Acute CNS infections – Expanding the spectrum of neurological manifestations of hepatitis E virus?

Fritz‐Weltin, Miriam; Isenmann, Nora; Frommherz, Estelle; Niedermeier, Lisa; Csernalabics, Benedikt; Böettler, Tobias; Endres, Dominique; Panning, Marcus; Berger, Benjamin

doi:10.1016/j.jns.2021.117387

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Recent data from our group indicated even higher seroprevalence of >50% in elderly patients [14,15]. Neurological manifestations occur in up to 16% of acute HEV infections [16], and in 2%-7% of acute nontraumatic neurological injuries acute HEV infections were previously described [9,17].…”

mentioning

confidence: 70%

“…The rational to investigate associations between neurological disorders and acute HEV infections, as previously done by our group for patients with neuralgic amyotrophy [19], Guillain-Barré syndrome [15] and central nervous system (CNS) infections [14], derives from neurotropic properties of the virus shown in experimental studies [23][24][25]. Furthermore, HEV RNA had been determined in CSF of few patients with Guillain-Barré syndrome [26,27], meningoencephalitis [11] and neuralgic amyotrophy [19].…”

Section: Discussionmentioning

confidence: 99%

“…Cases were also included if individual findings were abnormal either in CSF analysis (slightly elevated white blood cell count and/or elevated total protein) or electrophysiological studies (reduced amplitude of the combined muscle action potential after electrical stylomastoid stimulation or preserved potential after magnetic stimulation in the labyrinthine segment <72 h after symptom onset) [22], but no other cause was found, and facial palsy had therefore been classified as "idiopathic" at the time of diagnosis. Sera of 263 healthy volunteers and blood donors previously published by our group served as controls [14,15]. The study was approved by the local ethics committee (No.…”

Section: Me Thods Patientsmentioning

confidence: 99%

“…HEV is the most common pathogen of acute viral hepatitis worldwide, and genotype 3 is endemic throughout European countries, with an age‐dependent anti‐HEV immunoglobulin (Ig)G seroprevalence in Germany of up to 25% in individuals older than 50 years [13]. Recent data from our group indicated even higher seroprevalence of >50% in elderly patients [14,15]. Neurological manifestations occur in up to 16% of acute HEV infections [16], and in 2%–7% of acute nontraumatic neurological injuries acute HEV infections were previously described [9,17].…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis E virus and Bell’s palsy

Fritz‐Weltin

Niedermeier

Frommherz

et al. 2021

Euro J of Neurology

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Background and purpose Acute hepatitis E virus (HEV) infections have been associated with various neurological disorders, including individual cases with Bell's palsy. Nonetheless, systematic studies in the latter are lacking. Therefore, this retrospective study systematically screened a cohort of patients with Bell's palsy for an acute HEV infection. Methods Overall, 104 patients with Bell's palsy treated in our clinic between 2008 and 2018 were identified. Serum samples were analyzed for anti‐HEV immunoglobulin (Ig)M and IgG antibodies by enzyme‐linked immunosorbent assay. Additionally, serum samples were tested for HEV RNA by polymerase chain reaction in 92 of these 104 patients presenting within the first 7 days from symptom onset. A large group of 263 healthy individuals served as controls. Results None of the patients with Bell's palsy but two healthy controls (0.8%) had an acute HEV infection. Anti‐HEV IgG seroprevalence indicating previous infection was unexpectedly high in patients with Bell's palsy (34%) and revealed an age‐dependent increase. Conclusions In this first systematic study, no cases of Bell's palsy in association with an acute HEV infection were identified. However, based on previous case descriptions, rare associations cannot be excluded. Therefore, large prospective multicenter studies will be necessary for conclusions that are more definitive.

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mentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Me Thods Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hepatitis E virus and Bell’s palsy

Fritz‐Weltin

Niedermeier

Frommherz

et al. 2021

Euro J of Neurology

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“…Electrophysiological subtypes were determined according to the Hadden criteria [ 23 ]. For comparison, 263 individuals that had already been used in a previously published study [ 24 ] served as controls. These comprised 96 randomly selected blood donors and 167 healthy volunteers.…”

Section: Methodsmentioning

confidence: 99%

Hepatitis E virus as a trigger for Guillain-Barré syndrome

et al. 2021

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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.

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Neurological manifestation of HEV infection: still a rare disease entity?

Wiesenfarth,

Stamminger,

Zizer

et al. 2023

J Neurol

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Hepatitis E virus (HEV) infection is the most common form of viral hepatitis and is reported to cause neurological manifestation in up to 30% of diagnosed infections. We evaluated the medical reports of all patients (n = 29,994) who were discharged from the Department of Neurology of Ulm University between 01.01.2015 and 30.09.2022 to detect neurological manifestations of HEV. In addition, we retrospectively analyzed the serum samples of n = 99 patients representing different neurological diseases possibly related to HEV for anti-HEV-IgM and anti-HEV-IgG. At the time of discharge from hospital, the etiology of neurological symptoms in these patients was unclear. Overall, five cases of extrahepatic neurological manifestation of HEV (defined as anti-HEV-IgM and HEV-IgG positive) could be detected. An increase of both, anti-IgM- and anti-IgG-serum levels was significantly more common in neuralgic amyotrophy/plexus neuritis/radiculitis than in AIDP/CIDP (P = 0.01), meningitis/encephalitis (P = 0.02), idiopathic peripheral facial paralysis (P = 0.02) and tension headache (P = 0.02). In 15% (n = 15 out of 99) of retrospectively analyzed serum samples, conspicuous positive anti-HEV-IgG levels were detected. This finding was most common in AIDP/CIDP. In conclusion, results of this study indicate neurological manifestation of HEV to be a rare but still underestimated course of disease, occurring at any age and gender. Therefore, testing for HEV should be considered in patients with neurological symptoms of unknown origin, especially in those with neuralgic amyotrophy/plexus neuritis.

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Acute CNS infections – Expanding the spectrum of neurological manifestations of hepatitis E virus?

Cited by 9 publications

References 17 publications

Hepatitis E virus and Bell’s palsy

Hepatitis E virus and Bell’s palsy

Hepatitis E virus as a trigger for Guillain-Barré syndrome

Neurological manifestation of HEV infection: still a rare disease entity?

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