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Guenifi W, Gasmi A, Lacheheb A. [Extra hepatic manifestations of hepatitis A]. Rev Med Interne 2022; 43:603-607. [PMID: 35906107 DOI: 10.1016/j.revmed.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
Viral hepatitis A is characterized by a wide range of clinical pictures ranging from a completely unapparent infection to a fulminant, potentially fatal hepatitis or the classical icteric form. Hepatitis A can develop in an unusual way and extrahepatic manifestations (neurological, renal, haematological, cholecystitis, acute pancreatitis, vasculitis, etc.) can occasionally complicate the course of the disease. Although hepatitis A infection was identified in the early 1970s, there are few or no studies assessing the actual frequency of these complications. They have been studied mainly through clinical case reports. Currently, since the disease has become more common in adults, these complications are being increasingly observed. We present an update on extrahepatic complications during hepatitis A, which should be known by both specialist doctors (infectiologists internists, hepatologists and others) and general practitioners.
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Affiliation(s)
- W Guenifi
- Faculté de Médecine, Universite Ferhat Abbas Setif 1 et Service des Maladies Infectieuses, CHU de Sétif;, Sétif, Algérie.
| | - A Gasmi
- Faculté de Médecine, Universite Ferhat Abbas Setif 1 et Service des Maladies Infectieuses, CHU de Sétif;, Sétif, Algérie
| | - A Lacheheb
- Faculté de Médecine, Universite Ferhat Abbas Setif 1 et Service des Maladies Infectieuses, CHU de Sétif;, Sétif, Algérie
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2
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Wei J, Duan S. Severe Guillain-Barré syndrome associated with chronic hepatitis B: A case report and literature review. Medicine (Baltimore) 2021; 100:e27989. [PMID: 35049206 PMCID: PMC9191321 DOI: 10.1097/md.0000000000027989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Guillain-Barré syndrome (GBS) is a postinfectious autoimmune peripheral neuropathy characterized by acute paralysis of the limbs. Clinically, extrahepatic manifestations of neurologic involvement in chronic hepatitis B (CHB) are uncommon. Little attention has been paid to the relationship between GBS and CHB viral infection. PATIENT CONCERNS We presented a severe case of a 34-year-old man with general fatigue, anorexia, jaundice, numbness, and even muscle atrophy in the limbs, and respiratory failure during an acute exacerbation of CHB. DIAGNOSES Serological liver enzymes test confirmed an acute exacerbation of CHB. Nerve conduction studies revealed the features of acute motor and sensory axonal neuropathy combined with acute inflammatory demyelinating polyneuropathy, and cerebrospinal fluid analysis showed albuminocytologic dissociation. Clinical manifestations and the test results were consistent with a diagnosis of severe CHB-related GBS. INTERVENTIONS He was treated with mechanical ventilation, 2 courses of intravenous immunoglobulin, antichronic hepatitis B drugs therapy supplemented by hepatoprotection, acupuncture and rehabilitation. OUTCOMES After 29 days of hospitalization, his neurological condition improved. At a 6-month follow-up visit, he was able to walk with the support of another person. LESSONS The acute exacerbation of CHB may be a potential predisposing factor for the onset of GBS. This case is a reminder to clinicians that during the acute exacerbation of CHB, patients with neurological symptoms in the limbs should be considered for potential CHB-related GBS.
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Guillaume M, Mouna L, Coustillères F, Lemée V, Roque-Afonso AM, Mourez T, Lefaucheur R. Invasive meningoencephalitis as the first manifestation of hepatitis A. J Viral Hepat 2019; 26:1330-1333. [PMID: 31319008 DOI: 10.1111/jvh.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/27/2019] [Accepted: 06/13/2019] [Indexed: 12/09/2022]
Abstract
Since mid-2016, Europe has been facing a major hepatitis A epidemic, with more than 25 000 cases reported to the European CDC, in 2018. We describe herein a rare case of invasive HAV meningoencephalitis as a prodrome of the classic hepatitis, which largely explains a delay in diagnosis.
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Affiliation(s)
- Maxime Guillaume
- Rouen University Hospital, Department of Neurology, Rouen, France
| | - Lina Mouna
- AP-HP, Paul Brousse Hospital, Virology, National Reference Center for HAV, Université Paris Sud, INSERM 1193, Villejuif, France
| | | | - Véronique Lemée
- UNIROUEN, EA2656, GRAM, Rouen University Hospital, Normandie Univ, Rouen, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Paul Brousse Hospital, Virology, National Reference Center for HAV, Université Paris Sud, INSERM 1193, Villejuif, France
| | - Thomas Mourez
- UNIROUEN, EA2656, GRAM, Rouen University Hospital, Normandie Univ, Rouen, France
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Samadi A, Mansour-Ghanaei F, Joukar F, Mavaddati S, Sufi Afshar I. A 30-Year-Old Man with Acute Motor Axonal Neuropathy Subtype of Guillain-Barré Syndrome Having Hepatitis A Virus Infection. Middle East J Dig Dis 2019; 11:110-115. [PMID: 31380008 PMCID: PMC6663291 DOI: 10.15171/mejdd.2018.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/18/2019] [Indexed: 11/09/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular power. In addition, the results of International normalized ratio (INR), partial thromboplastin time (PTT), prothrombin time (PT), alkaline phosphatase (ALK), alanine aminotransferase (ALT) , aspartate aminotransferase (AST), bilirubin total and direct (Bil T, D) tests were normal after 2-month follow-up. Although, acute viral infections such as hepatitis E virus (HEV) is common in patients with GBS; the possibility of HAV infection in patients with its risk factor should not be neglected.
