co-last authors
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13
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Heemelaar S, Hangula AL, Chipeio ML, Josef M, Stekelenburg J, van den Akker TH, Pischke S, Mackenzie SBP. Maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and the impact of HIV status: A cross-sectional study in Namibia. Liver Int 2022; 42:50-58. [PMID: 34623734 PMCID: PMC9298024 DOI: 10.1111/liv.15076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome. METHODS A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated. RESULTS Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%). CONCLUSIONS One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anna L. Hangula
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Melody L. Chipeio
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Mirjam Josef
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Jelle Stekelenburg
- Department of Health SciencesGlobal Health UnitUniversity Medical Center GroningenGroningenThe Netherlands,Department of Obstetrics and GynaecologyMedical Center LeeuwardenLeeuwardenThe Netherlands
| | - Thomas H. van den Akker
- Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands,Faculty of ScienceVU UniversityAthena InstituteAmsterdamThe Netherlands
| | - Sven Pischke
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shonag B. P. Mackenzie
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyBorders General HospitalMelroseUnited Kingdom
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14
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Piecha F, Gänßler JM, Ozga AK, Wehmeyer MH, Kluwe J, Lampalzer S, Creutzfeldt AM, Buescher G, Horvatits T, Sterneck M, Pischke S, Lohse AW, Schulze Zur Wiesch J. Evolution of liver stiffness and post-treatment surveillance by liver elastography for HCV patients in the DAA era. Scand J Gastroenterol 2021; 56:840-848. [PMID: 34010581 DOI: 10.1080/00365521.2021.1915374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Baseline liver stiffness (LS) is prognostically relevant in patients with chronic hepatitis C virus (HCV) infection but may change after successful HCV eradication. Data on post-treatment LS for a further risk stratification remain scarce. Here, we study the kinetics of LS and laboratory parameters in patients undergoing HCV treatment and analyze the association of post-treatment LS with outcome parameters. METHODS In a cohort of 1011 chronic HCV patients undergoing DAA treatment, we identified 404 patients with sequential LS and laboratory assessments with or without viral eradication. Additionally, outcome parameters were correlated with post-treatment LS after successful HCV therapy. RESULTS LS significantly decreased from a median of 8.8 to 6.1 kPa in 346 patients after HCV eradication, but significantly increased from a median of 10.5 to 11.9 kPa in 58 patients without viral clearance. In 78 patients with two sequential post-treatment measurements, LS decreased from 12.6 to 8.7 kPa after a median 344 d, with a further decrease to 7.0 kPa after a median of 986 d after end of treatment (EoT). In 400 patients with a post-treatment LS assessment after viral eradication, only 9 liver-related events occurred over a median follow-up (FU) of 23 months. All events were observed in patients with a post-treatment LS >20 kPa. CONCLUSIONS After successful HCV eradication, LS improves sequentially, suggesting an initial phase of necroinflammation regression followed by a second phase of true fibrosis regression. Overall, liver-related events were rarely observed and seem to be limited to patients with a post-treatment LS >20 kPa, so that these patients require a closer clinical monitoring.
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Affiliation(s)
- Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Jan-Michael Gänßler
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte H Wehmeyer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kluwe
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sibylle Lampalzer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Maria Creutzfeldt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gustav Buescher
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horvatits
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Martina Sterneck
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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15
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Horvatits T, Wißmann JE, Johne R, Groschup MH, Gadicherla AK, Schulze Zur Wiesch J, Eiden M, Todt D, Reimer R, Dähnert L, Schöbel A, Horvatits K, Lübke R, Wolschke C, Ayuk F, Rybczynski M, Lohse AW, Addo MM, Herker E, Lütgehetmann M, Steinmann E, Pischke S. Hepatitis E virus persists in the ejaculate of chronically infected men. J Hepatol 2021; 75:55-63. [PMID: 33484776 DOI: 10.1016/j.jhep.2020.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hepatitis E virus (HEV) infections are prevalent worldwide. Various viruses have been detected in the ejaculate and can outlast the duration of viremia, indicating replication beyond the blood-testis barrier. HEV replication in diverse organs, however, is still widely misunderstood. We aimed to determine the occurrence, features and morphology of HEV in the ejaculate. METHODS The presence of HEV in testis was assessed in 12 experimentally HEV-genotype 3-infected pigs. We further tested ejaculate, urine, stool and blood from 3 chronically HEV genotype 3-infected patients and 6 immunocompetent patients with acute HEV infection by HEV-PCR. Morphology and genomic characterization of HEV particles from various human compartments were determined by HEV-PCR, density gradient measurement, immune-electron microscopy and genomic sequencing. RESULTS In 2 of the 3 chronically HEV-infected patients, we observed HEV-RNA (genotype 3c) in seminal plasma and semen with viral loads >2 logs higher than in the serum. Genomic sequencing showed significant differences between viral strains in the ejaculate compared to stool. Under ribavirin-treatment, HEV shedding in the ejaculate continued for >9 months following the end of viremia. Density gradient measurement and immune-electron microscopy characterized (enveloped) HEV particles in the ejaculate as intact. CONCLUSIONS The male reproductive system was shown to be a niche of HEV persistence in chronic HEV infection. Surprisingly, sequence analysis revealed distinct genetic HEV variants in the stool and serum, originating from the liver, compared to variants in the ejaculate originating from the male reproductive system. Enveloped HEV particles in the ejaculate did not morphologically differ from serum-derived HEV particles. LAY SUMMARY Enveloped hepatitis E virus particles could be identified by PCR and electron microscopy in the ejaculate of immunosuppressed chronically infected patients, but not in immunocompetent experimentally infected pigs or in patients with acute self-limiting hepatitis E.
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Affiliation(s)
- Thomas Horvatits
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany.
