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Institute of Virology


Hepatitis E



Hepatitis E virus (HEV) has a worldwide distribution and is now recognized as the leading cause of acute hepatitis globally. Human infection follows two distinct epidemiological patterns. In developing countries, HEV genotypes 1 (HEV1) and 2 (HEV2) are prevalent. These genotypes are transmitted from human to human faecal-orally mainly via contaminated water. In contrast, HEV infection in developed countries is caused by genotypes 3 (HEV3) and 4 (HEV4) and is a locally acquired (porcine) zoonosis. A distinct epidemiological feature of HEV3 is its capability to cause chronic infection in immunosuppressed patients, such as solid organ transplant recipients or stem cell transplant recipients, and human immunodeficiency virus infected patients (Figure). In these vulnerable patient groups HEV infection can cause severe morbidity and mortality.

The overall burden of HEV infection is still ill defined and a number of new clinical presentations are still emerging. Amongst others, there is growing evidence that neuralgic amyotrophy (NA) is associated with acute HEV infection. NA is characterized by severe neuropathic pain in the arm and shoulder, which is usually bilateral. We have recently started to study the role of HEV in cases presenting with NA in Freiburg. We aim to characterize HEV-infected patients with neurological disorders in collaboration with the Department of Neurology and Neurophysiology. We hypothesize that neurotropic HEV variants exist which can explain a different clinical phenotype. In the long term we aim to establish a HEV reverse genetic system to study the molecular mechanisms of HEV-associated neurological disorders.



Selected publications from our group:

  1. Panning M, Basho K, Fahrner A, Neumann-Haefelin C. (2019) Chronic hepatitis E after kidney transplantation with an antibody response suggestive of reinfection: a case report. BMC Infect Dis 2019;19:675.
  2. Fritz M, Berger B, Schemmerer M, Endres D, Wenzel JJ, Stich O, Panning M. (2018) Pathological Cerebrospinal Fluid Findings in Patients With Neuralgic Amyotrophy and Acute Hepatitis E Virus Infection. J Infect Dis 217:1897-901.
  3. 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 O, Fraga M, Benninger D, Kuntzer T, Aubert V, Sahli R, Moradpour D, Blasco-Perrin H, Attarian S, Gerolami 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. (2017). Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy. Neurology 89:909-917.



  • University Medical Center, Department of Neurology and Neurophysiology, Freiburg
  • University Medical Center, Internal Medicine II, Freiburg
  • University Medical Center, Regensburg

Figure: Time course and level of HEV-RNA concentration and liver enzymes AST, ALT, and γGT in a patient after kidney transplantation in April 2016, who developed chronic HEV infection. Vertical broken lines indicate threshold for γ-GT (60 U/L, upper line) and AST, ALT (50 U/L, lower line), respectively. (Panning et al, BMC Infect Dis 2019)

Institute of Virology

Hermann-Herder-Strasse 11
D-79104 Freiburg


Prof. Dr. med. Hartmut Hengel

Team Leader:

Marcus Panning
(Dr. med., Professor)
Phone: +49 761 203 6610
Fax: +49 761 203 6603