Miriam Fritz-Weltin1, Estelle Frommherz1, Nora Isenmann1, Lisa Niedermeier1, Benedikt Csernalabics2, Tobias Boettler2, Christoph Neumann-Haefelin2, Dominique Endres3, Marcus Panning4, Benjamin Berger5. 1. Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. 2. Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 3. Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 4. Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 5. Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. benjamin.berger@uniklinik-freiburg.de.
Abstract
BACKGROUND: Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. An association with neuralgic amyotrophy and Guillain-Barré syndrome (GBS) was previously described. Concerning GBS, studies from other countries found an acute HEV infection in 5-11% of cases. However, HEV prevalence shows considerable regional variations. Therefore, we retrospectively analyzed the frequency of HEV infections in association with GBS in a monocentric cohort in Southwestern Germany. METHODS: Overall, 163 patients with GBS treated in our clinic between 2008 and 2018 of whom serum and/or cerebrospinal fluid (CSF) samples were available, were identified. Serum samples were analyzed for anti-HEV immunoglobulin (Ig)M and IgG antibodies by ELISA. Additionally, both serum and cerebrospinal fluid (CSF) samples were tested for HEV RNA by PCR if IgM was positive or patients presented within the first 7 days from GBS symptom onset. A group of 167 healthy volunteers and 96 healthy blood donors served as controls. RESULTS: An acute HEV infection was found in two GBS patients (1.2%) with anti-HEV IgM and IgG antibodies. HEV PCR in serum and CSF was negative in these two patients as well as in all other tested cases. Seroprevalences indicated that acute infection did not differ significantly from controls (0.8%). Anti-HEV IgG seroprevalence indicating previous infection was unexpectedly high (41%) and revealed an age-dependent increase to more than 50% in patients older than 60 years. CONCLUSION: In this study, serological evidence of an acute HEV infection in patients with GBS was rare and not different from controls. Comparing our data with previous studies, incidence rates show considerable regional variations.
BACKGROUND:Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. An association with neuralgic amyotrophy and Guillain-Barré syndrome (GBS) was previously described. Concerning GBS, studies from other countries found an acute HEV infection in 5-11% of cases. However, HEV prevalence shows considerable regional variations. Therefore, we retrospectively analyzed the frequency of HEV infections in association with GBS in a monocentric cohort in Southwestern Germany. METHODS: Overall, 163 patients with GBS treated in our clinic between 2008 and 2018 of whom serum and/or cerebrospinal fluid (CSF) samples were available, were identified. Serum samples were analyzed for anti-HEV immunoglobulin (Ig)M and IgG antibodies by ELISA. Additionally, both serum and cerebrospinal fluid (CSF) samples were tested for HEV RNA by PCR if IgM was positive or patients presented within the first 7 days from GBS symptom onset. A group of 167 healthy volunteers and 96 healthy blood donors served as controls. RESULTS: An acute HEV infection was found in two GBS patients (1.2%) with anti-HEVIgM and IgG antibodies. HEV PCR in serum and CSF was negative in these two patients as well as in all other tested cases. Seroprevalences indicated that acute infection did not differ significantly from controls (0.8%). Anti-HEV IgG seroprevalence indicating previous infection was unexpectedly high (41%) and revealed an age-dependent increase to more than 50% in patients older than 60 years. CONCLUSION: In this study, serological evidence of an acute HEV infection in patients with GBS was rare and not different from controls. Comparing our data with previous studies, incidence rates show considerable regional variations.
Authors: Jeroen J J van Eijk; Richie G Madden; Annemiek A van der Eijk; Jeremy G Hunter; Johan H J Reimerink; Richard P Bendall; Suzan D Pas; Vic Ellis; Nens van Alfen; Laura Beynon; Lucy Southwell; Brendan McLean; Bart C Jacobs; Baziel G M van Engelen; Harry R Dalton Journal: Neurology Date: 2014-01-08 Impact factor: 9.910
Authors: Harry R Dalton; Jeroen J J van Eijk; Pascal Cintas; Richie G Madden; Catherine Jones; Glynn W Webb; Benjamin Norton; Julie Pique; Suzanne Lutgens; Nikki Devooght-Johnson; Kathy Woolson; John Baker; Maria Saunders; Liz Househam; James Griffiths; Florence Abravanel; Jacques Izopet; Nassim Kamar; Nens van Alfen; Baziel G M van Engelen; Jeremy G Hunter; Annemiek A van der Eijk; Richard P Bendall; Brendan N Mclean; Bart C Jacobs Journal: J Hepatol Date: 2017-07-20 Impact factor: 25.083
Authors: Bianca van den Berg; Annemiek A van der Eijk; Suzan D Pas; Jeremy G Hunter; Richie G Madden; Anne P Tio-Gillen; Harry R Dalton; Bart C Jacobs Journal: Neurology Date: 2014-01-10 Impact factor: 9.910