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Volume 17, Number 8—August 2011
Dispatch

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)

Main Article

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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References
  1. Kejariwal  D, Roy  S, Sarkar  N. Seizure associated with acute hepatitis E. Neurology. 2001;57:1935.PubMedGoogle Scholar
  2. Dixit  VK, Abhilash  VB, Kate  MP, Jain  AK. Hepatitis E infection with Bell's palsy. J Assoc Physicians India. 2006;54:418.PubMedGoogle Scholar
  3. Dalton  HR, Stableforth  W, Thurairajah  P, Hazeldine  S, Remnarace  R, Usama  W, Autochthonous hepatitis E in southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol. 2008;20:784–90. DOIPubMedGoogle Scholar
  4. Kamar  N, Izopet  J, Cintas  P, Garrouste  C, Uro-Coste  E, Cointault  O, Hepatitis E virus induced neurological symptoms in a kidney-transplant patient with chronic hepatitis. Am J Transplant. 2010;10:1321–4. DOIPubMedGoogle Scholar
  5. Colson  P, Borentain  P, Queyriaux  B, Kaba  M, Moal  V, Gallian  P, Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis. 2010;202:825–34. DOIPubMedGoogle Scholar
  6. Sood  A, Midha  V, Sood  N. Guillain-Barré syndrome with acute hepatitis E. Am J Gastroenterol. 2000;95:3667–8.PubMedGoogle Scholar
  7. Kumar  R, Bhoi  S, Kumar  M, Sharma  B, Singh  BM, Gupta  BB. Guillain-Barré syndrome and acute hepatitis E: a rare association. J Indian Acad Clin Med. 2002;3:389–91.
  8. Kamani  P, Baijal  R, Amarapurkar  D, Gupte  P, Patel  N, Kumar  P, Guillain-Barré syndrome associated with acute hepatitis E. Indian J Gastroenterol. 2005;24:216.PubMedGoogle Scholar
  9. Loly  JP, Rikir  E, Seivert  M, Legros  E, Defrance  P, Belaiche  J, Guillain-Barré syndrome following hepatitis E. World J Gastroenterol. 2009;15:1645–7. DOIPubMedGoogle Scholar
  10. Chalupa  P, Holub  M. Jaundice complicated by an atypical form of Guillain-Barré syndrome. J Clin Virol. 2010;49:229–30. DOIPubMedGoogle Scholar
  11. Cronin  S, McNicholas  R, Kavanagh  E, Reid  V, O'Rourke  K. Anti-glycolipid GM2-positive Guillain-Barré syndrome due to hepatitis E infection. Ir J Med Sci. 2011;180:255–7. DOIPubMedGoogle Scholar
  12. Mandal  K, Chopra  N. Acute transverse myelitis following hepatitis E virus infection. Indian Pediatr. 2006;43:365–6.PubMedGoogle Scholar
  13. Fong  F, Illahi  M. Neuralgic amyotrophy associated with hepatitis E virus. Clin Neurol Neurosurg. 2009;111:193–5. DOIPubMedGoogle Scholar
  14. Zhai  L, Dai  X, Meng  J. Hepatitis E virus genotyping based on full-length genome and partial genomic regions. Virus Res. 2006;120:57–69. DOIPubMedGoogle Scholar
  15. Kang  JH, Sheu  JJ, Lin  HC. Increased risk of Guillain-Barré syndrome following recent herpes zoster: a population-based study across Taiwan. Clin Infect Dis. 2010;51:525–30. DOIPubMedGoogle Scholar

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