| | - Jan-Erik Wißmann
- Ruhr University Bochum, Faculty of Medicine, Department of Molecular and Medical Virology, Bochum, Germany
| | - Reimar Johne
- German Federal Institute for Risk Assessment, Department Biological Safety, Berlin, Germany
| | - Martin H Groschup
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany; Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institute, Greifswald-Isle of Riems, Germany
| | - Ashish K Gadicherla
- German Federal Institute for Risk Assessment, Department Biological Safety, Berlin, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany
| | - Martin Eiden
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany; Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institute, Greifswald-Isle of Riems, Germany
| | - Daniel Todt
- Ruhr University Bochum, Faculty of Medicine, Department of Molecular and Medical Virology, Bochum, Germany; European Virus Bioinformatics Center (EVBC), Jena, Germany
| | - Rudolph Reimer
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Lisa Dähnert
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany; Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institute, Greifswald-Isle of Riems, Germany
| | - Anja Schöbel
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - Karoline Horvatits
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rabea Lübke
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany
| | - Eva Herker
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany; Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Steinmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany; Ruhr University Bochum, Faculty of Medicine, Department of Molecular and Medical Virology, Bochum, Germany
| | - Sven Pischke
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems and Heidelberg Partner sites, Germany
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16
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Kamar N, Abravanel F, Behrendt P, Hofmann J, Pageaux GP, Barbet C, Moal V, Couzi L, Horvatits T, De Man RA, Cassuto E, Elsharkawy AM, Riezebos-Brilman A, Scemla A, Hillaire S, Donnelly MC, Radenne S, Sayegh J, Garrouste C, Dumortier J, Glowaki F, Matignon M, Coilly A, Figueres L, Mousson C, Minello A, Dharancy S, Rerolle JP, Lebray P, Etienne I, Perrin P, Choi M, Marion O, Izopet J, Cointault O, Del Bello A, Espostio L, Hebral AL, Lavayssière L, Lhomme S, Mansuy JM, Wedemeyer H, Nickel P, Bismuth M, Stefic K, Büchler M, D’Alteroche L, Colson P, Bufton S, Ramière C, Trimoulet P, Pischke S, Todesco E, Sberro Soussan R, Legendre C, Mallet V, Johannessen I, Simpson K. Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study. Clin Infect Dis 2021; 71:1204-1211. [PMID: 31793638 DOI: 10.1093/cid/ciz953] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response. METHODS Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29-1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25-18) months. RESULTS After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event. CONCLUSIONS This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance.This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, Centre Hospitalier Universitaire (CHU) Rangueil, Institut National de la Santé et de la Recherche Médicale (INSERM) U1043, Institut Fédératif de Recherche Bio-médicale de Toulouse (IFR-BMT), University Paul Sabatier, Toulouse, France
| | - Florence Abravanel
- Department of Virology, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
| | - Patrick Behrendt
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, and Institute of Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Medical School Hannover and the Helmholtz Centre for Infection Research, German Centre for Infection Research, Hannover, Germany
| | - Jörg Hofmann
- Charité Universitätsmedizin Berlin, Department of Nephrology and Intensive Care and Institute of Virology, Labor Berlin Charité-Vivantes-GmbH, Berlin, Germany
| | | | - Christelle Barbet
- Department of Nephrology and Clinical Immunology, Bretonneau Hospital, University Hospital, Tours, France
| | - Valérie Moal
- Aix Marseille Université, Asistance Publique Hôpitaux de Marseille, Institut Pour la Recherche Pour le Développement, Microbes, Evolution, Phylogénie et Infection, Institut Hospitalo-Universitaire-Méditerranée Infection, Hôpital Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Lionel Couzi
- Department of Nephrology and Transplantation, CHU Bordeaux, Bordeaux, France
| | - Thomas Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert A De Man
- Departments of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Annelies Riezebos-Brilman
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Scemla
- Service de néphrologie-transplantation, Hôpital Necker, Assitance publique- Hôpitaux de Paris (AP-HP), Paris et Université Paris Descartes, Paris, France
| | | | - Mhairi C Donnelly
- Department of Hepatology and Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sylvie Radenne
- Department of Hepatology and Liver Transplantation, CHU de la Croix Rousse, Lyon, France
| | - Johnny Sayegh
- Department of Nephrology and Transplantation, CHU Angers, Angers, France
| | - Cyril Garrouste
- Department of Nephrology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Dumortier
- Department of Hepatology, Edouard Herriot Hospital, CHU Lyon, Lyon, France
| | | | - Marie Matignon
- Assistance Publique-Hôpitaux de Paris, Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est-Créteil, Département Hospitalo-Universitaire Virus-Immunité-Cancer, Institut Mondor de Recherche Biomédicale, Equipe 21, INSERM U 955, Créteil, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, INSERM U1193, Université Paris-Sud Paris-Saclay, Villejuif, France
| | - Lucile Figueres
- Department of Nephrology and Clinical Immunology, CHU Nantes, Nantes, France
| | | | - Anne Minello
- Department of Hepatogastroenterology and Digestive Oncology, CHU François Mitterrand, Dijon, France
| | - Sébastien Dharancy
- Hôpital Claude Huriez, Services Maladies de l'Appareil Digestif, INSERM Unité 995, Lille, France
| | | | - Pascal Lebray
- Department of Hepatology, Pitié Salpétrière Hospital, Paris, France
| | | | - Peggy Perrin
- Department of Nephrology, CHU Strasbourg, Strasbourg, France
| | - Mira Choi
- Charité Universitätsmedizin Berlin, Department of Nephrology and Intensive Care and Institute of Virology, Labor Berlin Charité-Vivantes-GmbH, Berlin, Germany
| | - Olivier Marion
- Department of Virology, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
| | - Jacques Izopet
- Department of Virology, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
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17
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Buescher G, Ozga AK, Lorenz E, Pischke S, May J, Addo MM, Horvatits T. Hepatitis E seroprevalence and viremia rate in immunocompromised patients: a systematic review and meta-analysis. Liver Int 2021; 41:449-455. [PMID: 33034121 DOI: 10.1111/liv.14695] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Hepatitis E is an infectious disease of the liver caused by the hepatitis E virus (HEV). Immunocompromised patients present a particular risk group, as chronification of hepatitis E leading to life-threatening cirrhosis occurs when these patients are infected. Therefore, this study aims to estimate and compare the anti-HEV seroprevalence and the rate of HEV RNA positivity in transplant recipients and patients with human immunodeficiency virus (HIV). METHODS This systematic review and meta-analysis involved a literature search (PubMed, Scopus; 1,138 studies) including 120 studies from 1996 to 2019, reporting anti-HEV seroprevalence and/or HEV-RNA positivity. Statistical analysis was performed using a linear mixed-effects meta regression model. RESULTS Anti-HEV seroprevalence in 14 626 transplant recipients ranged from 6% (95% CI: 1.9-17.2) to 29.6% (95% CI: 21.6-39.) in different commercially available assays and did not differ significantly compared to 20 825 HIV positive patients (range: 3.5% (95% CI: 0.9-12.8) - 19.4% (95% CI: 13.5-26.9). In contrast, HEV-RNA positivity rate was significantly higher in transplant recipients than in HIV positive patients (1.2% (95% CI: 0.9-1.6) vs 0.39% (95% CI: 0.2-0.7); P-value = 0.0011). CONCLUSION Anti-HEV seroprevalence did not differ significantly between transplant recipients and HIV positive patients. Interestingly, rates of HEV-RNA positivity, indicating ongoing infection, were significantly higher in transplant recipients. These findings demonstrate that transplant patients have an elevated risk of chronic infection in comparison to HIV patients at comparable risk of HEV-exposure.
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Affiliation(s)
- Gustav Buescher
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Marylyn M Addo
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Thomas Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
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18
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Horvatits T, Schulze zur Wiesch J, Polywka S, Buescher G, Lütgehetmann M, Hussey E, Horvatits K, Peine S, Haag F, Addo MM, Lohse AW, Weiler-Normann C, Pischke S. Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection. Pathogens 2020; 9:E755. [PMID: 32947995 PMCID: PMC7558372 DOI: 10.3390/pathogens9090755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) has been associated with immunological phenomena. Their clinical significance, however, still needs to be clarified, that is, whether cryoglobulins or autoantibodies impact overt disease in HEV-infected individuals. To better understand, we analyzed these different immune phenomena in three cohorts, each representing different types of HEV infection. METHODS The cohorts included: (i) immunocompetent patients with acute hepatitis E, (ii) immunosuppressed patients with chronic hepatitis E, and (iii) individuals with asymptomatic HEV infection. Together, they consisted of 57 individuals and were studied retrospectively for the presence of anti-nuclear antibodies (ANAs), cryoglobulins, and serum total IgG. They were then compared with a control cohort of 17 untreated patients with chronic hepatitis B virus (HBV) infection or hepatitis C virus (HCV) infection. RESULTS Thirteen (23%) were immunocompetent patients with acute hepatitis E (median alanine aminotransferase (ALT) = 872 U/L), 15 (26%) were immunosuppressed patients with chronic hepatitis E (median ALT = 137 U/L), and 29 (51%) were blood donors with asymptomatic HEV infection (median ALT = 35 U/L). Overall, 24% tested positive for elevated ANA titers of >1:160, and 11% presented with a specific ANA pattern. ANA detection was not associated with the type of HEV infection, IgG levels, sex, or age. All individuals tested negative for anti-mitochondrial antibodies, anti-neutrophil cytoplasmic antibodies, liver-kidney microsomal antibodies, anti-myeloperoxidase-, and anti-proteinase-3 antibodies. Five patients (9%) tested positive for cryoglobulins. Notably, cryoglobulinemia was present in overt hepatitis E (Groups (i) and (ii); one acute and four chronic HEV infections), but was not present in any of the asymptomatic blood donors (p = 0.02). The frequency of cryoglobulins and elevated ANAs did not differ significantly between HEV and HBV/HCV patients. CONCLUSION In line with findings on HBV and HCV infections, we frequently observed detection of ANAs (24%) and cryoglobulins (9%) in association with HEV infections. The presence of cryoglobulins was limited to patients with overt hepatitis E. We add to the findings on the immune phenomena of hepatitis E.
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Affiliation(s)
- Thomas Horvatits
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
| | - Julian Schulze zur Wiesch
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
| | - Susanne Polywka
- Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Gustav Buescher
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
- Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Elaine Hussey
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
| | - Karoline Horvatits
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
| | - Sven Peine
- Institute of Transfusion Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Marylyn M. Addo
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
| | - Ansgar W. Lohse
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
| | - Christina Weiler-Normann
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- Martin Zeitz Center for rare diseases, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sven Pischke
- I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.z.W.); (G.B.); (E.H.); (K.H.); (M.M.A.); (A.W.L.); (C.W.-N.); (S.P.)
