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Westhoff M, Arias A, Litterst P. Hepatitis E and diaphragmatic dysfunction: Case series and review of the literature. Pneumologie 2024; 78:400-408. [PMID: 38657646 DOI: 10.1055/a-2291-0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The causes of diaphragmatic paresis are manifold. An association between neuralgic amyotrophy (NA) and hepatitis E virus (HEV) infection has been reported. We wondered about the prevalence of diaphragmatic disfunction and hepatitis E infection in our clinic. METHODS From July 1st, 2020 to August 31st, 2023, patients presenting with diaphragmatic dysfunction and simultaneous clinical symptoms of an acute NA, or a history of NA, as well as patients with previously unexplained diaphragmatic dysfunction were examined for HEV infection. RESULTS By August 31st, 2023, 13 patients with diaphragmatic dysfunction and HEV infection were diagnosed (4 women, 9 men). Mean age was 59 ± 10 years. Liver values were normal in all patients. The median latency to diagnosis was five months (range: 1-48 months); nine patients, 4 of them with typical symptoms of NA, presented with acute onset three patients showed bilateral diaphragmatic dysfunction. All patients had a positive IgG immunoblot. Seven patients, three with NA, had an elevated hepatitis E IgM titer and six of them also a positive IgM immunoblot. In all cases, O2C hepatitis genotype 3 was identified. In eight cases, all those with a high IgG titer >125, the O2 genotype 1 was also detected. CONCLUSION NA that shows involvement of the phrenic nerve resulting in diaphragmatic dysfunction and dyspnoea, may be associated with HEV infection. The observation of 13 patients with diaphragmatic dysfunctions and HEV infection within a period of three years indicates a high number of undetected HEV-associated diaphragmatic dysfunction in the population, especially in the absence of NA symptoms. Therefore, even in diaphragmatic dysfunction without NA symptoms and causative damaging event, HEV infection should be considered, as it may represent a subform of NA with only phrenic nerve involvement. Therapy of HEV-associated diaphragmatic dysfunction in the acute phase is an open question. In view of the poor prognosis for recovery, antiviral therapy should be discussed. However, no relevant data are currently available.
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Affiliation(s)
- Michael Westhoff
- Pneumology, Lungenklinik Hemer, Hemer, Germany
- Private University Witten/Herdecke, Witten, Germany
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2
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Rojc B, Šarabon N. A patient with bilateral neuralgic amyotrophy and hepatitis E virus infection: an educational communication. Eur J Transl Myol 2024; 34:12143. [PMID: 38226557 PMCID: PMC11017166 DOI: 10.4081/ejtm.2024.12143] [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: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024] Open
Abstract
Neuralgic Amyotrophy, a peripheral nervous system disorder, is characterized by severe pain and muscle weakness, which can have a significant impact on patients' quality of life. The exact cause of neuralgic amyotrophy is unknown, but it may be linked to immunopathological mechanisms. Recent research has found an association between neuralgic amyotrophy and hepatitis E virus infection. This communication aims to expand knowledge on the clinical phenotype of patients with neuralgic amyotrophy and hepatitis E virus infection, presenting the case of a 55-year-old man diagnosed with bilateral neuralgic amyotrophy and hepatitis E virus infection.
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Affiliation(s)
- Bojan Rojc
- General Hospital Izola, Neurology Service, Izola, Slovenia; University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper.
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Department of Physiotherapy, Izola.
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Parsonage-Turner Syndrome After COVID-19 Vaccination in a Child. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00006. [PMID: 36893168 PMCID: PMC10005827 DOI: 10.5435/jaaosglobal-d-22-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/28/2023] [Indexed: 03/10/2023]
Abstract
Parsonage-Turner syndrome (PTS) is a peripheral neuropathy involving the brachial plexus very rare in childhood. To date, no cases of PTS after COVID-19 vaccination have been reported in children. We report a case of a 15-year-old boy affected by PTS after the second dose of the BNT162b2 (Comirnaty, Pfizer-BioNTech) COVID-19 vaccine.
