Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study.

Ripellino, Paolo; Lascano, Agustina Maria; Scheidegger, Olivier; Schilg-Hafer, Lenka; Schreiner, Bettina; Tsouni, Pinelopi; Vicino, Alex; Peyer, Anne-Kathrin; Humm, Andrea Maria; Décard, Bernhard; Pianezzi, Enea; Zezza, Giulia; Sparasci, Davide; Hundsberger, Thomas; Dietmann, Anelia; Jung, Hans; Kuntzer, Thierry; Wilder-Smith, Einar; Martinetti-Lucchini, Gladys; Petrini, Orlando; ... (2024). Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study. European journal of neurology, 31(1), e16030. Wiley 10.1111/ene.16030

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BACKGROUND

Acute hepatitis E virus (HEV) infection recently emerged as a potential trigger for acute dysimmune neuropathies, but prospective controlled studies are lacking.

AIMS

To compare the frequency of concomitant acute HEV infection in patients with neuralgic amyotrophy (NA), Guillain-Barré syndrome (GBS), and Bell's palsy with a matched control population.

METHODS

Swiss multicentre, prospective, observational matched case-control study over 3 years (09.2019-10.2022). Neurological cases with NA, GBS or Bell's palsy were recruited within 1 months from disease onset. Healthy controls were matched for age, sex, geographical location, and timing of blood collection. Diagnostic criteria for acute hepatitis E were reactive serum anti-HEV IgM and IgG assays (ELISA test) and/or HEV RNA detection in serum by Real-time-PCR (RT-PCR). RT-PCR was performed on sera to confirm IgM positivity.

RESULTS

We included 180 patients (59 GBS, 51 NA, and 70 Bell's palsy cases) and corresponding matched controls (blood donors), with median age of 51 years for both groups and equal gender distribution. Six IgM+ cases were detected in the NA, two in the GBS, and none in the Bell's palsy group. Two controls were anti-HEV IgM positive. At disease onset, most cases with acute HEV infection had increased liver enzymes. A moderate association (p=0.027; Cramér's V = -0.25, Fisher exact test) was observed only between acute HEV infection and NA.

CONCLUSION

This prospective observational study suggests an association between concomitant acute HEV infection and NA, but not with GBS or Bell's palsy.

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