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Volume 17, Number 8—August 2011


Neurologic Disorders and Hepatitis E, France, 2010

Laura-Anne Despierres, Elsa Kaphan, Shahram Attarian, Stephan Cohen-Bacrie, Jean Pelletier, Jean Pouget, Anne Motte, Rémi N. Charrel, René Gerolami, and Philippe ColsonComments to Author 
Author affiliations: Author affiliations: Centre Hospitalo-Universitaire Timone, Marseille, France (L.-A. Despierres, E. Kaphan, S. Attarian, S. Cohen-Bacrie, J. Pelletier, J. Pouget , A. Motte, R. Charrel, P. Colson); Université de la Méditerranée, Marseille (S. Cohen-Bacrie, R. Charrel, P. Colson); Centre Hospitalo-Universitaire Conception, Marseille (R. Gerolami)

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Table A1

Clinical features and laboratory findings for neurologic disorders associated with hepatitis E infection*

Reference and year Country Age, y/sex Neurologic symptoms ALT, IU/L CSF Other infectious etiologies excluded by serologic or molecular testing Serum CSF Treatment/outcome
Leukocytes, cells/mm3 Protein, g/L Anti-HEV IgM Anti-HEV IgG HEV RNA Anti-HEV IgM Anti-HEV IgG HEV RNA
Cases from this study
Case 1, 2010 France 54/F Meningitis with neuralgic pain: headaches, photophobia, diffuse paresthesia, and pain of upper and lower limbs 566 74 1.03 Serum: HAV, HBV, HCV, HIV, measles virus, rubella virus, HSV, VZV, EBV, parvovirus B19, dengue virus, Leptospira spp., Brucella spp., Coxiella burnetii, Rickettsia conorii, R. typhi, R. felis + + + Genotype 3 + NT + Genotype 3 Total recovery in 2 wk
CSF: CMV, HSV, VZV, EBV, HHV6, Toscana virus, mumps virus, measles virus, Listeria monocytogenes, Mycobacteria spp., Mycoplasma spp., all bacteria (16S ribosomal RNA detection)
Case 2, 2010 France 49/M Polyradiculoneuropathy: Proximal muscle weakness, paresthesia, and pain of upper and lower limbs 78 10 1.02 Serum: HAV, HBV, HCV, HIV, EBV, CMV, VZV, parvovirus B19, mumps virus, brucellosis, Bartonella henselae, Bartonella quintana + + + Genotype 3 NT Clinical recovery in 2 wk
CSF: EBV, HSV, VZV, enterovirus, Toscana virus, WNV, Borrelia burgdorferi, all bacteria (16S ribosomal RNA detection)
Cases reported in the literature
Guillain-Barré syndrome:
(6), 2000 India 50/M Generalized paresthesia, weakness of the lower limbs, hypotonia, areflexia 114 <5 1.86 Serum: HAV, HBV, HCV + NT NT NT NT NT Improvement 2 wk after neurologic onset; total recovery within 1 mo
(7), 2002 India 35/M Weakness of upper and lower limbs and of respiratory muscles 752 NT NT Serum: HAV, HBV, HCV, HDV, HIV + NT NT NT NT NT IVIG; total recovery within 2 wk
(8), 2005 India 58/F Muscular weakness, diffuse areflexia, left infranuclear facial palsy 1,448 <2 0.80 Serum: HAV, HBV, HCV + NT NT NT NT NT IVIG, plasmapheresis; total neurologic recovery in 2 wk; tiver biochemistry normalized after about 5 wk
(3), 2008 United Kingdom 42/M Paresthesia and weakness in lower limbs 632 NA NA NA + NA + Genotype 3 NT NT Total recovery after 3 mo
(9), 2009 Belgium 66/M Progressive ataxia; weakness and paresthesia of legs, with ataxia and neuropathic pain 1,813 <5 1.72 Serum: HAV, HBV, HCV, HIV, VZV, CMV, EBV, HSV, adenovirus, Campylobacter spp. + NT NT NT NT NT IVIG; progressive improvement of walking perimeter and pain within 4 mo
(10), 2010 Czech Republic 65/M Loss of strength in upper limbs and partially in lower limbs; pain in both shoulders 1,920 7 0.7 Serum: HSV, EBV, CMV, HAV, HBV, HCV, enterovirus, inflluenza A/B virus, parainfluenza viruses 1–3, adenovirus, tick-borne encephalitis virus, Borrelia burgdorferi, Anaplasma phagocytophilum,Chlamydia pneumoniae, Mycoplasma spp. + +† NT NT NT NT Persistence of residual tetraparesis 19 mo after onset (chronic demyelinating polyneuropathy); improvement after IVIG
CSF: VZV,HSV, enterovirus, A. phagocytophilum,C. pneumoniae, Mycoplasma spp. B. burgdorferi.
(11), 2010 Ireland 40/M Progressive weakness of the legs; paresthesia of hands and feet, then quadriplegia, repiratory insufficiency, and facial weakness 57 <5 0.38 Serum: HAV, HBV, HCV, HIV, CMV, EBV +‡ NA NT NT NT NT IVIG, followed by plasmapheresis; total recovery within 6 mo
(4), 2010 France 44/M Peripheral nerve involvement; proximal muscular weakness of the joints of the 4 limbs; bilateral pyramidal syndrome 105 7 0.76 Serum: HBV, HCV, HIV, CMV, EBV + + + Genotype 3 + Genotype 3 IVIG; no improvement; death 1 mo later from decompensated cirrhosis
CSF: CMV, HSV, VZV, JC virus, Cryptococcus antigen, Toxoplasma gondii, Candida spp
Other neurologic diagnosis
(1), 2001 India 28/F Meningoencephalitis: nuchal rigidity; drowsiness; desorientation; bilateral Babinski reflex and seizure 1,890 12 1.10 Serum: HAV, HBV, HCV, HIV, EBV, Treponema pallidum + + at mo 6 NT NT NT NT Improvement of neurologic symptoms in 3 wk
(12), 2006 India 12/F Acute transverse myelitis: weakness of lower limbs with sphincter dysfunction, pyramidal syndrome NA NA NA Serum: HAV, HBV, HCV, measles virus, rubella virus, HSV + NA NT NT NT NT Total recovery within 10 d without treatment
(2), 2006 India 32/M Bell palsy: right-sided lower motor neuron facial palsy 1,000 NA NA Serum: HAV, HBV, HIV, T. pallidum + NT NT NT NT NT Total recovery in 3 wk
(13), 2009 United Kingdom 44/M Bilateral neuralgic amyotrophy of upper limbs 2,547 NT NT Serum: HAV, HBV, HCV, Borrelia burgdorferi, Treponema pallidum, HTLV + NT NT NT NT NT Resolution of pain 6 wk after onset; total recovery of sensory motor deficiency in 2 y

*ALT, alanine aminotransferase level; CSF, cerebrospinal fluid; HEV, hepatitis E virus; Ig, immunoglobulin; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HSV, herpes simplex virus; VZV, varicella zoster virus; EBV, Epstein-Barr virus; +, positive; NT, not tested; CMV, cytomegalovirus; HHV6, human herpes virus 6; –, negative; HDV, hepatitis D virus, WNV, West Nile virus; HDV, hepatitis D virus; IVIG, intravenous immunoglobulin; NA, not available; HTLV, human T-lymphotropic virus.
†Two weeks after first anti-HEV IgM detection.
‡Weakly positive.

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