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Affiliation(s)
- Alireza Samadi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Mavaddati
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Iman Sufi Afshar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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5
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Molokwu O, Young BM, Singh M, Menezes K, Mian R. Reactivation of Chronic Hepatitis C as a Potential Trigger for Guillain-Barré Syndrome. Cureus 2019; 11:e5244. [PMID: 31565642 PMCID: PMC6759041 DOI: 10.7759/cureus.5244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A 74-year-old man with a past medical history of chronic low back pain presented with two to three weeks of progressive weakness starting in the lower extremities and then spreading to the upper extremities. Distal muscles were more affected than proximal muscles; weakness was accompanied by numbness and paresthesias. There was no preceding acute viral, respiratory, or gastrointestinal illness. Initial workup revealed hepatitis C antibody reactivity, and cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation. MRI demonstrated multilevel degenerative changes and diffuse enhancement of the cauda equina nerve roots compatible with Guillain-Barré syndrome (GBS). Repeat testing confirmed ongoing hepatitis C infection with increasing quantitative hepatitis C virus (HCV) levels. This case illustrates an interesting presentation of GBS potentially triggered by hepatitis C reactivation. This is the first case, to our knowledge, with serologic evidence demonstrating acute hepatitis C reactivation concurrent with GBS which presented in the absence of immunomodulatory interferon treatment. The patient continues to recover with ongoing rehabilitation at the time of this case report.
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Affiliation(s)
- Ogochukwu Molokwu
- Medicine, University of California San Francisco Fresno School of Medicine, Fresno, USA
| | - Brittany M Young
- Medicine, University of California San Francisco Fresno School of Medicine, Fresno, USA
| | - Manjit Singh
- Medicine, University of California San Francisco Fresno School of Medicine, Fresno, USA
| | - Krishe Menezes
- Medicine, University of California San Francisco Fresno School of Medicine, Fresno, USA
| | - Raza Mian
- Internal Medicine, University of California San Francisco Fresno School of Medicine, Fresno, USA
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6
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Severe Guillain-Barré syndrome associated with chronic active hepatitis C and mixed cryoglobulinemia: a case report. BMC Infect Dis 2019; 19:636. [PMID: 31315560 PMCID: PMC6637463 DOI: 10.1186/s12879-019-4278-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background We describe a case of severe Guillain-Barre syndrome (GBS) associated with chronic active hepatitis C and mixed cryoglobulinemia (MC). To our knowledge, this association between GBS and hepatitis C virus (HCV) infection has been rarely reported. Case presentation A 56-year-old man developed symmetrical muscle weakness in all extremities, areflexia and sensorial disorder followed by acute respiratory failure associated with chronic active hepatitis C, which was confirmed by the presence of anti-HCV antibodies in the serum and persistence of HCV RNA viral load for more than 6 months. Chronic hepatitis C was further complicated by type 3 MC. Electromyography showed peripheral nerve injury (mainly in axon). A severe acute motor sensory axonal neuropathy (AMSAN) was diagnosed. After treatment with intravenous immunoglobulin and plasma exchange followed by antiviral therapy by direct-acting antiviral agent, patient showed progressive recovery and was transferred 3 months after his first admission to a rehabilitation center. Conclusions Our case reported a severe GBS associated with HCV infection and MC. EMG classified for the first time the subtype of GBS (severe AMSAN) correlated with severe clinical form. HCV infection should be screened in high-risk patients to prevent silent progression of the chronic hepatitis C and its potentially severe extra-hepatic manifestations.
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Rodríguez Y, Rojas M, Pacheco Y, Acosta-Ampudia Y, Ramírez-Santana C, Monsalve DM, Gershwin ME, Anaya JM. Guillain-Barré syndrome, transverse myelitis and infectious diseases. Cell Mol Immunol 2018; 15:547-562. [PMID: 29375121 PMCID: PMC6079071 DOI: 10.1038/cmi.2017.142] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023] Open
Abstract
Guillain-Barré syndrome (GBS) and transverse myelitis (TM) both represent immunologically mediated polyneuropathies of major clinical importance. Both are thought to have a genetic predisposition, but as of yet no specific genetic risk loci have been clearly defined. Both are considered autoimmune, but again the etiologies remain enigmatic. Both may be induced via molecular mimicry, particularly from infectious agents and vaccines, but clearly host factor and co-founding host responses will modulate disease susceptibility and natural history. GBS is an acute inflammatory immune-mediated polyradiculoneuropathy characterized by tingling, progressive weakness, autonomic dysfunction, and pain. Immune injury specifically takes place at the myelin sheath and related Schwann-cell components in acute inflammatory demyelinating polyneuropathy, whereas in acute motor axonal neuropathy membranes on the nerve axon (the axolemma) are the primary target for immune-related injury. Outbreaks of GBS have been reported, most frequently related to Campylobacter jejuni infection, however, other agents such as Zika Virus have been strongly associated. Patients with GBS related to infections frequently produce antibodies against human peripheral nerve gangliosides. In contrast, TM is an inflammatory disorder characterized by acute or subacute motor, sensory, and autonomic spinal cord dysfunction. There is interruption of ascending and descending neuroanatomical pathways on the transverse plane of the spinal cord similar to GBS. It has been suggested to be triggered by infectious agents and molecular mimicry. In this review, we will focus on the putative role of infectious agents as triggering factors of GBS and TM.
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Affiliation(s)
- Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yovana Pacheco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, USA, CA
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia.
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Sonavane AD, Saigal S, Kathuria A, Choudhary NS, Saraf N. Guillain-Barré syndrome: rare extra-intestinal manifestation of hepatitis B. Clin J Gastroenterol 2018. [PMID: 29542024 DOI: 10.1007/s12328-018-0847-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Extrahepatic syndromes are uncommon manifestations of acute and chronic hepatitis B. The pathogenesis likely involves an aberrant immunologic response to extrahepatic viral proteins. Antiviral therapy reduces the availability of these viral protein antigens and thus halts immune activation. Approximately 1% of all cases of acute inflammatory demyelinating polyneuropathy are associated with hepatitis B. Guillain-Barre syndrome (GBS) is a remarkably clinically diverse disorder with distinctive variants characterised by an immune-mediated attack to components of the peripheral nervous system. In this report, we present a rare case of GBS with chronic hepatitis B that resolved with antiviral and intravenous immunoglobulin therapy.
