László Rókusz

New therapeutic options for HCV in Central Europe

New therapeutic options became available in 2015 in the European Union. We present the availability of interferon-free regimens with direct acting antivirals (DAA) in four Central European countries – the Czech Republic, Hungary, Poland and Slovakia – which despite similar historical, geographical and economic situations demonstrate different systems for access to anti-HCV (hepatitis C virus) medication. Treatment of patients in the Czech Republic was based in 2015 on an exceptional individual reimbursement procedure, but regular reimbursement procedures are expected in 2016. In Hungary the decision for treatment is balanced against budget limitations and the national Priority Index system reflecting stage of liver disease, activity of the disease and predictive factors. A reimbursed interferon (IFN)-free therapeutic program for all genotypes, without restrictions related to hepatic fibrosis and treatment history, is already available in Poland. In Slovakia patients with advanced fibrosis are currently selected for possible IFN-free therapy in 2016.

Ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin in HCV genotype 1 infected patients who failed previous protease inhibitor therapy

Aim of the study Combination of ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (3DDA±RBV) therapy is shown to be effective in HCV genotype 1 (GT1) infected patients. However, sparse data exist in patients who failed previous boceprevir or telaprevir based therapies. Real life efficacy and safety of this combination were evaluated in HCV GT1b infected patients (mostly cirrhotics) with compensated liver disease who failed previous boceprevir or telaprevir based therapies more than a year before. Material and methods Data of previous protease inhibitor failure patients, treated with 3DAA+RBV for 12 weeks (GT1b and/or non-cirrhotics) or 24 weeks (non-GT1b cirrhotics), were retrospectively collected. Results Population characteristics: boceprevir/telaprevir-failure: 82/45, GT1b: 117, cirrhotic: 111 (87.4%). SVR12/24 was observed in 103/105 patients (98.1%) of those who reached either time point. Four SAEs reported: one death due to myocardial infarction, another due to recurrent hepatocellular carcinoma after achieving SVR12, two hospitalizations (elevation of transaminases, pneumonia). Grade ≥ 3 AEs or laboratory abnormalities were reported in < 10% of patients; they were transient in all patients. No early discontinuation of drugs due to SAE has been reported. Conclusions One year after previous failure of boceprevir or telaprevir based therapy, 12 weeks of 3DAA+RBV combination in HCV GT1b infected patients is similarly effective and safe as in those with no previous HCV therapy, even in the presence of cirrhosis. These findings might be of particular interest in settings where alternative therapies for such patients are not available or not affordable.

A hepatitis B- és D-vírus-fertőzés diagnosztikája, antivirális kezelése. Magyar konszenzusajánlás. Érvényes: 2017. szeptember 22-től

1Budai Hepatológiai Centrum, Budapest, Szent János Kórház és Észak-budai Egyesített Kórházak, Hepatológiai Szakambulancia, Budapest Semmelweis Egyetem, Általános Orvostudományi Kar, 2Transzplantációs és Sebészeti Klinika, 3II. Belgyógyászati Klinika, 4I. Belgyógyászati Klinika, Budapest 5Szent György Egyetemi Oktató Kórház, I. Belgyógyászat és Molekuláris Diagnosztikai Laboratórium, Székesfehérvár 6Egyesített Szent István és Szent László Kórház, Budapest 7Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Pécs 8MH Egészségügyi Központ Honvédkórház, I. Belgyógyászati Osztály, Budapest 9Debreceni Egyetem, Általános Orvostudományi Kar, Orvosés Egészségtudományi Centrum, Belgyógyászati Intézet, Debrecen 10Somogy Megyei Kaposi Mór Oktató Kórház, Belgyógyászati Osztály, KaposvárDiagnosis and treatment of hepatitis B virus (HBV) and hepatitis D virus infection mean for the patient to be able to maintain working capacity, to increase quality of life, to prevent cancer, and to prolong life expectancy, while the society benefits from eliminating the chances of further transmission of the viruses, and decreasing the overall costs of serious complications. The guideline delineates the treatment algorithms from 22 September 2017 set by a consensus meeting of physicians involved in the treatment of these diseases. The prevalence of HBV infection in the Hungarian general population is 0,5-0,7%. The indications of treatment are based upon viral examinations (including viral nucleic acid determination), determinations of disease activity and stage (including biochemical, pathologic, and/or non-invasive methods), and excluding contraindications. To avoid unnecessary side effects and for a cost-effective approach, the guideline stresses the importance of quick and detailed virologic evaluations, the applicability of transient elastography as an acceptable alternative of liver biopsy in this regard as well as the relevance of appropriate consistent follow-up schedule for viral response during therapy. The first choice of therapy in chronic HBV infection can be pegylated interferon for 48 weeks or continuous entecavir or tenofovir therapy. The latter two must be continued for at least 12 months after hepatitis B surface antigen seroconversion. Lamivudine is no longer the first choice; patients currently taking lamivudine must switch if the response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection. Orv Hetil. 2018; 159(Suppl 1): 24-37.