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, Germany;
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Cornberg M, Pischke S, Müller T, Behrendt P, Piecha F, Benckert J, Todt D, Steinmann E, Papkalla A, von Karpowitz M, Koch A, Lohse A, Hardtke S, Manns MP, Wedemeyer H. Sofosbuvir monotherapy fails to achieve HEV RNA elimination in patients with chronic hepatitis E - The HepNet SofE pilot study. J Hepatol 2020; 73:696-699. [PMID: 32624195 DOI: 10.1016/j.jhep.2020.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany; Center for Individualised Infection Medicine (CiiM), Hannover, Germany; German Center for Infection Research (DZIF); HepNet Study-House, Hannover, Germany; German Center for Infection Research (DZIF); Partner Site Hannover-Braunschweig, Germany.
| | - Sven Pischke
- I.Medical Clinic and Polyclinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Tobias Müller
- Department of Gastroenterology and Hepatology, Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Patrick Behrendt
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany; German Center for Infection Research (DZIF); Partner Site Hannover-Braunschweig, Germany
| | - Felix Piecha
- I.Medical Clinic and Polyclinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Benckert
- Department of Gastroenterology and Hepatology, Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Armin Papkalla
- Hannover Clinical Trial Center (HCTC-KKS), Hannover, Germany
| | | | - Armin Koch
- Institute for Biometry, Hannover Medical School, Germany
| | - Ansgar Lohse
- I.Medical Clinic and Polyclinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Svenja Hardtke
- German Center for Infection Research (DZIF); HepNet Study-House, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany; German Center for Infection Research (DZIF); HepNet Study-House, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany; German Center for Infection Research (DZIF); Partner Site Hannover-Braunschweig, Germany.
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20
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Pflüger LS, Bannasch JH, Brehm TT, Pfefferle S, Hoffmann A, Nörz D, van der Meirschen M, Kluge S, Haddad M, Pischke S, Hiller J, Addo MM, Lohse AW, Schulze Zur Wiesch J, Peine S, Aepfelbacher M, Lütgehetmann M. Clinical evaluation of five different automated SARS-CoV-2 serology assays in a cohort of hospitalized COVID-19 patients. J Clin Virol 2020; 130:104549. [PMID: 32763809 PMCID: PMC7367003 DOI: 10.1016/j.jcv.2020.104549] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
Clinical performance of five different commercially available automated SARS-CoV-2 antibody tests. No overlap of “false” positive samples between different serology assays was observed. The ability to rule out acute SARS-CoV-2 infection at hospital admission with serology is limited.
Background The global market for SARS-CoV-2-immunoassays is becoming ever more crowded with antibody-tests of various formats, targets and technologies, careful evaluation is crucial for understanding the implications of individual test results. Here, we evaluate the clinical performance of five automated immunoassays on a set of clinical samples. Methods Serum/plasma samples of 75 confirmed COVID-19 patients and 320 pre-pandemic serum samples of healthy blood donors were subjected to two IgG and three total antibody SARS-CoV-2-immunoassays. All test setups were automated workflows. Results Positivity of assays (onset of symptoms > 10 days) ranged between 68.4 % and 81.6 % (Diasorin 68.4 %, Euroimmun 70.3 %, Siemens 73.7 %, Roche 79.0 % and Wantai 81.6 %). All examined assays demonstrated high specificity of >99 % (Euroimmun, Diasorin: 99.1 %, Wantai: 99.4 %) but only two reached levels above 99.5 % (Roche: 99.7 %, Siemens 100 %). Interestingly, there was no overlap in false positive results between the assays. The strongest correlation of quantitative results was observed between the Diasorin and Euroimmun IgG tests (r2 = 0.76). Overall, we observed no difference in the distribution of test results between female and male patients (p-values: 0.18−0.87). A significant difference between severely versus critically ill patients was demonstrated for the Euroimmun, Diasorin, Wantai and Siemens assays (p-values: < 0.041). Conclusion All assays showed good clinical performance. Our data confirm that orthogonal test strategies as recommended by the CDC can enhance clinical specificity. However, the suboptimal rates of test positivity found at time of hospitalization in this cohort underline the importance of molecular diagnostics to rule out/confirm active infection with SARS-CoV-2.
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Affiliation(s)
- Lisa Sophie Pflüger
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Johannes H Bannasch
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Thomas Theo Brehm
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Susanne Pfefferle
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Armin Hoffmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dominik Nörz
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marc van der Meirschen
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefan Kluge
- Center for Anesthesiology and Intensive Care Medicine, Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Munif Haddad
- Center for Diagnostics, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sven Pischke
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jens Hiller
- Center for Diagnostics, Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marylyn M Addo
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Ansgar W Lohse
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Julian Schulze Zur Wiesch
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Sven Peine
- Center for Diagnostics, Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Aepfelbacher
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marc Lütgehetmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany.
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21
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Horvatits T, Varwig-Janssen D, Schulze Zur Wiesch J, Lübke R, Reucher S, Frerk S, Addo MM, Schneider SW, Lohse AW, Luetgehetmann M, Pischke S. No link between male infertility and HEV genotype 3 infection. Gut 2020; 69:1150-1151. [PMID: 31118248 DOI: 10.1136/gutjnl-2019-319027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Thomas Horvatits
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Domenica Varwig-Janssen
- Department of Dermatology and Venerology, University Medical Centre Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Rabea Lübke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Svenja Reucher
- Institute of Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Frerk
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Medical Centre Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - Marc Luetgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany.,Institute of Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
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22
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Piecha F, Gänßler JM, Ozga AK, Wehmeyer MH, Dietz J, Kluwe J, Laschtowitz A, von Felden J, Sterneck M, Jordan S, Pischke S, Lohse AW, Schulze zur Wiesch J. Treatment and re-treatment results of HCV patients in the DAA era. PLoS One 2020; 15:e0232773. [PMID: 32369527 PMCID: PMC7200014 DOI: 10.1371/journal.pone.0232773] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Re-treatment in patients with a chronic hepatitis C virus (HCV) infection and a previous failure to direct-acting antiviral (DAA) treatment remains a challenge. Therefore, we investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018. Methods A retrospective analysis of DAA-based HCV therapies of 1096 patients was conducted. Factors associated with a virological relapse were identified by univariable and multivariable logistic regression, treatment success of the re-treatment regimens was evaluated by an analysis of sustained virological response (SVR) rates in patients with a documented follow-up 12 weeks after the end of treatment. Results Of 1096 patients treated with DAA-based regimens, 91 patients (8%) were lost to follow-up, 892 of the remaining 1005 patients (89%) achieved an SVR12. Most patients (65/113, 58%) who experienced a virological relapse received an interferon-based DAA regimen. SVR rates were comparable in special cohorts like liver transplant recipients (53/61, 87%) and people with a human immunodeficiency virus (HIV) coinfection (41/45, 91%). On multivariable analysis, interferon-based DAA therapy was associated with treatment failure (odds ratio 0.111, 95%-confidence interval 0.054–0.218) among others. One hundred seventeen patients with multiple DAA treatment courses were identified, of which 97 patients (83%) experienced a single relapse, but further relapses after two (18/117, 15%) or even three (2/117, 2%) treatment courses were also observed. Eighty-two of 96 (85%) re-treatment attempts with all-oral DAA regimens were successful after an initial treatment failure. Conclusion Overall, DAA re-treatments were highly effective in this real-world cohort and only a minority of patients failed more than two treatment courses. Switching to–or addition of–a new drug class seem to be valid options for the re-treatment of patients especially after failure of an interferon-based regimen.