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Affiliation(s)
- Amey Dilip Sonavane
- Department of Liver Transplantation and Regenerative Medicine, Medanta - the Medicity, 14th Floor, Gurugram, 122001, India.
| | - Sanjiv Saigal
- Department of Liver Transplantation and Regenerative Medicine, Medanta - the Medicity, 14th Floor, Gurugram, 122001, India
| | - Abhishek Kathuria
- Department of Liver Transplantation and Regenerative Medicine, Medanta - the Medicity, 14th Floor, Gurugram, 122001, India
| | - Narendra S Choudhary
- Department of Liver Transplantation and Regenerative Medicine, Medanta - the Medicity, 14th Floor, Gurugram, 122001, India
| | - Neeraj Saraf
- Department of Liver Transplantation and Regenerative Medicine, Medanta - the Medicity, 14th Floor, Gurugram, 122001, India
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9
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Mariotto S, Ferrari S, Monaco S. HCV-related central and peripheral nervous system demyelinating disorders. ACTA ACUST UNITED AC 2015; 13:299-304. [PMID: 25198705 PMCID: PMC4428084 DOI: 10.2174/1871528113666140908113841] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 12/20/2022]
Abstract
Chronic infection with hepatitis C virus (HCV) is associated with a large spectrum of extrahepatic
manifestations (EHMs), mostly immunologic/rheumatologic in nature owing to B-cell proliferation and clonal expansion.
Neurological complications are thought to be immune-mediated or secondary to invasion of neural tissues by HCV, as
postulated in transverse myelitis and encephalopathic forms. Primarily axonal neuropathies, including sensorimotor
polyneuropathy, large or small fiber sensory neuropathy, motor polyneuropathy, mononeuritis, mononeuritis multiplex, or
overlapping syndrome, represent the most common neurological complications of chronic HCV infection. In addition, a
number of peripheral demyelinating disorders are encountered, such as chronic inflammatory demyelinating
polyneuropathy, the Lewis-Sumner syndrome, and cryoglobulin-associated polyneuropathy with demyelinating features.
The spectrum of demyelinating forms also includes rare cases of iatrogenic central and peripheral nervous system
disorders, occurring during treatment with pegylated interferon. Herein, we review HCV-related demyelinating
conditions, and disclose the novel observation on the significantly increased frequency of chronic demyelinating
neuropathy with anti-myelin-associated glycoprotein antibodies in a cohort of 59 consecutive patients recruited at our
institution. We also report a second case of neuromyelitis optica with serum IgG autoantibody against the water channel
aquaporin-4. The prompt recognition of these atypical and underestimated complications of HCV infection is of crucial
importance in deciding which treatment option a patient should be offered.
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Affiliation(s)
| | | | - Salvatore Monaco
- Department of Neurological and Movement Sciences, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Vergnon-Miszczycha D, Suy F, Robert F, Carricajo A, Fresard A, Cazorla C, Guglielminotti C, Lucht F, Botelho-Nevers E. Guillain-Barré syndrome associated with Mycobacterium bovis lymphadenitis. Infection 2015; 43:603-8. [PMID: 25814190 DOI: 10.1007/s15010-015-0762-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/12/2015] [Indexed: 11/26/2022]
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disease that can be triggered by different infectious agents. Here we report the case of a 26-year-old Algerian woman who developed GBS associated with a Mycobacterium bovis cervical lymphadenitis. Following intravenous immunoglobulin therapy, the patient's neurologic state returned to normal after 3 months. The lymphadenitis responded more slowly to the antituberculous treatment and an excision of necrotic cervical lymph nodes had to be performed four times. Antibiotics were administered for 16 months: ethambutol was stopped after 2 months, and rifampicin and isoniazid pursued for 14 months. An extensive etiological investigation showed that, in this case, the only likely infectious trigger GBS was the concomitant M. bovis infection. To our knowledge, this is the first report of GBS triggered by M. bovis. We performed a literature review revealing that the association between tuberculosis and Guillain-Barré syndrome is very rare (only seven cases previously reported) but is not coincidental. Physicians should be aware that tuberculosis can be a cause of GBS.
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Affiliation(s)
- Delphine Vergnon-Miszczycha
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France.
| | | | - Florence Robert
- Service de Neurologie, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Anne Carricajo
- Laboratoire de Bactériologie-Virologie, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Anne Fresard
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Céline Cazorla
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Claire Guglielminotti
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Frédéric Lucht
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France
| | - Elisabeth Botelho-Nevers
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Nord, 42055, Saint-Etienne Cedex 2, France.
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Jo YS, Han SD, Choi JY, Kim IH, Kim YD, Na SJ. A case of acute motor and sensory axonal neuropathy following hepatitis a infection. J Korean Med Sci 2013; 28:1839-41. [PMID: 24339719 PMCID: PMC3857385 DOI: 10.3346/jkms.2013.28.12.1839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/20/2012] [Indexed: 11/20/2022] Open
Abstract
Acute motor and sensory axonal neuropathy (AMSAN) are recently described subtypes of Guillain-Barre syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness. In laboratory findings, immunoglobulin M antibodies against hepatitis A were detected in blood and cerebrospinal fluid. The findings of motor nerve conduction studies showed markedly reduced amplitudes of compound muscle action potentials in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. Based on clinical features, laboratory findings, and electrophysiologic investigation, the patient was diagnosed the AMSAN following acute hepatitis A viral infection. The patient was treated with intravenous immunoglobulin and recovered slowly. Clinicians should consider this rare but a serious case of AMSAN following acute hepatitis A infection.
