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Ripellino P, Lascano AM, Scheidegger O, Schilg-Hafer L, Schreiner B, Tsouni P, Vicino A, Peyer AK, Humm AM, Décard BF, Pianezzi E, Zezza G, Sparasci D, Hundsberger T, Dietmann A, Jung H, Kuntzer T, Wilder-Smith E, Martinetti-Lucchini G, Petrini O, Fontana S, Gowland P, Niederhauser C, Gobbi C. Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study. Eur J Neurol 2024; 31:e16030. [PMID: 37548584 DOI: 10.1111/ene.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Acute hepatitis E virus (HEV) infection has recently emerged as a potential trigger for acute dysimmune neuropathies, but prospective controlled studies are lacking. AIMS To compare the frequency of concomitant acute HEV infection in patients with neuralgic amyotrophy (NA), Guillain-Barré syndrome (GBS), and Bell's palsy with a matched control population. METHODS Swiss multicenter, prospective, observational, matched case-control study over 3 years (September 2019-October 2022). Neurological cases with NA, GBS, or Bell's palsy were recruited within 1 month of disease onset. Healthy controls were matched for age, sex, geographical location, and timing of blood collection. Diagnostic criteria for acute hepatitis E were reactive serum anti-HEV IgM and IgG assays (ELISA test) and/or HEV RNA detection in serum by real-time polymerase chain reaction (RT-PCR). RT-PCR was performed on sera to confirm IgM positivity. RESULTS We included 180 patients (59 GBS, 51 NA, 70 Bell's palsy cases) and corresponding matched controls (blood donors) with median age 51 years for both groups and equal gender distribution. Six IgM+ cases were detected in the NA, two in the GBS, and none in the Bell's palsy group. Two controls were anti-HEV IgM-positive. At disease onset, most cases with acute HEV infection had increased liver enzymes. A moderate association (p = 0.027, Fisher's exact test; Cramér's V = -0.25) was observed only between acute HEV infection and NA. CONCLUSION This prospective observational study suggests an association between concomitant acute HEV infection and NA, but not with GBS or Bell's palsy.
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Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Agustina Maria Lascano
- Neurology Division, Department of Clinical Neuroscience, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Bettina Schreiner
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | | | - Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Kathrin Peyer
- Cantonal Hospital, Lucerne, Switzerland
- Neuroliestal, Liestal, Switzerland
| | - Andrea Monika Humm
- Department of Medicine, Neurology Unit, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Enea Pianezzi
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Giulia Zezza
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Davide Sparasci
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | | | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hans Jung
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Einar Wilder-Smith
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Cantonal Hospital, Lucerne, Switzerland
| | | | - Orlando Petrini
- University of Applied Sciences and Arts of Southern Switzerland, Bellinzona, Switzerland
| | - Stefano Fontana
- Blood Transfusion Service SRC Southern Switzerland, Lugano, Switzerland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Peter Gowland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Christoph Niederhauser
- Interregional Blood Transfusion SRC, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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