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Affiliation(s)
- Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- * E-mail:
| | - Jan-Michael Gänßler
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte H. Wehmeyer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
- German Center for Infection Research (DZIF), External Partner Site Frankfurt, Frankfurt, Germany
| | - Johannes Kluwe
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Laschtowitz
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Sterneck
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Jordan
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Julian Schulze zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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23
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von Felden J, Mallet V, Pischke S. Reply to: "Burden of hepatitis E infection and associated healthcare resource utilization among hematological malignancy-related hospitalizations: A national perspective in the United States, 2007-2014". J Hepatol 2019; 71:1268-1269. [PMID: 31585738 DOI: 10.1016/j.jhep.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Vincent Mallet
- Hepatology Service, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France; Institut National de la Santé et de la Recherche Médicale unité 1223, Institut Pasteur, Paris, France
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg Site, Hamburg, Germany.
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24
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Beer A, Holzmann H, Pischke S, Behrendt P, Wrba F, Schlue J, Drebber U, Neudert B, Halilbasic E, Kreipe H, Lohse A, Sterneck M, Wedemeyer H, Manns M, Dienes HP. Chronic Hepatitis E is associated with cholangitis. Liver Int 2019; 39:1876-1883. [PMID: 31102493 PMCID: PMC6790616 DOI: 10.1111/liv.14137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Sporadic hepatitis E is an emerging indigenous disease in Europe induced by genotype 3 of the virus. While the disease takes an acute self-limited course in immunocompetent individuals, under immunocompromised conditions chronic hepatitis E might develop. The histology of chronic hepatitis E has not been described in detail systematically. METHODS Liver biopsies from 19 immunosuppressed patients with chronic hepatitis E were collected: 17 were organ transplant recipients, one had a CD4-deficiency and one had received steroid therapy because of ulcerative colitis. Biopsies were processed with standard stains. Evaluation of histologic activity and fibrosis was performed according to Ishak. Additionally, immunohistochemistry with antibodies directed against open reading frame 2 and 3 of the virus was performed and liver biopsies were tested for hepatitis E virus RNA. RESULTS Biochemical data showed an increase in alanine transaminase, aspartate transaminase, gamma-glutamyl transferase and total bilirubin. Histopathology displayed typical features of chronic hepatitis with mild to moderate activity. The number of polymorphonuclear leucocytes was considerably increased and all patients had a florid cholangitis that presented as a destructive form in five of them. Hepatocytes and bile duct epithelia stained positive for hepatitis E virus by immunohistochemistry. CONCLUSIONS Chronic hepatitis E in immunocompromised individuals runs a similar course as hepatitis B and C and shows similar histopathology. However, the presence of destructive cholangitis in some cases accompanied by an increased number of polymorphonuclear leucocytes is markedly different. Immunohistochemically the virus is present in bile duct epithelia, seemingly the cause for cholangitis.
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Affiliation(s)
- Andrea Beer
- Department of PathologyMedical University of ViennaViennaAustria
| | | | | | - Patrick Behrendt
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Fritz Wrba
- Department of PathologyMedical University of ViennaViennaAustria
| | - Jerome Schlue
- Institute for PathologyMedical School of HanoverHanoverGermany
| | - Uta Drebber
- Institute of PathologyUniversity Hospital CologneCologneGermany
| | - Barbara Neudert
- Department of PathologyMedical University of ViennaViennaAustria
| | - Emina Halilbasic
- Department of GastroenterologyMedical University of ViennaViennaAustria
| | - Hans Kreipe
- Institute for PathologyMedical School of HanoverHanoverGermany
| | | | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Hans P. Dienes
- Department of PathologyMedical University of ViennaViennaAustria
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25
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von Felden J, Alric L, Pischke S, Aitken C, Schlabe S, Spengler U, Giordani MT, Schnitzler P, Bettinger D, Thimme R, Xhaard A, Binder M, Ayuk F, Lohse AW, Cornelissen JJ, de Man RA, Mallet V. The burden of hepatitis E among patients with haematological malignancies: A retrospective European cohort study. J Hepatol 2019; 71:465-472. [PMID: 31108159 DOI: 10.1016/j.jhep.2019.04.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The burden of hepatitis E virus (HEV) infection among patients with haematological malignancy has only been scarcely reported. Therefore, we aimed to describe this burden in patients with haematological malignancies, including those receiving allogeneic haematopoietic stem cell transplantation. METHODS We conducted a retrospective, multicentre cohort study across 11 European centres and collected clinical characteristics of 50 patients with haematological malignancy and RNA-positive, clinically overt hepatitis E between April 2014 and March 2017. The primary endpoint was HEV-associated mortality; the secondary endpoint was HEV-associated liver-related morbidity. RESULTS The most frequent underlying haematological malignancies were aggressive non-Hodgkin lymphoma (NHL) (34%), indolent NHL (iNHL) (24%), and acute leukaemia (36%). Twenty-one (42%) patients had received allogeneic haematopoietic stem cell transplantation (alloHSCT). Death with ongoing hepatitis E occurred in 8 (16%) patients, including 1 patient with iNHL and 1 patient >100 days after alloHSCT in complete remission, and was associated with male sex (p = 0.040), cirrhosis (p = 0.006) and alloHSCT (p = 0.056). Blood-borne transmission of hepatitis E was demonstrated in 5 (10%) patients, and associated with liver-related mortality in 2 patients. Hepatitis E progressed to chronic hepatitis in 17 (34%) patients overall, and in 10 (47.6%) and 6 (50%) alloHSCT and iNHL patients, respectively. Hepatitis E was associated with acute or acute-on-chronic liver failure in 4 (8%) patients with 75% mortality. Ribavirin was administered to 24 (48%) patients, with an HEV clearance rate of 79.2%. Ribavirin treatment was associated with lower mortality (p = 0.037) and by trend with lower rates of chronicity (p = 0.407) when initiated <24 and <12 weeks after diagnosis of hepatitis E, respectively. Immunosuppressive treatment reductions were associated with mortality in 2 patients (28.6%). CONCLUSION Hepatitis E is associated with mortality and liver-related morbidity in patients with haematological malignancy. Blood-borne transmission contributes to the burden. Ribavirin should be initiated early, whereas reduction of immunosuppressive treatment requires caution. LAY SUMMARY Little is known about the burden of hepatitis E among patients with haematological malignancy. We conducted a retrospective European cohort study among 50 patients with haematological malignancy, including haematopoietic stem cell transplant recipients, with clinically significant HEV infection and found that hepatitis E is associated with hepatic and extrahepatic mortality, including among patients with indolent disease or among stem cell transplant recipients in complete remission. Hepatitis E virus infection evolved to chronic hepatitis in 5 (45.5%) patients exposed to a rituximab-containing regimen and 10 (47.6%) stem cell transplant recipients. Reducing immunosuppressive therapy because of hepatitis E was associated with mortality, while early ribavirin treatment was safe and effective.
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Affiliation(s)
- Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Divisions of Liver Diseases and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, Toulouse, France; UMR 152, IRD Toulouse 3 University, France
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg site, Hamburg, Germany
| | - Celia Aitken
- Virology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Stefan Schlabe
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Maria Teresa Giordani
- Infectious Diseases and Tropical Medicine Unit, San Bortolo Hospital, Vicenza, Italy
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Germany; Berta-Ottenstein-Program, Faculty of Medicine, University of Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Germany
| | - Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Mascha Binder
- Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan J Cornelissen
- Department of Haematology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Vincent Mallet
- Hepatology Service, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France; Institut National de la Santé et de la Recherche Médicale unité 1223, Institut Pasteur, Paris, France.
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26
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Horvatits T, Schulze Zur Wiesch J, Lütgehetmann M, Lohse AW, Pischke S. The Clinical Perspective on Hepatitis E. Viruses 2019; 11:E617. [PMID: 31284447 PMCID: PMC6669652 DOI: 10.3390/v11070617] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Every year, there are an estimated 20 million hepatitis E virus (HEV) infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. HEV is largely circulating in the west and is associated with several hepatic and extrahepatic diseases. HEV Genotype 1 and 2 infections are waterborne and causative for epidemics in the tropics, while genotype 3 and 4 infections are zoonotic diseases and are mainly transmitted by ingestion of undercooked pork in industrialized nations. The clinical course of these infections differs: genotype 1 and 2 infection can cause acute illness and can lead to acute liver failure (ALF) or acute on chronic liver failure (ACLF) with a high mortality rate of 20% in pregnant women. In contrast, the majority of HEV GT-3 and -4 infections have a clinically asymptomatic course and only rarely lead to acute on chronic liver failure in elderly or patients with underlying liver disease. Immunosuppressed individuals infected with genotype 3 or 4 may develop chronic hepatitis E, which then can lead to life-threatening cirrhosis. Furthermore, several extra-hepatic manifestations affecting various organs have been associated with ongoing or previous HEV infections but the causal link for many of them still needs to be proven. There is no approved specific therapy for the treatment of acute or chronic HEV GT-3 or -4 infections but off-label use of ribavirin has been demonstrated to be safe and effective in the majority of patients. However, in approximately 15% of chronically HEV infected patients, cure is not possible.
