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Erschienen in: Infection 6/2022

Open Access 16.06.2022 | Correspondence

No link between the prevalence of hepatitis E virus infection and the diagnosis of schizophrenia

verfasst von: Claudia Beisel, Sven Pischke, Maria Mader, Steffen Moritz, Daniel Schöttle, Daniel Lüdecke

Erschienen in: Infection | Ausgabe 6/2022

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Infection with the Hepatitis E Virus (HEV) may cause strong inflammation of the liver and represents one of the most common causes of acute hepatitis in the world. Extrahepatic manifestations, such as neurological, hematological, or renal manifestation as well as several autoimmune phenomena have been reported in association with HEV infection [1]. There are only limited data about the association between HEV infection and psychiatric disorders. Few epidemiological studies from Taiwan, China, and Germany, demonstrated high anti-HEV IgG seroprevalence rates in psychiatric patients [25]. However, these studies often lack adequate control cohorts, making it difficult to adequately classify seroprevalence rates. Systematic studies that address the risk of psychiatric patients acquiring HEV infection, or if a previous HEV infection may trigger psychiatric diseases are missing.
Here, we present a cohort of 39 patients with the initial diagnosis of acute schizophrenia. Serum samples and cerebrospinal fluid (CSF) were tested for HEV by PCR (Altona diagnostics Realstar HEV RT-PCR kit, Altona diagnostics, Hamburg, Germany) and anti-HEV IgG (Wantai assay, Wantai, Bejing, China) to define the prevalence of acute or previous HEV infection in this psychiatric patient cohort. CSF was available in 32 patients (82%). Patients were identified between January 2016 and March 2018 at the Department of Psychiatry of the University Medical Center Hamburg-Eppendorf and included in this monocenter study. The diagnosis of acute schizophrenia was established by a highly specialist psychiatrist. Patients’ age ranged from 18 to 52 years, with a mean age of 31 years. With 21 of 39 patients (54%), there was a slightly higher proportion of female individuals.
Since 35 patients (90%) were tested negative for HEV serum Immunoglobulin G (IgG), in four patients HEV IgG was found to be positive (10%), indicating a recent or prior HEV infection. The seroprevalence of anti-HEV IgG was higher in males compared to females (22% versus 0%, p = 0.01). To exclude recent, ongoing HEV infection, we performed HEV polymerase chain reaction (PCR) in serum and CSF samples. HEV ribonucleic acid (RNA) was not detected in any of the serum or CSF samples, which allowed us to exclude active HEV infection in all of the 39 patients (see Table 1).
Table 1
Patient characteristics
Characteristic
Total study population
n = 39 (100%)
Females
n = 21 (54%)
Males
n = 18 (46%)
Age in years; mean, range
31; 18–52
29; 19–41
30; 18–52
HEV IgG, serum
 Available, n (%)
39 (100)
21 (100)
18 (100)
 Negative, n (%)
35 (90)
21 (100)
14 (78)
 Positive, n (%)
4 (10)
0 (0)
4 (22)
HEV RNA, serum
 Available, n (%)
39 (100)
21 (100)
18 (100)
 Negative
39 (100)
21 (100)
18 (100)
 Positive
0 (0)
0 (0)
0 (0)
HEV RNA, CSF
 Available, n (%)
29 (74)
17 (81)
12 (67)
 Negative
29 (100)
17 (100)
12 (100)
 Positive
0 (0)
0 (0)
0 (0)
A total number of 39 patients with the diagnosis of acute schizophrenia were included in this study. There were 21 female patients. The mean age of the study population was 31 years. In all patients serum samples were available. Four patients were tested positive for HEV IgG (10%). HEV RNA was not detected in any of the serum samples. Cerebrospinal fluid (CSF) was available in 29 patients (74%). In none of the serum or CSF samples, HEV RNA was detected by PCR
Taken together, the overall HEV IgG seroprevalence of the presented cohort was 10%. According to previously published cohorts, the HEV IgG seroprevalence in German healthy controls ranges from 15.3 to 18.6% in recent years [6]. Unlike previous studies [25], our database is a well-defined cohort of patients with acute schizophrenia at the time point of initial diagnosis. None of these patients tested positive for HEV RNA and the seroprevalence rate was in no way elevated in comparison to healthy individuals.
In conclusion, the presented data provided no evidence for an association between the diagnosis of HEV infection and an acute episode of schizophrenia and therefore we cannot confirm the previous studies, which unfortunately did not refer to comparative cohorts with healthy people.

Acknowledgements

We sincerely thank the patients participating in this study.

Declarations

Conflict of interest

The corresponding author (SP) states on behalf of all authors that there is no conflict of interest.

Institutional review board statement

According to our ethical court either an agreement for testing of anonymized samples nor a formal approvement are necessary for this retrospective study (Ethics Committee of the Medical Council of Hamburg WF-138/20). However, the aim of this study has been approved (PV 7049).
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Metadaten
Titel
No link between the prevalence of hepatitis E virus infection and the diagnosis of schizophrenia
verfasst von
Claudia Beisel
Sven Pischke
Maria Mader
Steffen Moritz
Daniel Schöttle
Daniel Lüdecke
Publikationsdatum
16.06.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Infection / Ausgabe 6/2022
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-022-01871-2

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