Hepatitis C-vírus-fertőzés: diagnosztika, antivirális terápia, kezelés utáni gondozás. Magyar konszenzusajánlás @@@Diagnosis, treatment, and follow-up of hepatitis C virus related liver disease. National consensus guideline in Hungary

Magyarorszagon 70000 egyen lehet fertőzott hepatitis C-virussal, nagyobbik reszuk nem tud a fertőzottsegeről. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A 2003 ota alkalmazott pegilalt interferon+ribavirin kettős kezelessel a hazankban dominaloan 1-es genotipussal fertőzott, korabban terapiaban nem reszesult betegek 40–45%-a, a korabban sikertelenul kezeltek 5–21%-a gyogyithato meg. 2011-ben a korabbiaknal lenyegesen hatekonyabb, ket uj, direkt antiviralis hatasu proteazgatlo szer kerult forgalomba (boceprevir es telaprevir). A keszitmenyek – az előrehaladott stadiumban levő majbeteg szamara – 2013 majusa ota hazankban is fi...Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

Hepatitis C-vírus-fertőzés: diagnosztika, antivirális terápia, kezelés utáni gondozás. Magyar konszenzusajánlás

Magyarorszagon 70000 egyen lehet fertőzott hepatitis C-virussal, nagyobbik reszuk nem tud a fertőzottsegeről. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A 2003 ota alkalmazott pegilalt interferon+ribavirin kettős kezelessel a hazankban dominaloan 1-es genotipussal fertőzott, korabban terapiaban nem reszesult betegek 40–45%-a, a korabban sikertelenul kezeltek 5–21%-a gyogyithato meg. 2011-ben a korabbiaknal lenyegesen hatekonyabb, ket uj, direkt antiviralis hatasu proteazgatlo szer kerult forgalomba (boceprevir es telaprevir). A keszitmenyek – az előrehaladott stadiumban levő majbeteg szamara – 2013 majusa ota hazankban is fi...Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

[Hepatitis C: diagnosis, anti-viral therapy, after-care. Hungarian consensus guideline].

Magyarorszagon 70000 egyen lehet fertőzott hepatitis C-virussal, nagyobbik reszuk nem tud a fertőzottsegeről. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A 2003 ota alkalmazott pegilalt interferon+ribavirin kettős kezelessel a hazankban dominaloan 1-es genotipussal fertőzott, korabban terapiaban nem reszesult betegek 40–45%-a, a korabban sikertelenul kezeltek 5–21%-a gyogyithato meg. 2011-ben a korabbiaknal lenyegesen hatekonyabb, ket uj, direkt antiviralis hatasu proteazgatlo szer kerult forgalomba (boceprevir es telaprevir). A keszitmenyek – az előrehaladott stadiumban levő majbeteg szamara – 2013 majusa ota hazankban is fi...Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

Diagnosis, treatment, and follow-up of hepatitis C virus related liver disease. National consensus guideline in Hungary