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Naum R, Gwathmey KG. Autoimmune polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:587-608. [PMID: 37562888 DOI: 10.1016/b978-0-323-98818-6.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The autoimmune peripheral neuropathies with prominent motor manifestations are a diverse collection of unusual peripheral neuropathies that are appreciated in vast clinical settings. This chapter highlights the most common immune-mediated, motor predominant neuropathies excluding acute, and chronic inflammatory demyelinating polyradiculoneuropathy (AIDP and CIDP, respectively). Other acquired demyelinating neuropathies such as distal CIDP and multifocal motor neuropathy will be covered. Additionally, the radiculoplexus neuropathies, resulting from microvasculitis-induced injury to nerve roots, plexuses, and nerves, including diabetic and nondiabetic lumbosacral radiculoplexus neuropathy and neuralgic amyotrophy (i.e., Parsonage-Turner syndrome), will be included. Finally, the motor predominant peripheral neuropathies encountered in association with rheumatological disease, particularly Sjögren's syndrome and rheumatoid arthritis, are covered. Early recognition of these distinct motor predominant autoimmune neuropathies and initiation of immunomodulatory and immunosuppressant treatment likely result in improved outcomes.
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Affiliation(s)
- Ryan Naum
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Graham Gwathmey
- Neuromuscular Division, Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
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Scanvion Q, Morell-Dubois S. Neuralgic amyotrophy triggered by cytomegalovirus: to be aware of this clinical diagnosis. Neurocase 2022; 28:320-322. [PMID: 35654085 DOI: 10.1080/13554794.2022.2085118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuralgic amyotrophy (NA) is a multifocal inflammatory neuropathy. Although the exact etiopathogenesis of the latter is unknown, the literature reports frequent associations with immunological events such as different infectious diseases. Our case reveals a rarely described etiology of NA. NA is mainly a clinical diagnosis. The etiology shown in our case study is interesting for the scientific community, because CMV is an ubiquitous disease. NA is frequently under-recognized and misdiagnosed. This is particularly common in the early phase of the disease, when neurologic signs have not yet developed.
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Affiliation(s)
- Quentin Scanvion
- Department of Internal Medicine and Clinical Immunology, National Reference Centre for Rare Systemic Autoimmune Disease North and North-West of France, University of Lille, CHU Lille, Lille, France
| | - Sandrine Morell-Dubois
- Department of Internal Medicine and Clinical Immunology, National Reference Centre for Rare Systemic Autoimmune Disease North and North-West of France, University of Lille, CHU Lille, Lille, France
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6
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Garofoli R, Zauderer J, Seror P, Roren A, Guerini H, Rannou F, Drapé JL, Nguyen C, Lefèvre-Colau MM. Neuralgic amyotrophy and hepatitis E infection: 6 prospective case reports. RMD Open 2021; 6:rmdopen-2020-001401. [PMID: 33219125 PMCID: PMC8011528 DOI: 10.1136/rmdopen-2020-001401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 11/01/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Hepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis
worldwide. It is known that neuralgic amyotrophy (NA) is one of the most frequent
neurological manifestations of HEV. However, clinical, electrodiagnostic (EDX) and MRI
characteristics, as well as long-term follow-up of HEV-related NA have not been fully
described yet. Case reports We describe longitudinally clinical, EDX, biological and MRI results of six cases of
HEV-associated NA, diagnosed from 2012 to 2017. Patients were between the ages of 33 and
57 years old and had a positive HEV serology. Clinical patterns showed the whole
spectrum of NA, varying from extensive multiple mononeuropathy damage to single
mononeuropathy. EDX results showed that the patients totalised 26 inflammatory
mononeuropathies (1 to 8 per patient). These involved classical nerves such as
suprascapular (6/6 cases), long thoracic (5/6 cases) and accessory spinal nerves (2/6
cases) and, some less frequent more distal nerves like anterior interosseous nerve (3/6
cases), as well as some unusual ones such as the lateral antebrachial cutaneous nerve
(1/6 case), sensory fibres of median nerve (1/6 case) and phrenic nerves (1/6 case).
After 2 to 8 years, all nerves had clinically recovered (muscle examination above
3/5 on MRC scale for all muscles except in one patient). Discussion HEV should be systematically screened when NA is suspected, whatever the severity, if
the onset is less than 4 months (before IgM HEV-antibodies disappear) and appears
to be frequently associated with severe clinical and EDX pattern, without increasing the
usual recovery time.