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Affiliation(s)
- Thomas Horvatits
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany
- Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany.
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27
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Kamar N, Pischke S. Acute and Persistent Hepatitis E Virus Genotype 3 and 4 Infection: Clinical Features, Pathogenesis, and Treatment. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a031872. [PMID: 29735575 DOI: 10.1101/cshperspect.a031872] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis E virus (HEV) genotype (gt)3 and 4 infections are prevalent in industrialized and high-income countries. Although most HEV gt3 and gt4 infections are clinically silent, acute infection may be symptomatic in some patients. In persons with underlying liver disease and in elderly men, HEV infections may present as acute or acute-on-chronic liver failure. Chronic hepatitis may develop in immunosuppressed individuals, including transplant recipients, human immunodeficiency virus (HIV)-infected patients, and persons with hematologic malignancy undergoing chemotherapy, and may progress to life-threatening liver cirrhosis. Extrahepatic manifestations of infection may include neurological and renal disease. Although there is no approved specific therapy for the treatment of acute or chronic HEV gt3 or gt4 infection, off-label use of ribavirin appears to be capable of eliminating chronic HEV infection, and may reduce disease severity in patients suffering from acute liver failure.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology and Organ Transplantation, Université Paul Sabatier, Toulouse 31059, France
| | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
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28
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Denner J, Pischke S, Steinmann E, Blümel J, Glebe D. Why all blood donations should be tested for hepatitis E virus (HEV). BMC Infect Dis 2019; 19:541. [PMID: 31221098 PMCID: PMC6585104 DOI: 10.1186/s12879-019-4190-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis E is a liver disease caused by a small RNA virus known as hepatitis E virus (HEV). Four major genotypes infect humans, of which genotype 1 and 2 (HEV-1, HEV-2) are endemic mainly in Asia and responsible for waterborne epidemics. HEV-3 and HEV-4 are widely distributed in pigs and can be transmitted to humans mainly by undercooked meat, and contact with pigs. HEV-3 is the main genotype in industrialised countries with moderate climate conditions and object of this debate. Main text Whereas an HEV-3 infection in healthy humans is mostly asymptomatic, HEV-3 can induce chronic infection in immunocompromised individuals and acute-on-chronic liver failure (ACLF) in patients with underlying liver diseases. The number of reported cases of HEV-infections in industrialised nations increased significantly in the last years. Since HEV-3 has been transmitted by blood transfusion to other humans, testing of blood donors has been introduced or introduction is being discussed in some industrialised countries. In this article we summarise the arguments in favour of testing all blood donations for HEV-3. Conclusion The number of HEV infection in the population and the possibility of HEV transmission by blood transfusion are increasing. Transmission by blood transfusion can be dangerous for the recipients considering their immunosuppressive status, underlying disease or other circumstances requiring blood transfusion. This argues in favour of testing all blood donations for HEV-3 to prevent transmission.
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Affiliation(s)
- Joachim Denner
- Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Sven Pischke
- 1. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Eike Steinmann
- Ruhr-Universität Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Johannes Blümel
- Paul-Ehrlich-Institut, Paul-Ehrlich-Straße 51-59, 63225, Langen, Germany
| | - Dieter Glebe
- Institute of Medical Virology, National Reference Centre for Hepatitis B and D Viruses, German Center for Infection Research (DZIF), Schubertstr. 81, Justus-Liebig-Universität Giessen, 35392, Giessen, Germany
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29
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Heinemann M, Tafrishi B, Pischke S, Fischer L, Rösch T, Lohse AW, Sterneck M, Denzer UW. Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long-term outcome predictors and influence on patient survival. Liver Int 2019; 39:1155-1164. [PMID: 30367552 DOI: 10.1111/liv.13995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/11/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Biliary strictures are common complications after orthotopic liver transplantation. Endoscopic retrograde cholangiography evolved as standard and percutaneous transhepatic cholangiodrainage as alternative therapy. This study analysed predictors of long-term success of biliary strictures after endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage and its impact on patient survival. METHODS All adult patients with biliary strictures receiving endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage between 2009 and 2015 at the University Medical Center Hamburg-Eppendorf were retrospectively analysed. Potential predictors of long-term success (≥12 months) were identified by univariate and logistic regression analyses. Patient survival was analysed by Kaplan-Meier method and log-rank test. RESULTS Hundred and sixteen patients were treated with endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, including 67 patients with anastomotic strictures, 22 with nonanastomotic strictures and 27 with both stricture types. Eighty-five patients received endoscopic retrograde cholangiography, 17 percutaneous transhepatic cholangiodrainage and 14 both techniques. Long-term success was achieved in 60 patients (52%). Predictors of treatment failure were a preinterventional C-reactive protein >8 g/dL in anastomotic strictures (P = 0.039) and a body mass index ≤21 kg/m2 in nonanastomotic strictures (P = 0.021). In patients who received endoscopic retrograde cholangiography only, balloon dilatation of anastomotic strictures with larger diameters favoured success (P = 0.015). Achievement of long-term success was associated with prolonged patient survival in anastomotic strictures (P = 0.036) and nonanastomotic strictures (P = 0.025), but not in combined strictures (P = 0.739). CONCLUSION In post-orthotopic liver transplantation biliary strictures treated by endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, patient BMI and preinterventional C-reactive protein may influence prognosis. Endoscopic retrograde cholangiography with larger balloon diameter may favour success in anastomotic strictures. Long-term success by endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage is associated with superior survival in patients with anastomotic strictures and nonanastomotic strictures only.
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Affiliation(s)
- Melina Heinemann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bita Tafrishi
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department for Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Sterneck
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike W Denzer
- Department for Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
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30
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Affiliation(s)
- Thomas Horvatits
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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31
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Piecha F, Gänßler JM, Jordan S, Ergen C, Ittrich H, Kluwe J, Pischke S, Lohse AW, Schulze Zur Wiesch J. Transjugular Intrahepatic Portosystemic Shunt: A Possible Risk Factor for Direct-Acting Antiviral Treatment Failure in Patients With Hepatitis C? Hepatol Commun 2019; 3:614-619. [PMID: 31061950 PMCID: PMC6492468 DOI: 10.1002/hep4.1337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/24/2019] [Indexed: 12/14/2022] Open
Abstract
Direct‐acting antiviral (DAA) therapies have revolutionized the treatment of chronic hepatitis C virus infection, achieving sustained virological response (SVR) rates of >90% even in patients with advanced liver cirrhosis. Having observed an unusual case of repeated DAA therapy failures in a patient with a transjugular intrahepatic portosystemic shunt (TIPS), we assessed a possible association between prior TIPS placement and DAA failure. A structured search of our clinical database revealed 10 patients who had received DAA therapy after TIPS placement. At the time of therapy, most patients (8; 80%) presented with a Child‐Pugh score B, and the following DAA regimens were used: sofosbuvir/ledipasvir ± ribavirin (5 patients), sofosbuvir/daclatasvir ± ribavirin (3), sofosbuvir/velpatasvir (2), and sofosbuvir/velpatasvir/voxilaprevir (1). In total, 5 patients (50%) achieved an SVR, whereas a virological relapse occurred in the other half of the cases, including 2 patients with multiple relapses. In this patient cohort, SVR rates were unusually low for all regimens: sofosbuvir/ledipasvir ± ribavirin, 3/5 (60%); sofosbuvir/daclatasvir ± ribavirin, 2/3 (66%); sofosbuvir/velpatasvir, 0/2 (0%); and sofosbuvir/velpatasvir/voxilaprevir, 0/1 (0%), and patients with a TIPS made up a relevant proportion of DAA failures in patients with cirrhosis at our center: sofosbuvir/ledipasvir, 2/18 (11%); sofosbuvir/daclatasvir, 1/4 (25%); sofosbuvir/velpatasvir, 2/3 (66%); and sofosbuvir/velpatasvir/voxilaprevir, 1/1 (100%). Conclusion: We observed a high rate of virological relapse in patients with a TIPS who received DAA treatment and therefore postulate that TIPS placement may be a possible risk factor for DAA failure due to the profound hemodynamic changes evoked by the intervention. Longer treatment duration or addition of ribavirin might be warranted in these patients.