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Affiliation(s)
- Yoon-Sik Jo
- Department of Neurology, Konkuk University School of Medicine, Chungju, Korea
| | - Sang-Don Han
- Department of Neurology, Konkuk University School of Medicine, Chungju, Korea
| | - Jin-Yong Choi
- Department of Neurology, Konkuk University School of Medicine, Chungju, Korea
| | - Ick Hee Kim
- Department of Surgery, Konkuk University School of Medicine, Chungju, Korea
| | - Yong-Duk Kim
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Sang-Jun Na
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
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Abstract
Approximately 400 million worldwide are chronically infected with the hepatitis B virus (HBV). During the course of illness, approximately 20% of patients develop disease manifestations outside the liver. Neuropathy develops in approximately 5% of patients with chronic HBV infection and rarely during acute HBV infection. The pathogenesis of the various HBV-associated neuropathy syndromes possibly involves deposition of immune complexes in nerves or blood vessel walls. Direct viral infection of nerves has not been demonstrated. Management entailed supportive care with antiviral and immunomodulatory treatment as clinically indicated. Rare cases of muscle disease, mostly inflammatory myopathy, have been associated with HBV infection. Presumably, HBV-associated antigens trigger immune mechanisms directed against components of muscle tissue. There is no evidence of replicative virus infection of muscle fibers. Management entailed immunomodulatory treatment, occasionally with anti-HBV therapy. Physicians should be aware that HBV infection has the potential to trigger presumed immune-mediated neuromuscular syndromes.
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13
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Zuckerman AJ. Safety of hepatitis B vaccines. Travel Med Infect Dis 2012; 2:81-4. [PMID: 17291963 DOI: 10.1016/j.tmaid.2004.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Accepted: 03/25/2004] [Indexed: 10/26/2022]
Abstract
Although concerns about vaccine safety have increased, true adverse reactions associated with hepatitis B vaccines are few, apart from minor symptoms at the site of injection and occasionally systemic reactions. There is no evidence of an association with hepatitis B vaccination and Sudden Infant Death Syndrome, Multiple Sclerosis and the Chronic Fatigue Syndrome. Hepatitis B vaccines are safe and essential for the prevention of this important and common infection.
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Affiliation(s)
- Arie J Zuckerman
- WHO Collaborating Centre for Reference and Research on Viral Diseases, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK
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Abstract
The primary hepatotropic viruses are associated with various extrahepatic manifestations including peripheral nervous system disorders. The pathogenesis of these complications is not clear-cut. Patients with confirmed liver damage coexisting with peripheral nervous system manifestations, especially Guillain-Barré syndrome, mononeuropathy, mononeuropathy multiplex and polyneuropathy should be screened for the viral hepatitis in the differential diagnosis. There are no defined strategies of treatment for these manifestations, so the therapy should be individualized. The purpose of this review is to discuss the etiology, pathogenesis and treatment of the neuropathies in the course of primary hepatotropic viral infections such as hepatitis A, B, C and E viruses.
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Jha AK, Nijhawan S, Nepalia S, Suchismita A. Association of Bell's Palsy with Hepatitis E Virus Infection: A Rare Entity. J Clin Exp Hepatol 2012; 2:88-90. [PMID: 25755411 PMCID: PMC3940373 DOI: 10.1016/s0973-6883(12)60082-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 02/06/2012] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV) infection is a common cause of acute hepatitis in India and other developing countries. The data regarding the neurologic manifestation of HEV infection are limited. The neurologic disorders including Guillain-Barré syndrome, polyradiculopathy, neuralgic amyotrophy, encephalitis, bilateral brachial neuritis, ataxia/proximal myopathy, and acute transverse myelitis have been described. Bell's palsy and other cranial nerve involvement in hepatitis A virus (HAV) and HEV infection are rare. We present the second case of Bell's palsy associated with HEV.
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Affiliation(s)
- Ashish K Jha
- Department of Gastroenterology, SMS Medical College, Jaipur, India
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Stübgen JP. Immune-mediated myelitis associated with hepatitis virus infections. J Neuroimmunol 2011; 239:21-7. [PMID: 21945641 DOI: 10.1016/j.jneuroim.2011.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/24/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
Virus-induced spinal cord damage results from a cytolytic effect on anterior horn cells or from predominantly cellular immune-mediated damage of long white matter tracts. Infection with the hepatitis virus group, most notably hepatitis C virus, has infrequently been associated with the occurrence of myelitis. The pathogenesis of hepatitis virus-associated myelitis has not been clarified: virus-induced autoimmunity (humoral or cell-mediated, possibly vasculitic) seems the most likely disease mechanism. Limited available information offers no evidence of direct hepatitis virus infection of the spinal cord. Virus neuropenetration may occur after virus-infected mononuclear cells penetrate the blood-brain barrier, but a true neurolytic effect has not been demonstrated. Attacks of acute myelitis usually respond favorably to immunomodulatory therapy. Antiviral therapy plays no confirmed role in the treatment of acute bouts of myelitis, but may limit the relapsing course of HCV-associated myelitis.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology and Neuroscience, Cornell University Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
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17
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Stübgen JP. Neuromuscular complications of hepatitis A virus infection and vaccines. J Neurol Sci 2011; 300:2-8. [PMID: 20920814 DOI: 10.1016/j.jns.2010.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 12/18/2022]
Abstract
The hepatitis A virus (HAV) infects millions of people worldwide every year. Case histories report on various acute neuropathy syndromes in the context of acute HAV infection, but any causal link has not been established. Epidemiological data also cast doubt on the importance of HAV as a trigger for Guillain-Barré syndrome. The virtual absence of a chronic HAV-infected state likely explains the rare occurrence of extrahepatic immune-mediated diseases, including an absence of chronic autoimmune neuromuscular disorders. Several vaccines against HAV provide effective protection against natural infection. Isolated case histories report on an unconvincing association between HAV vaccination and neuropathy. Medical and epidemiological data show insufficient evidence to support a causal relationship between HAV vaccines and neuropathy syndromes. Aluminum hydroxide, a HAV vaccine adjuvant, is considered a trigger of the macrophagic myofasciitis syndrome. This review concludes that it seems unnecessary to routinely consider HAV infection or vaccination as triggers of neuromuscular diseases.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology and Neuroscience, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
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18
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Lee JJ, Kang K, Park JM, Kwon O, Kim BK. Encephalitis associated with acute hepatitis a. J Epilepsy Res 2011; 1:27-8. [PMID: 24649441 PMCID: PMC3952310 DOI: 10.14581/jer.11005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/25/2010] [Indexed: 12/11/2022] Open
Abstract
Encephalitis is caused by multiple organisms, but rarely by the hepatitis A virus. A 27-year-old man visited our hospital because of fever, altered consciousness, and seizures. On physical exam, a stuporous mentality and neck stiffness were found. On laboratory exam, elevated liver enzymes and cerebrospinal fluid abnormalities, including pleocytosis and elevated protein levels were observed. The hepatitis A virus (HAV) IgM antibody was also detected. We conclude that these findings were compatible with encephalitis associated with HAV and discuss the pathomechanisms.