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Affiliation(s)
- Romain Garofoli
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Jennifer Zauderer
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Paul Seror
- Département De Neurophysiologie, Univ. Paris Pierre Et Marie Curie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Henri Guerini
- Service de Radiologie ostéo-articulaire, Hôpital Cochin, Paris, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jean-Luc Drapé
- Service de Radiologie ostéo-articulaire, Hôpital Cochin, Paris, France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
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HEV-Associated Neuralgic Amyotrophy: A Multicentric Case Series. Pathogens 2021; 10:pathogens10060672. [PMID: 34070707 PMCID: PMC8230081 DOI: 10.3390/pathogens10060672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Neuralgic amyotrophy (NA) has been described as a possible extrahepatic manifestation of hepatitis E virus (HEV) infection. Usually, HEV-associated NA occurs bilaterally. The clinical characteristics determining the course of HEV-associated NA have still not been defined. Methods: In this retrospective multicentric case series, 16 patients with HEV-associated NA were studied and compared to 176 HEV patients without NA in terms of their age, sex, and ALT levels. Results: Neither gender distribution (75% vs. 67% male) nor age (47 vs. 48 years median) differed significantly between the NA patients and controls. Eight NA patients (50%) presented with bilateral involvement—seven of these had right-side dominance and one had left-side dominance. Thirteen cases (81%) were hospitalized. Eight of these patients stayed in hospital for five to seven days, and five patients stayed for up to two weeks. The time from the onset of NA to the HEV diagnosis, as well as the diagnostic and therapeutic proceedings, showed a large variability. In total, 13 (81%) patients received treatment: 1/13 (8%) received intravenous immunoglobulins, 8/13 (62%) received glucocorticoids, 3/13 (23%) received ribavirin, and 6/13 (46%) received pregabalin/gabapentin. Patients with ages above the median (47 years) were more likely to be treated (p = 0.001). Conclusion: HEV-associated NA causes a relevant morbidity. In our case series neither the type of treatment nor the time of initiation of therapy had a significant effect on the duration of hospitalization or the course of the disease. The clinical presentation, the common diagnostic and therapeutic procedures, and the patients’ characteristics showed large variability, demonstrating the necessity of standardized protocols for this rare but relevant disease.
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Jha AK, Kumar G, Dayal VM, Ranjan A, Suchismita A. Neurological manifestations of hepatitis E virus infection: An overview. World J Gastroenterol 2021; 27:2090-2104. [PMID: 34025066 PMCID: PMC8117739 DOI: 10.3748/wjg.v27.i18.2090] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/27/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Gaurav Kumar
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Abhay Ranjan
- Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Arya Suchismita
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, Basant Kunj 110070, New Delhi, India
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Abstract
Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and
its actual incidence rate is about 1 per 1000 per year. In the current article,
we provide an overview of essential information about NA, including the
etiology, clinical manifestations, diagnostic investigations, differential
diagnosis, treatment, and prognosis. The causes of NA are multifactorial and
include immunological, mechanical, or genetic factors. Typical clinical findings
are a sudden onset of pain in the shoulder region, followed by patchy flaccid
paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a
patient’s clinical history and physical examination. Gadolinium-enhanced
magnetic resonance imaging and high-resolution magnetic resonance neurography
are useful for confirming the diagnosis and choosing the appropriate treatment.
However, before a diagnosis of NA is confirmed, other disorders with similar
symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled
out. The prognosis of NA depends on the degree of axonal damage. In conclusion,
many patients with motor weakness and pain are encountered in clinical practice,
and some of these patients will exhibit NA. It is important that clinicians
understand the key features of this disorder to avoid misdiagnosis.
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Affiliation(s)
- Tae Uk Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Mendoza-Lopez C, Lopez-Lopez P, Atienza-Ayala S, Rivero-Juarez A, Benito R. Parsonage-Turner syndrome associated with hepatitis E infection in immunocompetent patients. Virus Res 2020; 290:198165. [PMID: 33007343 DOI: 10.1016/j.virusres.2020.198165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023]
Abstract
Introduction The hepatitis E virus (HEV) is the leading cause of acute hepatitis around the world. In recent years, knowledge has increased concerning extrahepatic manifestations caused by HEV, including neurological manifestations such as Parsonage-Turner syndrome (PTS). PTS is characterized by severe shoulder or arm pain and patchy paresis with muscle weakness. The aim of the present study was to assess the association between HEV and PTS. Materials and Methods We reported two cases of PTS associated with HEV, which were diagnosed in a short period of time in the same village. PTS was diagnosed by physical examination and electrophysiological studies, and serology testing for IgM, low-avidity IgG, and RNA of HEV established the diagnosis of acute HEV infection. Results A 44-year-old man who presented cervicobrachial pain accompanied by paresthesia, dyspnea, and isolated derangement of liver enzymes and 57-year-old women with cervical pain radiated to upper limbs, paresthesia, and liver cytolysis, although, this patient was initially diagnosed as having drug-induced hepatitis. Finally, the diagnosis was Parsonage- Turner syndrome associated with hepatitis e virus. In both patients, symptoms were bilateral and they required hospital admission. Both consumed vegetables are grown in a local patch and the phylogenetic analysis showed genotype 3f. Then, we reviewed the literature on PTS and HEV and we found 62 previously described cases that were more likely to be men (86.20 %) with more frequent bilateral symptoms (85.71 %). Genotype 3 is the most commonly associated. Three of those cases were diagnosed in Spain. Conclusions According to our findings, HEV should be considered in patients with neuralgic amyotrophy, including those with the absence of liver cytolysis.
