To assess the prevalence and clinical features of neurologic involvement in patients with acute hepatitis E virus (HEV) infection in Southern Switzerland.
Among 1,940 consecutive patients investigated for acute hepatitis E, we identified 141 cases of acute of HEV infection (anti-HEV immunoglobulin M and immunoglobulin G both reactive and/or HEV RNA positive) between June 2014 and September 2017. Neurologic cases were followed up for 6 months. We compared patients with and without neurologic symptoms.
Neurologic symptoms occurred in 43 acute HEV cases (30.4%) and consisted of neuralgic amyotrophy (NA, n = 15, 10.6%) and myalgia (n = 28, 19.8%). All NA cases were immunocompetent. Men had higher odds (OR = 5.2, CI 1.12–24.0, p = 0.03) of developing NA after infection with HEV, and in 3 couples simultaneously infected with HEV, only men developed NA. Bilateral involvement of NA was predominant (2:1) and occurred only in men. Seven NA cases were viremic (all genotype 3), but HEV was undetectable in their CSF. In the acute phase of NA, 9 patients were treated with intravenous immunoglobulin and 4 with prednisone, reporting no side effects and improvement in pain and strength. Myalgia occurred both without (n = 16) or with (n = 12) concomitant elevated serum creatinine kinase. Seven cases with myalgia in the shoulder girdle did not have muscle weakness (“forme fruste” of NA).
But these are specified in the acknowledgment session: 1-ABREOC (EOC) grant 2016 2-NERAB Foundation grant 2016 3-Baasch-Medicus Stiftung grant 2018
1-GBS/CIDP Foundation grant 2018 for research on Guillain- Barré syndrome (IGOS study) This grant support is not related to the present project.
GFE Blut MBh: travel and speaker honorariumMecrk: travel and speaker honorariumWantai Biological Enterprise, Beijing, China: travelPaul Ehrlich Institute: travel and speaker honorariumRoche
HEV viral strain, named Kernow C1, jointly with NIH,Bethesda MD and Royal Cornwall Hospital, Truro, UK
Speaker honoraria or travel funding from Abbvie, Almirall, Biogen Idec, Celgene, Genzyme, Merck Serono, Novartis, Teva Pharma, Roche.
Speaker honoraria from Abbvie, Almirall, Biogen Idec, Celgene, Genzyme, Merck Serono, Novartis, Teva Pharma, Roche.
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