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Affiliation(s)
- Jung-Ju Lee
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Ohyun Kwon
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
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19
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Lee DH, Choi YH, Cho KH, Lee HM, Yun SY. Convulsion Due to Meningoencephalitis in Hepatitis a Virus Infection. HONG KONG J EMERG ME 2010. [DOI: 10.1177/102490791001700218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatitis A virus (HAV) infection usually has a self-limited clinical course and sometimes remains subclinical. HAV infection rarely causes neurologic problems. There are only a few case reports on seizure and meningoencephalitis associated with serologically confirmed hepatitis A infection. We report a case of a 27-year-old man admitted to the emergency department due to confusion after an episode of generalised tonic convulsion. Laboratory test results included AST 441 units/L and ALT 1294 units/L. A diagnosis of hepatitis A was confirmed by the finding of serum IgM-HAV antibody. HAV infection should be considered one of the aetiologies of meningoencephalitis.
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20
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Thapa R, Mallick D, Biswas B, Ghosh A. Childhood hepatitis A virus infection complicated by Bell's palsy. Clin Pediatr (Phila) 2009; 48:427-8. [PMID: 19131587 DOI: 10.1177/0009922808327059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rajoo Thapa
- Department of Pediatrics, The Institute of Child Health, Kolkata, West Bengal, India.
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21
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Thapa R, Biswas B, Ghosh A, Mukherjee S. Unilateral palatal and abducens palsy in childhood hepatitis A virus infection. J Child Neurol 2009; 24:628-9. [PMID: 19406760 DOI: 10.1177/0883073808323026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Isolated cranial nerve paresis in childhood hepatitis A virus infection is rare. The authors report an instance of concomitant right-hand side palatal and abducens palsy, developing in the course of an otherwise uncomplicated hepatitis A virus infection in a 5-year-old girl. The neurological complications were transient, and she recovered completely with supportive therapy.
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Affiliation(s)
- Rajoo Thapa
- Department of Pediatrics, The Institute of Child Health, West Bengal, India.
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22
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Abstract
A 4-year-old male child with hepatitis A virus (HAV) infection is presented. His disease course was complicated by the development of pseudotumor cerebri (PC), as evidenced by symptoms and signs of increased intracranial pressure in the presence of normal cerebrospinal fluid examination and cranial magnetic resonance scan. The neurological examination was normal with the exception of the right-sided sixth cranial nerve paresis. His neurological course was uncomplicated with spontaneous recovery within three days. To our knowledge, this is the first report in the English literature of PC complicating the course of HAV in a child.
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23
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Takikawa Y, Yasumi Y, Sato A, Endo R, Suzuki K, Mori Y, Akasaka H, Miura Y, Sawai T, Okamoto H. A case of acute hepatitis E associated with multidrug hypersensitivity and cytomegalovirus reactivation. Hepatol Res 2007; 37:158-65. [PMID: 17300712 DOI: 10.1111/j.1872-034x.2007.00021.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 65-year-old Japanese man was hospitalized because of acute hepatitis and severe cholestasis due to hepatitis E virus (HEV) infection combined with a drug reaction to a cold preparation. He died of disseminated intravascular coagulation and severe intestinal bleeding due to systemic cytomegalovirus reactivation following the development of severe eruptions with marked eosinophilia due to drug hypersensitivity to taurine and ursodeoxycholate preparations. The close interaction between viral infection or reactivation and drug hypersensitivity was considered as a pathophysiology in this case, which emphasizes the need for further study of the immunological mechanism of the interaction.
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Affiliation(s)
- Yasuhiro Takikawa
- First Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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24
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Sainokami S, Abe K, Ishikawa K, Suzuki K. Influence of load of hepatitis A virus on disease severity and its relationship with clinical manifestations in patients with hepatitis A. J Gastroenterol Hepatol 2005; 20:1165-75. [PMID: 16048563 DOI: 10.1111/j.1440-1746.2005.03908.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The purpose of the present study was to investigate the influence of viral load on disease severity and analyze the possible relationship of the load of hepatitis A virus (HAV) with disease severity and laboratory findings. METHODS Fifty-eight patients diagnosed with acute hepatitis A were used in the current study, of whom 12 patients progressed to severe acute hepatitis (s-AH) defined on the basis of a prothrombin time (PT) of <40% and 46 patients were diagnosed as having mild acute hepatitis (m-AH). The load of HAV was measured with real-time polymerase chain reaction. RESULTS Peak viral load showed a significant correlation with alanine aminotransferase (ALT) (r = 0.363, P = 0.0048) and PT levels (r = -0.330, P = 0.0110). In terms of disease severity, there was a significant correlation with ALT (r = 0.462, P = 0.0012) and PT levels (r = 0.400, P = 0.0059) in the m-AH group, but not in the s-AH group. A significant positive correlation of peak viral load with the C-reactive protein level (r = 0.270, P = 0.0400) and a significant negative correlation of peak viral load with the platelet count (r = -0.313, P = 0.0015) was also found. CONCLUSIONS The load of HAV was closely correlated with liver damage and disease severity in m-AH, but not in s-AH. The load of HAV was also closely associated with the increase in C-reactive protein level and enhancement of thrombocytopenia.