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Affiliation(s)
- Felix Piecha
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jan-Michael Gänßler
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Sabine Jordan
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Can Ergen
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Johannes Kluwe
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Sven Pischke
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Ansgar W Lohse
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany.,German Center for Infection Research Partner Site Hamburg-Lübeck-Borstel-Riems Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg Germany.,German Center for Infection Research Partner Site Hamburg-Lübeck-Borstel-Riems Germany
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32
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Horvatits T, Ozga AK, Lohse AW, Dalton HR, Pischke S. Response for letter "Be cautious in comparing the seroprevalence of hepatitis E detected at different years in different countries". Liver Int 2018; 38:2341. [PMID: 30480377 DOI: 10.1111/liv.13915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Thomas Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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33
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Taubert R, Diestelhorst J, Junge N, Kirstein MM, Pischke S, Vogel A, Bantel H, Baumann U, Manns MP, Wedemeyer H, Jaeckel E. Increased seroprevalence of HAV and parvovirus B19 in children and of HEV in adults at diagnosis of autoimmune hepatitis. Sci Rep 2018; 8:17452. [PMID: 30487523 PMCID: PMC6261942 DOI: 10.1038/s41598-018-35882-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022] Open
Abstract
Preceding viral infections have mostly been described in autoimmune hepatitis (AIH) in single cases. We aimed to identify viral infections that potentially trigger AIH, as suggested for hepatitis E virus (HEV) infections. Therefore, antibodies against hepatitis A (HAV), B, C and E viruses; hepatotropic herpesviruses; and parvovirus B19 (PVB19) were analyzed retrospectively in 219 AIH patients at diagnosis, 356 patients with other liver diseases and 89 children from our center. Untreated adult AIH (aAIH) patients showed higher anti-HEV seroprevalences at diagnosis than patients with other liver diseases. Untreated aAIH patients had no increased incidence of previous hepatitis A, B or C. Antibodies against hepatotropic herpesviruses in untreated AIH were in the range published for the normal population. Untreated pediatric AIH (pAIH) patients had evidence of more previous HAV and PVB19 infections than local age-matched controls. The genetic AIH risk factor HLA DRB1*03:01 was more frequent in younger patients, and DRB1*04:01 was more frequent in middle-aged patients without an obvious link to virus seropositivities. Pediatric and adult AIH seem to be distinct in terms of genetic risk factors and preceding viral infections. While associations cannot prove causal relations, the results suggest that hepatotropic virus infections could be involved in AIH pathogenesis.
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Affiliation(s)
- Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - Jana Diestelhorst
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Norman Junge
- Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sven Pischke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Internal Medicine, Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany.,Department of Gastroenterology and Hepatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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34
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Pischke S, Fischer L, Lohse AW. Very Severe Secondary Sclerosing Cholangitis as a Sequela of Influenza. Dtsch Arztebl Int 2018; 114:429. [PMID: 28683859 DOI: 10.3238/arztebl.2017.0429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Horvatits T, Ozga AK, Westhölter D, Hartl J, Manthey CF, Lütgehetmann M, Rauch G, Kriston L, Lohse AW, Bendall R, Wedemeyer H, Dalton HR, Pischke S. Hepatitis E seroprevalence in the Americas: A systematic review and meta-analysis. Liver Int 2018; 38:1951-1964. [PMID: 29660259 DOI: 10.1111/liv.13859] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS While hepatitis E virus infections are a relevant topic in Europe, knowledge about epidemiology of hepatitis E virus infections in the USA and Latin America is still limited. Aim of this study was to estimate anti-hepatitis E virus IgG seroprevalence in the Americas and to assess whether low socioeconomic status is associated with hepatitis E virus exposure. METHODS We performed a systematic review and meta-analysis. Literature search was performed in PubMed for articles published 01/1994-12/2016. Prevalence was estimated using a mixed-effects model and reported in line with PRISMA reporting guidelines. RESULTS Seroprevalence was significantly higher in the USA than in Latin America, independently of assay, patient cohort, methodological quality or study year (OR: 1.82 (1.06-3.08), P = .03). Patients in the USA had a more than doubled estimated seroprevalence (up to 9%, confidence interval 5%-15.6%) than those in Brazil (up to 4.2%, confidence interval 2.4%-7.1%; OR: 2.27 (1.25-4.13); P = .007) and Mixed Caribbean (up to 1%, OR: 8.33 (1.15-81.61); P = .04). A comparison with published data from Europe demonstrated that anti-hepatitis E virus seroprevalence in the USA and Europe did not differ significantly (OR: 1.33 (0.81-2.19), P = .25), while rate in South America was significantly lower than that in Europe (OR: 0.67 (0.45-0.98), P = .04). CONCLUSIONS Hepatitis E virus is common in the USA. Surprisingly, the risk of hepatitis E virus exposure was low in many South American countries. Seroprevalence did not differ significantly between Europe and the USA. Hence, hepatitis E virus is not limited to countries with low sanitary standards, and a higher socioeconomic status does not protect populations from hepatitis E virus exposure.
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Affiliation(s)
- Thomas Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Westhölter
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin F Manthey
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Richard Bendall
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany.,Department of Gastroenterology, Hepatology, University Hospital of Essen, Essen, Germany
| | - Harry R Dalton
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
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36
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Herzer K, Gerken G, Kroy D, Tacke F, Plewe J, Eurich D, Spengler U, Strassburg CP, Welker MW, Pischke S, Sterneck M, Mehrabi A, Weiss KH, Herber A, Berg T, Zimmermann T, Galle PR, Heinzow H, Schmidt H, Markova A, Serfert Y, Manns MP, Zeuzem S, Wedemeyer H. Impact of direct-acting antiviral therapy on the need for liver transplantation related to hepatitis C in Germany. J Hepatol 2018; 69:982-984. [PMID: 30089577 DOI: 10.1016/j.jhep.2018.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/18/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg Essen, Germany.
