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Hepatitis E Virus and neurological disorders

Hepatitis E virus (HEV) has a worldwide distribution and is now recognized as the leading cause of acute hepatitis. Human infection follows two distinct epidemiological patterns. In developing countries, HEV genotypes 1 (HEV1) and 2 (HEV2) are prevalent and transmitted from human to human via the fecal-oral route. In contrast, HEV infection in industrialized countries is caused by HEV genotypes 3 (HEV3) and 4 (HEV4) and is a locally acquired (porcine) zoonosis.

The overall burden of HEV infection is still ill defined. There is growing evidence that neuralgic amyotrophy (NA) is associated with acute HEV infection. NA is characterized by severe and usually bilateral neuropathic pain in the arm and shoulder. We have recently started to study the role of HEV infection in cases presenting with NA and other neurological disorders in Freiburg. We aim to characterize these patients with acute HEV infection. We hypothesize that a neurotropic HEV phenotype might exist for selected clinical presentations. Further, we aim to characterize HEV strains from patients showing neurological disorders using novel full genome sequencing approaches (Section Clinical Virusgenomics)

Selected publications from our group:

  1. Fritz-Weltin M, Niedermeier L, Frommherz E, Isenmann N, Csernalabics B, Boettler T, Neumann-Haefelin C, Endres D, Panning M, Berger B. Hepatitis E virus and Bell's palsy. Eur J Neurol 2021.
  2. Fritz-Weltin M, Frommherz E, Isenmann N, Niedermeier L, Csernalabics B, Boettler T, Neumann-Haefelin C, Endres D, Panning M, Berger B. Hepatitis E virus as a trigger for Guillain-Barre syndrome. BMC Neurol 2021;21:304.

  3. Panning M, Basho K, Fahrner A, Neumann-Haefelin C. Chronic hepatitis E after kidney transplantation with an antibody response suggestive of reinfection: a case report. BMC Infect Dis 2019;19:675.
  4. Fritz M, Berger B, Schemmerer M, Endres D, Wenzel JJ, Stich O, Panning M. Pathological Cerebrospinal Fluid Findings in Patients With Neuralgic Amyotrophy and Acute Hepatitis E Virus Infection. J Infect Dis 2018 217:1897-901.


  • University Medical Center, Department of Neurology and Neurophysiology, Freiburg
  • University Medical Center, Department of Medicine II, Freiburg
  • University Medical Center, Institute for Transfusion Medicine and Gene Therapy, Freiburg
  • University Medical Centre, Institute of Clinical Microbiology and Hygiene, Regensburg

Figure: Age-adjusted HEV-IgG antibody prevalence across different age groups in Bell´s palsy (BP) patient cohort and a control group (Fritz-Weltin et al., Eur J Neurol 2022).


Prof. Dr. med. Hartmut Hengel


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