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Affiliation(s)
- Shigehiko Sainokami
- First Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
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25
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Abstract
Hepatitis A infection rarely causes extrahepatic manifestations. Here we present a 5-year-old patient with an initial complaint of nuchal rigidity and convulsions during the course of hepatitis A infection. Because hepatitis A virus RNA was demonstrated in the cerebrospinal fluid, it was thought that convulsions might be related to this viral infection.
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Affiliation(s)
- Sebahat Cam
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Marmara University School of Medicine, Istanbul, Turkey
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26
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Boz C, Ozmenoglu M, Aktoz G, Velioglu S, Alioglu Z. Guillain-Barré syndrome during treatment with interferon α for hepatitis B. J Clin Neurosci 2004; 11:523-5. [PMID: 15177399 DOI: 10.1016/j.jocn.2003.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 04/02/2003] [Indexed: 10/26/2022]
Abstract
We describe a patient who developed acute demyelinating polyneuropathy on the sixth week of interferon (IFN)alpha therapy for chronic hepatitis B (HBV) infection. A 23-year-old man with chronic HBV infection had acute onset of demyelinating polyneuropathy shortly after completing a standard 6-week course of therapy with IFNalpha 2a. Clinical findings, electrodiagnostic studies and elevated cerebrospinal fluid protein levels without cells supported the diagnosis of Guillain-Barré syndrome (GBS). Other potential causes of GBS were ruled out. It remains unknown whether IFNalpha or the HBV infection itself was the cause of GBS, but it is evident that IFNalpha could not have prevented the development of GBS in our patient. We suggest that coexistent HBV infection and IFNalpha therapy may play a role in triggering an autoimmune response to peripheral nerve myelin.
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Affiliation(s)
- Cavit Boz
- Department of Neurology, Medical Faculty of Karadeniz Technical University, Trabzon, Turkey.
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27
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Blumenthal D, Prais D, Bron-Harlev E, Amir J. Possible association of Guillain-Barré syndrome and hepatitis A vaccination. Pediatr Infect Dis J 2004; 23:586-8. [PMID: 15194849 DOI: 10.1097/01.inf.0000130941.72712.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of Guillain-Barré syndrome in a previously healthy child who received a hepatitis A vaccination (HAVRIX) 5 days before onset of symptoms. No other precipitating factor could be identified. The relevant literature is reviewed and discussed.
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Affiliation(s)
- Danith Blumenthal
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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28
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Unay B, Sarici SU, Bulakbaşi N, Akin R, Gökçay E. Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis associated with hepatitis A infection. Pediatr Int 2004; 46:171-3. [PMID: 15056244 DOI: 10.1046/j.1442-200x.2004.01872.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bülent Unay
- Department of Pediatrics, Gulhane Military Medical Academy, Ankara, Turkey.
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29
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Mukhopadhya A, Chandy GM. Generalized lymphadenopathy as a marker of ongoing inflammation in prolonged cholestatic hepatitis A. Eur J Gastroenterol Hepatol 2002; 14:877-8. [PMID: 12172409 DOI: 10.1097/00042737-200208000-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Extrahepatic manifestations of hepatitis A are very unusual. We describe a case of prolonged cholestatic hepatitis A in a patient with generalized lymphadenopathy. With normalization of transaminases, there was an accompanying reduction in size of these lymph nodes. Lymphadenopathy reflects ongoing hepatic inflammation in prolonged cholestatic hepatitis A.
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Affiliation(s)
- Ashis Mukhopadhya
- Department of Clinical Gastroenterology and Hepatology, Christian Medical College Hospital, Vellore, Tamilnadu, India.
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30
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Abstract
The hepatitis A virus (HAV), a picornavirus, is a common cause of hepatitis worldwide. Spread of infection is generally person to person or by oral intake after fecal contamination of skin or mucous membranes; less commonly, there is fecal contamination of food or water. Hepatitis A is endemic in developing countries, and most residents are exposed in childhood. In contrast, the adult population in developed countries demonstrates falling rates of exposure with improvements in hygiene and sanitation. The export of food that cannot be sterilized, from countries of high endemicity to areas with low rates of infection, is a potentially important source of infection. After ingestion and uptake from the gastrointestinal tract, the virus replicates in the liver and is excreted into the bile. Cellular immune responses to the virus lead to destruction of infected hepatocytes with consequent development of symptoms and signs of disease. Humoral immune responses are the basis for diagnostic serologic assays. Acute HAV infection is clinically indistinguishable from other causes of acute viral hepatitis. In young children the disease is often asymptomatic, whereas in older children and adults there may be a range of clinical manifestations from mild, anicteric infection to fulminant hepatic failure. Clinical variants include prolonged, relapsing, and cholestatic forms. Management of the acute illness is supportive, and complete recovery without sequelae is the usual outcome. Research efforts during World War II led to the development of passive immunoprophylaxis. Pooled immune serum globulin is efficacious in the prevention and attenuation of disease in exposed individuals. More recently, active immunoprophylaxis by vaccination has been accomplished. Future eradication of this disease can now be contemplated.
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Affiliation(s)
- J A Cuthbert
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas 75390-9151, USA.