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg Essen, Germany
| | - Daniela Kroy
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Julius Plewe
- Department of Surgery Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Dennis Eurich
- Department of Surgery Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | | | - Martin-Walter Welker
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martina Sterneck
- Department of Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Adam Herber
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Tim Zimmermann
- I. Dept. of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter R Galle
- I. Dept. of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hauke Heinzow
- Department of Medicine B, Münster University Hospital (UKM), Münster, Germany
| | - Hartmut Schmidt
- Department of Medicine B, Münster University Hospital (UKM), Münster, Germany
| | - Antoaneta Markova
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Germany; Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg Essen, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leberstiftungs-GmbH Deutschland, Hannover, Germany; German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Germany; Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
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Affiliation(s)
- Thomas Horvatits
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Westhölter D, Hiller J, Denzer U, Polywka S, Ayuk F, Rybczynski M, Horvatits T, Gundlach S, Blöcker J, Schulze Zur Wiesch J, Fischer N, Addo MM, Peine S, Göke B, Lohse AW, Lütgehetmann M, Pischke S. HEV-positive blood donations represent a relevant infection risk for immunosuppressed recipients. J Hepatol 2018; 69:36-42. [PMID: 29551705 DOI: 10.1016/j.jhep.2018.02.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Routine HEV testing of blood products has recently been implemented in Great Britain and the Netherlands. The relevance of transfusion-transmitted HEV infections is still controversially discussed in Europe. METHODS All blood donations at the University Medical Center Hamburg-Eppendorf were prospectively tested for HEV RNA by pooled PCR from October 2016 to May 2017. Reactive samples were individually retested. Additionally, stored samples from previous donations of positive donors were tested to determine the duration of HEV viraemia. HEV RNA-positive donors and a control cohort were asked to answer a questionnaire. RESULTS Twenty-three out of 18,737 HEV RNA-positive donors were identified (0.12%). Only two of the positive donors (8.7%) presented with elevated aminotransferases at time of donation (alanine aminotransferase: 192 and 101 U/L). The retrospective analysis of all positive donors revealed that four asymptomatic donors had been HEV viraemic for up to three months with the longest duration of HEV viraemia exceeding four months. Despite the HEV-testing efforts, 14 HEV RNA-positive blood products were transfused into 12 immunocompromised and two immunocompetent patients. One recipient of these products developed fatal acute-on-chronic liver failure complicated by Pseudomonas septicemia. The questionnaire revealed that HEV RNA-positive donors significantly more often consumed raw pork meat (12 out of 18; 67%) than controls (89 out of 256; 35%; p = 0.01). In two donors, undercooked pork liver dishes were identified as the source of infection. HEV genotyping was possible in 7 out of 23 of HEV viraemic donors and six out of seven isolates belonged to HEV Genotype 3, Group 2. CONCLUSIONS Prolonged HEV viraemia can be detected at a relatively high rate in Northern German blood donors, leading to transfusion-transmitted HEV infections in several patients with the risk of severe and fatal complications. Eating raw pork tartare represented a relevant risk for the acquisition of HEV infection. LAY SUMMARY The relevance of transfusion-transmitted hepatitis E virus infections has been discussed controversially. Herein, we present the first report on routine hepatitis E virus screening of blood donations at a tertiary care centre in Germany. Hepatitis E viraemia was found at a relatively high rate of 0.12% among blood donors, which represents a relevant transfusion-related risk for vulnerable patient populations.
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Affiliation(s)
- Dirk Westhölter
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. MAILTO:
| | - Jens Hiller
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Denzer
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Polywka
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horvatits
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svantje Gundlach
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Johanna Blöcker
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Nicole Fischer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Marylyn M Addo
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Sven Peine
- Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Burkhard Göke
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
| | - Sven Pischke
- I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (Deutsche Zentrum für Infektionsforschung), Berlin, Germany
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Bettinger D, Schlabe S, Pischke S, Mallmann MR, Keyver-Paik MD, Kuhn W, Strassburg CP, Thimme R, Spengler U. Ribavirin in Acute Hepatitis E Infection in Patients with Gynecological Cancer: A Case Series. J Clin Transl Hepatol 2018; 6:237-240. [PMID: 29951369 PMCID: PMC6018315 DOI: 10.14218/jcth.2017.00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/23/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022] Open
Abstract
Hepatitis E virus infection is usually a self-limited disease. However, during the last years there has been growing evidence for prolonged and chronic infection occurring in patients with immunosuppression. Also patients with malignant and rheumatic diseases have been identified to be at risk for chronic hepatitis E. However, their course and prognosis are not well characterized and there have been no reports of hepatitis E virus infection in patients with gynecological cancer. Here, we report three Caucasian females with breast and ovarian cancers presenting with elevation of aminotransferase levels during anticancer treatment. Although only few or no clinical hints suggested hepatitis E virus infection, the diagnosis of hepatitis E virus infection was confirmed by seroconversion, which might occur with some delay, and/or by polymerase chain reaction. While two patients had a self-limited course, the third patient with a high-risk oncological constellation required ribavirin in order to resume chemotherapy. These cases highlight the need for hepatitis E virus testing in patients with gynecological cancer and elevated aminotransferase levels. Further, these cases show that in selected high-risk patients, ribavirin treatment may be necessary based on the decision of a multidisciplinary team.
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Affiliation(s)
- Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence to: Dominik Bettinger, Department of Medicine II, Medical Center University of Freiburg, Hugstetter Str. 55, Freiburg 79106, Germany. Tel: +49-761-270-32440, Fax: +49-761-270-32440, E-mail:
| | - Stefan Schlabe
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Sven Pischke
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael R. Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Mignon-Denise Keyver-Paik
- Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
- Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany
| | - Walther Kuhn
- Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
- Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany
| | - Christian P. Strassburg
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
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Gil-Ibanez I, Laqmani A, Pischke S. Sudden Dyspnea in a Liver Transplant Recipient. Dtsch Arztebl Int 2018; 115:323. [PMID: 29807561 DOI: 10.3238/arztebl.2018.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Horvatits T, Westhölter D, Peine S, Schulze Zur Wiesch J, Lohse AW, Lütgehetmann M, Pischke S. Lack of evidence for human serum albumin as major source of HEV infections. Transfus Med 2018; 28:470-471. [PMID: 29707836 DOI: 10.1111/tme.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Affiliation(s)
- T Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Westhölter
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Peine
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Schulze Zur Wiesch
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - A W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - M Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany.,Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
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Abstract
Hepatitis E is an infectious inflammatory disease of the liver caused by the hepatitis E virus (HEV), a single-stranded RNA virus. Today, it is estimated that there are more than 20 million HEV infections every year, leading to 3.3 million symptomatic cases and more than 56,000 deaths. For a long time it was believed that HEV was a travel-associated disease, endemic in developing countries with poor hygienic standards and unsafe water supply. However, over the past years, publications have demonstrated that autochthonous HEV infections in industrialized countries are far more common than previously thought. Awareness for HEV amongst health care practitioners in industrialized countries is still limited. This relatively rare disease is of great importance, especially in immunocompromised patients where it can cause chronic liver disease. This article comprehensively reviews current literature to give an overview on clinically important topics. It will focus on epidemiological aspects, acute and chronic HEV infection as well as extra-hepatic manifestations, diagnostic approach and treatment options. Furthermore, the article is concluded with a brief outlook on perspectives and urgent problems to be addressed in the future.
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Affiliation(s)
- Moritz von Wulffen
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Westhölter
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute for Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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43
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Wehmeyer MH, Hartl J, von Wulffen M, Lohse AW, Pischke S. Time trend of reported cases and publications: hepatitis E in comparison to hepatitis A - D in Germany from 2001 to 2016. Z Gastroenterol 2018; 56:29-35. [PMID: 29316575 DOI: 10.1055/s-0043-123830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The frequency of autochthonous hepatitis E virus (HEV) infections in Western countries has increased since the millennium, probably due to a higher awareness for HEV. The aim of this study was to analyze the epidemiological situation and regional distribution of HEV in comparison to hepatitis A - D in Germany. METHODS Data of the reported cases, patients' travel histories, and the regional distribution of hepatitis A - E virus infections from 2001 to 2017 were extracted from databases of the Robert Koch Institute. The number of publications per year on each hepatitis virus was used as a surrogate parameter for scientific awareness. RESULTS The incidence of HEV infections increased from 31 reported cases in 2001 to 1991 cases in 2016 with a rate of autochthonous HEV infections of 44.4 % in 2001 and 83.9 % in 2016. In 2016, the HEV incidence was 4.4/100 000 in Eastern Germany and 2.0/100 000 in Western Germany. From 2001 to 2016, the numbers of hepatitis A and C virus infections decreased, while the number of hepatitis B virus infections initially decreased followed by an increase since 2014. The incidence of hepatitis D virus infections remained low. The incidence rates of hepatitis A - D virus infections were comparable between Eastern and Western Germany in 2016. There was a strong correlation between publications on HEV and reported HEV cases (Pearson r = 0.9803, p < 0.01). CONCLUSIONS Especially in Eastern Germany, but also in Western Germany, the rate of reported HEV cases and the scientific awareness for this disease increased strongly since 2001.