Magyarorszagon 70000 egyen lehet fertőzott hepatitis C-virussal, nagyobbik reszuk nem tud a fertőzottsegeről. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A 2003 ota alkalmazott pegilalt interferon+ribavirin kettős kezelessel a hazankban dominaloan 1-es genotipussal fertőzott, korabban terapiaban nem reszesult betegek 40–45%-a, a korabban sikertelenul kezeltek 5–21%-a gyogyithato meg. 2011-ben a korabbiaknal lenyegesen hatekonyabb, ket uj, direkt antiviralis hatasu proteazgatlo szer kerult forgalomba (boceprevir es telaprevir). A keszitmenyek – az előrehaladott stadiumban levő majbeteg szamara – 2013 majusa ota hazankban is fi...Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

Hepatitis C-vírus-ferto{combining double acute accent}zés: Diagnosztika, antivirális terápia, kezelés utáni gondozás: Magyar konszenzusajánlás

Magyarorszagon 70000 egyen lehet fertőzott hepatitis C-virussal, nagyobbik reszuk nem tud a fertőzottsegeről. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A 2003 ota alkalmazott pegilalt interferon+ribavirin kettős kezelessel a hazankban dominaloan 1-es genotipussal fertőzott, korabban terapiaban nem reszesult betegek 40–45%-a, a korabban sikertelenul kezeltek 5–21%-a gyogyithato meg. 2011-ben a korabbiaknal lenyegesen hatekonyabb, ket uj, direkt antiviralis hatasu proteazgatlo szer kerult forgalomba (boceprevir es telaprevir). A keszitmenyek – az előrehaladott stadiumban levő majbeteg szamara – 2013 majusa ota hazankban is fi...Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

Hepatitis C-vírus-fertozés: diagnosztika, antivirális terápia, kezelés utáni gondozás. Magyar konszenzusajánlás. Érvényes: 2015. szeptember 12-tol.

Absztrakt Magyarorszagon a hepatitis C-virussal fertőzottek kivizsgalasa, antiviralis terapiaja es kezeles utani gondozasa evek ota orszagosan egyseges szakmai ajanlas szerint erre kijelolt hepatologai centrumokban tortenik. A fertőzes időben tortenő felfedezese es meggyogyitasa a beteg szempontjabol a munkakepesseg megőrzeset, az eletminőseg javulasat, a majzsugor es a majrak megelőzeset, valamint a betegsegmentes varhato elettartam meghosszabbodasat jelenti, mig a beteg kornyezete es a tarsadalom szempontjabol a tovabbfertőzes veszelyenek megallitasat, a kesőbbi sulyos majbetegsegekből adodo egeszsegugyi raforditasigeny jelentős csokkeneset eredmenyezi. A betegek kezelesere hazankban jelenleg is elsődlegesen alkalmazott pegilalt interferon+ribavirin kettős kezeles 2003 ota all rendelkezesre, 2013-tol pedig az ilyen terapiaval meg nem gyogyulo, 1-es genotipussal fertőzottek szamara harmadik szerkent bevezetesre kerultek a direkt antiviralis hatasu proteazgatlo szerek (boceprevir, telaprevir, majd simepre...

Importance of the case of coronavirus-associated severe acute respiratory syndrome detected in Hungary in 2005

Ten years have elapsed since the severe acute respiratory syndrome outbreak, which resulted in more than 8000 cases worldwide with more than 700 deaths. Recently, a new coronavirus, the Middle East Respiratory Syndrome Coronavirus emerged, causing serious respiratory cases and death. By the end of August 2013, 108 cases including 50 deaths were reported. The authors discuss a coronavirus-associated severe acute respiratory syndrome, which was detected in Hungary in 2005 and highlight its significance in 2013. In 2005 the patient was hospitalized and all relevant clinical and microbiological tests were performed. Based on the IgG antibody positivity of the serum samples, the patient was diagnosed as having severe acute respiratory syndrome coronavirus infection in the past. The time and source of the infection remained unknown. The condition of the patient improved and he was discharged from the hospital. The case raises the possibility of infections in Hungary imported from remote areas of the world and the importance of thorough examination of patients with severe respiratory syndrome with unknown etiology.