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31
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32
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Cacoub P, Sbaï A, Wechsler B, Maisonobe T, Pariser P, Piette JC. [Chronic inflammatory polyradiculoneuropathy and hepatitis C virus]. Rev Med Interne 1999; 20:1146-7. [PMID: 10635079 DOI: 10.1016/s0248-8663(00)87531-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Inoue A, Oguchi K, Iwahashi T, Arakura H, Koh CS. Prominent effect of immunoadsorption plasmapheresis therapy in a patient with chronic inflammatory demyelinating polyneuropathy associated with hepatitis B infection. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 1998; 2:305-7. [PMID: 10227761 DOI: 10.1111/j.1744-9987.1998.tb00128.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We encountered a patient with chronic inflammatory demyelinating polyneuropathy associated with hepatitis B infection. Immunohistochemical study revealed the deposition of immune complex composed of hepatitis B surface antigen (HBsAg) both around the endoneural capillary and in the endoneurium. Neurological signs were significantly improved by immunoadsorption plasmapheresis (IAPP) treatment without incorporating corticosteroid hormone therapy; weekly long-term IAPP has successfully maintained the patient's condition.
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Affiliation(s)
- A Inoue
- Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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34
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Lacaille F, Zylberberg H, Hagège H, Roualdès B, Meyrignac C, Chousterman M, Girot R. Hepatitis C associated with Guillain-Barré syndrome. LIVER 1998; 18:49-51. [PMID: 9548267 DOI: 10.1111/j.1600-0676.1998.tb00126.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hepatitis C is frequently associated with immune-mediated diseases, such as cryoglobulinemia. Guillain-Barré syndrome is an acute demyelinating neuropathy of probable immune pathogenesis. We describe two patients with Guillain-Barré syndrome, and associated chronic hepatitis C, the second one previously treated with interferon. The link between both conditions may be hepatitis C being the trigger of this immune polyneuropathy. Guillain-Barré syndrome should be added to the list of conditions associated with hepatitis C.
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Affiliation(s)
- F Lacaille
- Department of Paediatrics, Hôpital des Enfants Malades, Paris, France
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35
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Affiliation(s)
- A Kakar
- Department of Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi
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36
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Safadi R, Ben-Hur T, Shouval D. Mononeuritis multiplex: a rare complication of acute hepatitis A. LIVER 1996; 16:288-9. [PMID: 8878003 DOI: 10.1111/j.1600-0676.1996.tb00745.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 28-year-old man suffered from acute severe hepatitis A virus infection, documented by serologic diagnosis. During the clinical and enzymatic recovery phase, mononeuritis multiplex that involved the left ulnar and right lateral cutaneous nerves developed. It presented by sensorimotor disturbances in left arm and right thigh. Mononeuritis multiplex has been frequently described in patients with chronic hepatitis B, either isolated or associated with periarteritis nodosa. However, it has not been reported in association with hepatitis A infection.
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Affiliation(s)
- R Safadi
- Liver Unit, Hadassah University Hospital, Jerusalem, Israel
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37
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Terryberry J, Sutjita M, Shoenfeld Y, Gilburd B, Tanne D, Lorber M, Alosachie I, Barka N, Lin HC, Youinou P. Myelin- and microbe-specific antibodies in Guillain-Barré syndrome. J Clin Lab Anal 1995; 9:308-19. [PMID: 8531012 PMCID: PMC7167197 DOI: 10.1002/jcla.1860090506] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/1995] [Accepted: 02/27/1995] [Indexed: 01/31/2023] Open
Abstract
We surveyed the frequency of reported infections and target autoantigens in 56 Guillain Barré syndrome (GBS) patients by detecting antibodies to myelin and microbes. Sulfatide (43%), cardiolipin (48%), GD1a (15%), SGPG (11%), and GM3 (11%) antibodies were the most frequently detected heterogenous autoantibodies. A wide spectrum of antimicrobial IgG and IgM antibodies were also detected; mumps-specific IgG (66%), adenovirus-specific IgG (52%), varicella-zoster virus-specific IgG (46%), and S. pneumoniae serotype 7-specific IgG (45%) were the most prevalent. Our results indicate that polyclonal expansion of physiologic and pathologic antibodies and/or molecular mimicry likely occurs following infection and is related to other autoimmune factors in the etiology of GBS. Although no single definitive myelin-specific autoantibody was identified, our results suggest a unique pattern of reactivity against autoantigens.
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Affiliation(s)
- J Terryberry
- Specialty Laboratories, Santa Monica, CA 90404-3900, USA
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38
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Abstract
An acute disintegrative disorder in a child with acute hepatitis B virus (HBV) infection is described. Both hepatitis B surface antigen (HBsAg) and HBV-DNA were detected in cerebrospinal fluid (CSF) by means of enzyme-linked immunosorbent assay (ELISA) and the polymerase chain reaction (PCR) technique respectively. A markedly elevated level of CSF adenylate kinase (AK), which normalised as the patient recovered spontaneously, suggested an organic brain disorder. Demonstration of intra-blood-brain barrier production of IgG supported the possibility of local infection by HBV within the central nervous system.
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Affiliation(s)
- H C Weber
- Department of Paediatrics and Child Health, University of Stellenbosch, Faculty of Medicine, Tygerberg, South Africa
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39
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Trevisani F, Gattinara GC, Caraceni P, Bernardi M, Albertoni F, D'Alessandro R, Elia L, Gasbarrini G. Transverse myelitis following hepatitis B vaccination. J Hepatol 1993; 19:317-8. [PMID: 8301068 DOI: 10.1016/s0168-8278(05)80589-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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40
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McMahon BJ, Helminiak C, Wainwright RB, Bulkow L, Trimble BA, Wainwright K. Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons. Am J Med 1992; 92:254-6. [PMID: 1532114 DOI: 10.1016/0002-9343(92)90073-k] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine the incidence of adverse reactions to hepatitis B plasma-derived vaccine. PATIENTS Alaska natives (43,618) who received 101,360 doses of hepatitis B vaccine. METHODS All adverse reactions, excluding transient fever, myalgia, or soreness lasting less than 3 days, were reported. An intradermal skin test was developed to test purported adverse reactions. Records of the entire population were reviewed for Guillain-Barré syndrome (GBS). SETTING A statewide hepatitis B control program for Alaska natives. RESULTS Possible adverse reactions occurred in 39 persons. The most frequent adverse reactions were myalgia/arthralgia lasting longer than 3 days (14), followed by skin rashes (eight) and dizziness (seven). Skin tests were performed on 13 persons and were positive in five. Six of the persons with negative skin tests and eight persons who did not undergo skin testing received additional doses of vaccine without any adverse reactions. No increased incidence of GBS was found in the vaccinees. CONCLUSION Hepatitis B vaccine is safe and most adverse reactions are coincidental.