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Affiliation(s)
- Malte H Wehmeyer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf
| | - Johannes Hartl
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf
| | | | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf.,Deutsches Zentrum für Infektionsforschung (DZIF), Hamburg site
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf.,Deutsches Zentrum für Infektionsforschung (DZIF), Hamburg site
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44
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van Eijk JJJ, Dalton HR, Ripellino P, Madden RG, Jones C, Fritz M, Gobbi C, Melli G, Pasi E, Herrod J, Lissmann RF, Ashraf HH, Abdelrahim M, Masri OABAL, Fraga M, Benninger D, Kuntzer T, Aubert V, Sahli R, Moradpour D, Blasco-Perrin H, Attarian S, Gérolami R, Colson P, Giordani MT, Hartl J, Pischke S, Lin NX, Mclean BN, Bendall RP, Panning M, Peron JM, Kamar N, Izopet J, Jacobs BC, van Alfen N, van Engelen BGM. Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy. Neurology 2017; 89:909-917. [PMID: 28768846 DOI: 10.1212/wnl.0000000000004297] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/06/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. RESULTS Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all genotype 3). Fifty-one of 57 HEV-NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12-2,961 IU/L); in 6 cases, liver function tests were normal. HEV-NA cases were more likely to have bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between the 2 groups at 12 months. CONCLUSIONS Patients with HEV-NA are usually anicteric and have a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Involvement outside the brachial plexus is more common in HEV-NA. The relationship between HEV and NA is likely to be causal, but is easily overlooked. Patients presenting with NA should be tested for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV-NA are warranted.
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Affiliation(s)
- Jeroen J J van Eijk
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Harry R Dalton
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands.
| | - Paolo Ripellino
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Richard G Madden
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Catherine Jones
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Miriam Fritz
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Claudio Gobbi
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Giorgia Melli
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Emanuela Pasi
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jenny Herrod
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Rebecca F Lissmann
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Hamad H Ashraf
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Mohamed Abdelrahim
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Omar A B A L Masri
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Montserrat Fraga
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - David Benninger
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Thierry Kuntzer
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Vincent Aubert
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Roland Sahli
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Darius Moradpour
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Hélène Blasco-Perrin
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Shahram Attarian
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Rene Gérolami
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Philippe Colson
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Maria T Giordani
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Johannes Hartl
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Sven Pischke
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nan X Lin
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Brendan N Mclean
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Richard P Bendall
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Marcus Panning
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jean-Marie Peron
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nassim Kamar
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jacques Izopet
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Bart C Jacobs
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nens van Alfen
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
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Affiliation(s)
| | - Sven Pischke
- *Medizinische Klinik, Universitätsklinikum Hamburg Eppendorf,
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Pischke S, Hartl J, Pas SD, Lohse AW, Jacobs BC, Van der Eijk AA. Hepatitis E virus: Infection beyond the liver? J Hepatol 2017; 66:1082-1095. [PMID: 27913223 DOI: 10.1016/j.jhep.2016.11.016] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/13/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
Hepatitis E virus (HEV) infections are not limited to the liver but may also affect other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis, thyroiditis and myocarditis have been observed in the context of hepatitis E. To date, the definite pathophysiological links between HEV and extrahepatic manifestations are not yet established. However, it is suggested that HEV infection might be causative based on serological studies, case series, in vitro data and animal models. In particular, neuronal and renal diseases as well as pancreatitis seem to be caused by HEV, while a causative relationship between HEV and other diseases is more doubtful. Either direct cytopathic tissue damage by extrahepatic replication, or immunological processes induced by an overwhelming host immune response, are possible origins of HEV-associated extrahepatic manifestations. Hepatologists should be aware of the possibility that acute or chronically HEV-infected patients could develop extrahepatic manifestations. Neurologists, nephrologists, rheumatologists and other groups of physicians should consider HEV infection as a potential differential diagnosis when observing one of the diseases described in this review. Ribavirin and steroids have been used in small groups of patients with extrahepatic manifestations of HEV, but the efficacy of these drugs still needs to be verified by large, multicenter studies. This article comprehensively reviews the published literature regarding HEV and extrahepatic manifestations. We discuss the probability of specific extrahepatic diseases being caused by previous or ongoing HEV infection, and summarize the published knowledge about antiviral treatment in extrahepatic disorders.
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Affiliation(s)
- Sven Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Johannes Hartl
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Suzan D Pas
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Netherlands
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Netherlands
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Horvatits T, Pischke S, Proske VM, Fischer L, Scheidat S, Thaiss F, Fuhrmann V, Lohse AW, Nashan B, Sterneck M. Outcome and natural course of renal dysfunction in liver transplant recipients with severely impaired kidney function prior to transplantation. United European Gastroenterol J 2017; 6:104-111. [PMID: 29435320 DOI: 10.1177/2050640617707089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Since introduction of the MELD score in the liver allograft allocation system, renal insufficiency has emerged as an increasing problem. Here we evaluated the course of kidney function in patients with advanced renal insufficiency prior to liver transplantation (LT). Methods A total of 254 patients undergoing LT at the University Medical Centre Hamburg-Eppendorf (2011-2015) were screened for renal impairment (GFR < 30 ml/min) prior to LT in this observational study. Results Eighty (32%) patients (median 60 years; M/F: 48/32) had significant renal impairment prior to LT. Median follow-up post-LT was 619 days. Patient survival at 90 days, one year and two years was 76%, 66% and 64%, respectively. Need for dialysis postoperatively but not preoperatively was associated with increased mortality (p < 0.05). Renal function improved in 75% of survivors, but 78% of patients had chronic kidney disease ≥ stage 3 at end of follow-up. Of eight (16%) survivors remaining on long-term dialysis, so far only four patients have received a kidney transplant. Conclusion Postoperative dialysis affected long-term mortality. In 75% of survivors renal function improved, but still the majority of patients had an impaired renal function (CKD stage 3-5) at end of follow-up. Future studies should elucidate the impact of kidney dysfunction and dialysis on recipients' long-term survival.
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Affiliation(s)
- T Horvatits
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - V M Proske
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - L Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Scheidat
- Transplant Outpatient Clinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - F Thaiss
- Transplant Outpatient Clinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - V Fuhrmann
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - B Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Andresen-Streichert H, Beres Y, Weinmann W, Schröck A, Müller A, Skopp G, Pischke S, Vettorazzi E, Lohse A, Nashan B, Sterneck M. Improved detection of alcohol consumption using the novel marker phosphatidylethanol in the transplant setting: results of a prospective study. Transpl Int 2017; 30:611-620. [DOI: 10.1111/tri.12949] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/20/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yannick Beres
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Wolfgang Weinmann
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Alexandra Schröck
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Alexander Müller
- Department of Legal Medicine; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Gisela Skopp
- Department of Legal Medicine; University Medical Center Heidelberg; Heidelberg Germany
| | - Sven Pischke
- Department of Medicine (Med Klinik I); University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Ansgar Lohse
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Martina Sterneck
- Department of Medicine (Med Klinik I); University Medical Center Hamburg - Eppendorf; Hamburg Germany
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Pischke S, Bara C, Behrendt P, Haverich A, Manns MP, Wedemeyer H. Low Risk of Developing Chronic Hepatitis E in Heart Transplant Recipients: A Prospective 2-Year Follow-Up Study. Intervirology 2017; 59:254-255. [PMID: 28402973 DOI: 10.1159/000464133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sven Pischke
- Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Pischke S, Lege MC, von Wulffen M, Galante A, Otto B, Wehmeyer MH, Herden U, Fischer L, Nashan B, Lohse AW, Sterneck M. Factors associated with long-term survival after liver transplantation: A retrospective cohort study. World J Hepatol 2017; 9:427-435. [PMID: 28357030 PMCID: PMC5355765 DOI: 10.4254/wjh.v9.i8.427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/25/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.
METHODS Medical charts of all de novo adult liver transplant recipients (n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma (n = 5, 4%); (2) alcohol toxic liver disease (n = 25, 22.0%); (3) primary sclerosing cholangitis (n = 6, 5%); (4) autoimmune liver diseases (n = 7, 6%); (5) hepatitis C virus cirrhosis (n = 15, 13%); (6) hepatitis B virus cirrhosis (n = 21, 19%); and (7) other (n = 35, 31%). The group “other” included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease.
RESULTS The majority of patients were male (n = 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m2 to 33 kg/m2 (median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient’s age (P = 0.009) and BMI (P = 0.029) were identified as risk factors for death by χ2-test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival (P = 0.008 and P = 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival (P = 0.049, χ2-test, P = 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.
CONCLUSION The recipients’ age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors’ age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.
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