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Affiliation(s)
- Claudia Mendoza-Lopez
- Microbiology Department, University Clinical Lozano Blesa Hospital, Zaragoza, Spain.
| | - Pedro Lopez-Lopez
- Infectious Diseases Unit, Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Saida Atienza-Ayala
- Neurology Department, University Clinical Lozano Blesa Hospital, Zaragoza, Spain
| | - Antonio Rivero-Juarez
- Infectious Diseases Unit, Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Rafael Benito
- Microbiology Department, University Clinical Lozano Blesa Hospital, Zaragoza, Spain
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Rawla P, Raj JP, Kannemkuzhiyil AJ, Aluru JS, Thandra KC, Gajendran M. A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection. Med Sci (Basel) 2020; 8:E9. [PMID: 32033102 PMCID: PMC7151617 DOI: 10.3390/medsci8010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is a non-enveloped, positive-sense, single-stranded RNA icosahedral virus belongs to the genus Orthohepevirus within the Hepeviridae family. HEV infection can be asymptomatic, or it can cause icteric or fulminant hepatitis. Off late, there have been a number of publications reporting the extra-hepatic manifestations of HEV infection, and this systematic review is aimed at summarizing the available evidence in this regard. Two independent investigators searched PubMed, PubMed Central and Embase databases using the search string "(((hepatitis E) AND (Extrahepatic OR Extra-Hepatic))) OR ((Hepatitis E) AND (Neurology OR Cardiology OR Respiratory OR Lung OR Gastrointestinal OR musculoskeletal OR immunology OR pulmonary)) Filters: Abstract availability, English language, and Human studies". The extra-hepatic manifestations reported in each of the selected articles were classified and reported as neurological, cardiovascular, and hematological and miscellaneous manifestations. The total number of various manifestations reported in our study were n = 324. These include neurological manifestations (n = 178/324 (54.94%)), cardiovascular and hematological manifestations (n = 113/324 (34.88%)), gastro-intestinal/pancreaticobiliary manifestations (n = 24/324 (7.41%)) and other rarer manifestations involving systems such as renal (n = 4/324; 1.24%), endocrine (n = 1/324; 0.31%), dermatology (n = 1/324; 0.31%), respiratory (n = 1/324; 0.31%), muscular (n = 1/324; 0.31%) and immune system (n = 1/324; 0.31%). Thus, HEV can have extra-hepatic manifestations affecting any system of the human body. Further research is needed to elucidate the underlying pathophysiological manifestations of these extra-hepatic manifestations and to prove causal association with HEV.
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Affiliation(s)
- Prashanth Rawla
- Department of Medicine, Sovah Health, Martinsville, VA 24112, USA
| | - Jeffrey Pradeep Raj
- Department of Clinical Pharmacology, Seth G.S. Medical College & King Edward Memorial Hospital, Mumbai 400012, India;
| | - Alan Jose Kannemkuzhiyil
- St. Johns Medical College, St. John’s National Academy of Health Sciences, Bengaluru, Karnataka 560034, India;
| | - John Sukumar Aluru
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02212, USA;
| | - Krishna Chaitanya Thandra
- Department of Pulmonary and Critical Care Medicine, Sentara Virginia Beach General Hospital, Virginia Beach, VA 23454, USA;
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA;
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Situ J, Wang W, Long F, Yang W, Yang C, Wei D, Yu W, Huang F. Hepatitis E viral infection causes testicular damage in mice. Virology 2019; 541:150-159. [PMID: 32056713 DOI: 10.1016/j.virol.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
Hepatitis E virus (HEV) is the main pathogen of hepatitis E infections with multiple extrahepatic replication sites. The presence of HEV RNA in the semen of infertile males suggests HEV replicates in the male genital tract. However, the mechanism is largely remained elusive. A BALB/c-based animal model was used to evaluate the effects of HEV infection on the testicular damage. HEV RNA was detected in feces, blood and livers from 7 to 28 days post-inoculation (dpi), while was positive in male genital tract from 7 to 70 dpi. Positive signals of HEV antigens were observed in testes, epididymides and seminal vesicles (SVs). Impaired sperm quality, destroyed the blood-testis barrier (BTB) and drastically decreased spermatogonia suggested that HEV infection causes testicular damage. Antiviral immune response was barely found in the testes. Results demonstrated that HEV replicates in male genital tract, causes testicular damage, and consequently results in flawed fertility.