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Affiliation(s)
- B J McMahon
- Department of Medicine, Alaska Native Medical Center, Anchorage 99510-7741
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41
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Abstract
Recent developments in molecular biology have advanced our understanding of the pathogenesis of HBV-induced disease. New data derived from the molecular analysis of clinical material have begun to bridge the gap between bench research and the clinical arena. In this review, we consider topics that have relevance to clinical management and that have not been summarized in the recent literature. The recent advances that have been made in the areas of HBV variants, in vitro cell culture systems, and extrahepatic infection are discussed in greater detail.
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Affiliation(s)
- B Yoffe
- VAMC, Division of Digestive Diseases, Houston, Texas 77030
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42
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Abstract
Medical emergencies involving the liver and biliary tract are common clinical problems. If it is already known that the patient has cirrhosis it may be an easy matter to identify the cause of complications such as gastro-intestinal bleeding or coma, but it must be borne in mind that oesophageal varices are not the only cause of such bleeding in cirrhotics and that hepatic encephalopathy is not the only cause of coma. Bacterial infection should always be considered as a possible cause of deterioration in the clinical picture; it may be a complication of pre-existing acute or chronic liver or biliary tract disease or a cause of hepatobiliary disease; prompt administration of appropriate antibiotics may save the patient's life. If there is any suspicion of biliary obstruction in a patient with signs of bacteraemia the biliary tree should be drained without delay. The key to the management of hepatobiliary emergencies lies in prompt and appropriate supportive therapy, and then in a correct diagnosis which may allow specific treatment to be administered. However, it is often difficult to establish the cause, and the resources of a specialist centre may be needed. Prompt referral is indicated when a patient is clearly very ill and shows no signs of rapid improvement.
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43
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Johnson PA, Avery C. Infectious mononucleosis presenting as a parotid mass with associated facial nerve palsy. Int J Oral Maxillofac Surg 1991; 20:193-5. [PMID: 1940493 DOI: 10.1016/s0901-5027(05)80171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of infectious mononucleosis presenting as parotid lymphadenopathy and associated partial facial nerve palsy is described and the possible diagnostic confusion with a malignant neoplasm emphasised. Infectious mononucleosis and other viral diseases which caused facial nerve palsy are discussed and the literature reviewed.
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Affiliation(s)
- P A Johnson
- Department of Oral and Maxillofacial Surgery, Central Outpatients Department, North Staffs Hospital Centre, Stroke-on-Trent, England
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44
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Herbert A, Corbin D, Williams A, Thompson D, Buckels J, Elias E. Erythropoietic protoporphyria: unusual skin and neurological problems after liver transplantation. Gastroenterology 1991; 100:1753-7. [PMID: 2019380 DOI: 10.1016/0016-5085(91)90680-j] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The case of a woman with protoporphyria who developed liver failure and underwent liver transplantation is described. During the pretransplant episode of liver failure she developed quadriparesis that rapidly progressed after transplantation to a severe polyneuropathy. Following transplantation she also developed a second-degree burn of the light-exposed abdominal wall. The neuropathy resembled that observed in other forms of porphyria, and it is proposed that the extreme disturbance of protoporphyrin levels associated with protoporphyrin-induced liver failure caused this neuropathy. Such a neuropathy has not previously been described in protoporphyria. Erythrocyte protoporphyrin levels remain high and fecal levels normal, although results of liver tests are normal. She remains photosensitive, which emphasizes that although liver transplantation may be lifesaving in this disorder, it is not curative, and care must be taken to prevent photosensitive damage to skin and light-exposed internal organs.
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Affiliation(s)
- A Herbert
- Department of Neurology, Queen Elizabeth Hospital, Edgbaston, Birmingham, England
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45
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Lin SM, Ryu SJ, Liaw YF. Guillain-Barré syndrome associated with acute delta hepatitis virus superinfection. J Med Virol 1989; 28:144-5. [PMID: 2754426 DOI: 10.1002/jmv.1890280306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We describe a patient with the clinical characteristics of Guillain-Barré syndrome, including progressive ascending paresis; cerebrospinal fluid albumino-cytological dissociation; polyphasic small evoked potential, with prolonged latency and slow motor nerve conduction velocity; and active denervation pattern on electromyography, in association with acute delta hepatitis virus superinfection. The patient recovered from Guillain-Barré syndrome but developed chronic active delta hepatitis.
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Affiliation(s)
- S M Lin
- Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Xie JG, Cai Y, Davis LE. Guillain-Barré syndrome and hepatitis A: lack of association during a major epidemic. Ann Neurol 1988; 24:697-8. [PMID: 3202621 DOI: 10.1002/ana.410240525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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48
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Abstract
Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis. Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research. This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.
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Affiliation(s)
- B A Bannister
- Royal Free Hospital Department of Infectious Diseases, Coppetts Wood Hospital, London, UK
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Cargnel A, Davoli C, Vigano P, Caccia MR, Zanetti AR, Tovey G, Ellis DS, Zuckerman AJ. Seventh cranial nerve paralysis with myokymia during acute co-infection with hepatitis B and delta viruses. J Med Virol 1988; 25:245-7. [PMID: 3392524 DOI: 10.1002/jmv.1890250215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient with peripheral cranial nerve paresis and bilateral myokymia is described during the course of acute co-infection with hepatitis B and delta viruses. Specific circulating hepatitis B immune complexes were found by electron microscopy concomitantly with the neurological symptoms.
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Affiliation(s)
- A Cargnel
- Second Division of Infectious Diseases, Hospital L. Sacco, Milan, Italy
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