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Affiliation(s)
- Jianwen Situ
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Wenjing Wang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Feiyan Long
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Weimin Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Chenchen Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Daqiao Wei
- Medical School, Kunming University of Science and Technology, Kunming, China.
| | - Wenhai Yu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
| | - Fen Huang
- Medical School, Kunming University of Science and Technology, Kunming, China.
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Arányi Z, Szpisjak L, Szőke K. Multiphasic presentation of neuralgic amyotrophy associated with hepatitis E virus infection. Muscle Nerve 2019; 61:108-110. [PMID: 31573093 DOI: 10.1002/mus.26722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this study was to further characterize the clinical phenotype of hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA). METHODS Three patients with HEV-associated NA underwent clinical, electrodiagnostic, and ultrasound assessment. RESULTS In all patients, symptoms developed in several phases within a time span of 4-6 weeks, with three or more nerves involved. Symptoms were bilateral in two. In two patients, nerves of the trunk and the lower limb were affected as well. In one patient, three bouts occurred, each heralded by an increase in pain. In the other two, pain subsided quickly and nerve damage developed in two phases. Segmental enlargement with or without hourglass-like constrictions of the nerves was demonstrated by ultrasound in all. CONCLUSIONS The multiphasic presentation, together with the extensive multi-nerve involvement, may reflect a severe and protracted inflammation of the nerves in HEV-associated NA.
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Affiliation(s)
- Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Szpisjak
- Department of Neurology, Faculty of Medicine, University of Szeged, Hungary
| | - Kristóf Szőke
- Department of Neurology, Semmelweis University, Budapest, Hungary
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van de Wardt J, Verrips A, van Griensven CH, van Eijk JJ. Hepatitis E. Neurol Clin Pract 2019; 9:e39-e41. [DOI: 10.1212/cpj.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022]
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16
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Brechot C, Bryant J, Endtz H, Garry RF, Griffin DE, Lewin SR, Mercer N, Osterhaus A, Picot V, Vahlne A, Verjans GMGM, Weaver S. 2018 international meeting of the Global Virus Network. Antiviral Res 2019; 163:140-148. [PMID: 30690044 PMCID: PMC7127431 DOI: 10.1016/j.antiviral.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/20/2022]
Abstract
The Global Virus Network (GVN) was established in 2011 to strengthen research and responses to emerging viral causes of human disease and to prepare against new viral pandemics. There are now 45 GVN Centers of Excellence and 7 Affiliate laboratories in 29 countries. The 10th International GVN meeting was held from November 28–30, 2018 in Veyrier du Lac, France and was co-hosted by the two GVN Centers of Excellence, the Mérieux Foundation and the University of Veterinary Medicine Hannover (TiHo). The theme of this 10th International GVN meeting was “Eradication and control of (re-) emerging viruses”. This report highlights the recent accomplishments of GVN researchers in several important areas of medical virology, including strategies for the eradication of smallpox, measles, polio, SARS and vector-borne or zoonotic infections, emergence and intervention strategies for retroviruses and arboviruses, preparedness for outbreaks of Filo- and other hemophilic viruses, pathogenesis, impact and prevention of respiratory viruses, as well as, viruses affecting the central and peripheral nervous system. Also threats in crisis settings like refugee camps were presented.
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Affiliation(s)
| | | | - Hubert Endtz
- Mérieux Foundation and the Erasmus University in Rotterdam, the Netherlands
| | | | - Diane E Griffin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, and Department of Infectious Diseases, Alfred Health and Monash University, Australia
| | | | | | | | - Anders Vahlne
- The Global Virus Network, Baltimore, MD, USA; Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands; TiHo-RIZ, Hannover, Germany
| | - Scott Weaver
- The University of Texas Medical Branch at Galveston, USA
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17
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Sánchez Azofra M, Romero Portales M, Tortajada Laureiro L, García-Samaniego J, Mora Sanz P. Hepatitis E virus in neurological disorders: a case of Parsonage-Turner syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:402-403. [PMID: 29685043 DOI: 10.17235/reed.2018.5506/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis E virus (HEV) infection is an emerging disease in developed countries with a broad clinical spectrum. In the absence of immunodeficiency or pregnancy, it is a mild and almost asymptomatic condition in most cases. However, extrahepatic manifestations, including neurological conditions, are common and may occasionally lead to permanent neurological sequelae. Herein, we report the case of an immunocompetent patient who was admitted to our hospital with paresthesia and weakness in both the upper extremities associated with anicteric-elevated transaminases. The diagnosis was Parsonage-Turner syndrome (neuralgic amyotrophy) secondary to HEV infection. The diagnosis was reached via electromyography and serology tests. Neuralgic amyotrophy (NA) is a demyelinating axonal disease that affects the brachial plexus and is associated with HEV infection in up to 10% of cases. We also emphasize the importance of requesting HEV serology in patients with neurological disease, especially with the involvement of the peripheral nervous system. Although the role of ribavirin remains to be fully determined, early diagnosis and treatment may result in an improved prognosis, thereby minimizing neurological sequelae.
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Affiliation(s)
| | | | | | | | - Pedro Mora Sanz
- Gastroenterología y Hepatología, Hospital Universitario La Paz
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18
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Essentials of the Production of Safe and Efficacious State-of-the-Art Polyclonal IgG Concentrates. ANTIBODY THERAPY 2018. [PMCID: PMC7122986 DOI: 10.1007/978-3-319-68038-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe noninfectious adverse events (AEs) and transmission of pathogens by plasma-derived protein concentrates from the very beginning of their clinical use were threats for recipients (see Chap. 10.1007/978-3-319-68038-5_11 for additional information). “Standard IgG” preparations were the first available for clinical use. They were produced by the cold-ethanol fractionation methods and did not make an exception. Noninfectious severe AEs occurred while infectious AEs were rarely reported. Indeed, prior to the introduction of mass screening for infection markers of plasma donations, inadvertent transmission of HIV to recipients of factor VIII and factor IX concentrates did occur, while IgG concentrates obtained from the same plasma pool did rarely transmit HIV (Morgenthaler 2001). Rare transmissions were restricted to products not exposed to low pH. The very few incidences of HIV and some incidences of HCV transmission by IgG concentrates in the early 1990s together with many cases of coagulation factor concentrates transmitted viral disease clearly demonstrated the need to establish standardized measures to render plasma products pathogen safe. In the second half of the 1990s, authorities shifted regulatory emphasis from a scientific review of the processes to a focus on compliance to current good manufacturing practice (cGMP). The focus on cGMP compliance was applied to all aspects of plasma fractionation and the clinical use of plasma products. Court injunctions and warning letters were the consequences of this paradigm shift by authorities. This in turn resulted in a paradigm shift how the modern plasma industry operates (Steinhardt 1998).
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19
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Swinnen B, Boeynaems S, Schrooten M, Saegeman V, Claeys KG, Van Damme P. Anterior interosseous mononeuropathy associated with HEV infection. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e429. [PMID: 29296634 PMCID: PMC5745356 DOI: 10.1212/nxi.0000000000000429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/27/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Bart Swinnen
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
| | - Steven Boeynaems
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
| | - Maarten Schrooten
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
| | - Veroniek Saegeman
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
| | - Kristl G Claeys
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
| | - Philip Van Damme
- Department of Neurosciences, Experimental Neurology (B.S., S.B., P.V.D.), KU Leuven-University of Leuven; Laboratory of Neurobiology (B.S., S.B., P.V.D.), Center for Brain & Disease Research, VIB; Departments of Neurology (B.S., M.S., K.G.C., P.V.D.), and Laboratory Medicine (V.S.), University Hospitals Leuven; and Laboratory for Cognitive Neurology (M.S.), Department of Neurosciences, Department of Microbiology and Immunology (V.S.), Laboratory for Muscle Diseases and Neuropathies (K.G.C.), Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
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