Neurologic complications of acute hepatitis E virus infection

ObjectiveTo assess the prevalence and clinical features of neurologic involvement in patients with acute hepatitis E virus (HEV) infection in Southern Switzerland.MethodsAmong 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.ResultsNeurologic 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).ConclusionsNeurologic symptoms occurred in one-third of acute HEV infections and consisted of NA and myalgia. NA seems to occur more frequently in men infected by HEV and has a predominant (but not exclusive) bilateral involvement.

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Detection of Hepatitis E Virus-Specific Immunoglobulin A in Patients Infected with Hepatitis E Virus Genotype 1 or 3

Clinical and Vaccine Immunology ◽

10.1128/cvi.00312-06 ◽

2007 ◽

Vol 14 (3) ◽

pp. 276-280 ◽

Cited By ~ 23

Author(s):

M. Herremans ◽

E. Duizer ◽

E. Jusic ◽

M. P. G. Koopmans

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Genotype 1 ◽

Genotype 3 ◽

Route Of Transmission

ABSTRACT Currently, diagnosis of acute hepatitis E virus (HEV) in patients is primarily based on anti-HEV immunoglobulin M (IgM) detection. However, several investigations suggest the use of HEV-specific IgA for diagnosing acute HEV infections. We evaluated two commercially available assays, an IgA enzyme-linked immunosorbent assay (ELISA) (Diacheck) and an adapted immunoblot protocol (Mikrogen) for IgA detection and compared the performance in genotype 1- and 3-infected patients. The specificity of the IgA assays was high, with no positive reactions in a control group of 18 acute hepatitis patients who were negative for HEV. The sensitivity calculated in nine PCR-positive type 1-infected patients was 100% in both assays but was clearly lower in genotype 3-infected patients (n = 14), with sensitivities of only 67% and 57% for the ELISA and immunoblot assay, respectively. The lower IgA responses detected in genotype 3-infected patients could be caused by the use of only the genotype 1 and 2 antigens in the serological assays. Interestingly in two patients with possible infection through blood transfusion no response or intermediate IgA responses were detected, and this might confirm the parenteral route of transmission. In both the type 1- and type 3-infected patients both the IgA and IgM responses disappeared simultaneously. We conclude that IgA detection is of limited value for the serodiagnosis of acute HEV cases, particularly with genotype 3.

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Hepatitis E virus in Italy: molecular analysis of travel-related and autochthonous cases

Journal of General Virology ◽

10.1099/vir.0.031278-0 ◽

2011 ◽

Vol 92 (7) ◽

pp. 1617-1626 ◽

Cited By ~ 45

Author(s):

Giuseppina La Rosa ◽

Michele Muscillo ◽

Valentina Spuri Vennarucci ◽

Anna Rosa Garbuglia ◽

Patrizia La Scala ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

The Body ◽

Industrialized Countries ◽

Genotype 3 ◽

Serum Samples ◽

Specific Primers ◽

Body Of Knowledge ◽

Acute Hepatitis E

Human hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The aim of the present study was to contribute to the body of knowledge available on the molecular epidemiology of acute hepatitis E in Italy. Three sets of HEV-specific primers targeting the ORF1 and ORF2 were used to examine serum samples collected from acute hepatitis patients positive for anti-HEV IgG and/or IgM, between 2007 and 2010. Seventeen patients (39.5 %) tested HEV RNA-positive: 12 infections, due to genotype 1, were associated with travel to endemic areas (Bangladesh, India and Pakistan), while five infections, due to genotype 3, were presumably autochthonous. Risk factors identified in this group included exposure to raw seafood, pork liver sausages and wild boar. Results from the present study confirm that human HEV infection in Italy is caused by different genotypes, depending on whether the infection is travel-related or autochthonous.

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Clinical and Epidemiological Relevance of Quantitating Hepatitis E Virus-Specific Immunoglobulin M

Clinical and Vaccine Immunology ◽

10.1128/cdli.9.5.1072-1078.2002 ◽

2002 ◽

Vol 9 (5) ◽

pp. 1072-1078 ◽

Cited By ~ 7

Author(s):

Jitvimol Seriwatana ◽

Mrigendra P. Shrestha ◽

Robert M. Scott ◽

Sergei A. Tsarev ◽

David W. Vaughn ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Case Series ◽

Hepatitis E ◽

Immunoglobulin M ◽

Operating Characteristics ◽

True Negative ◽

Cut Point ◽

Specific Immunoglobulin ◽

Acute Hepatitis E

ABSTRACT Diagnosis of acute hepatitis E by detection of hepatitis E virus (HEV)-specific immunoglobulin M (IgM) is an established procedure. We investigated whether quantitation of HEV IgM and its ratio to HEV total Ig furnished more information than conventional IgM tests that are interpreted as positive or negative. A previously described indirect immunoassay for total Ig against a baculovirus-expressed HEV capsid protein was modified to quantitate HEV-specific IgM in Walter Reed (WR) antibody units by using a reference antiserum and the four-parameter logistic model. A receiver-operating characteristics curve derived from 197 true-positive specimens and 449 true-negative specimens identified 30 WR units/ml as an optimum cut point. The median HEV IgM level in 36 patients with acute hepatitis E fell from 3,000 to 100 WR units/ml over 6 months, suggesting that 100 WR units/ml would be a more appropriate cut point for distinguishing recent from remote IgM responses. Among three hepatitis E case series, determination of the HEV IgM-to-total-Ig ratio in acute-phase serum revealed that most patients had high ratios consistent with primary infections whereas a few had low ratios, suggesting that they had sustained reinfections that elicited anamnestic antibody responses. The diagnostic utility of the new IgM test was similar to that of a commercially available test that uses different HEV antigens. In conclusion, we found that HEV IgM can be detected specifically in >95% of acute hepatitis E cases defined by detection of the virus genome in serum and that quantitation of HEV IgM and its ratio to total Ig provides insight into infection timing and prior immunity.

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Four cases of sporadic acute hepatitis E in Mie, Japan who were infected with European type genotype 3 hepatitis E virus

Kanzo ◽

10.2957/kanzo.52.295 ◽

2011 ◽

Vol 52 (5) ◽

pp. 295-302 ◽

Cited By ~ 5

Author(s):

Hiroshi Okano ◽

Tatsunori Nakano ◽

Shimpei Matsusaki ◽

Tomohiro Sase ◽

Tomonori Saitou ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Genotype 3 ◽

Sporadic Acute Hepatitis ◽

Acute Hepatitis E

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Icteric acute hepatitis E with no response of immunoglobulin M class anti-hepatitis E virus antibody

Hepatology Research ◽

10.1111/j.1872-034x.2012.01023.x ◽

2012 ◽

Vol 42 (11) ◽

pp. 1146-1149 ◽

Cited By ~ 3

Author(s):

Yasuhiro Takikawa ◽

Yasuhiro Miyamoto ◽

Mio Onodera ◽

Hidekatu Kuroda ◽

Kazuhiro Kasai ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Immunoglobulin M ◽

Virus Antibody ◽

Acute Hepatitis E

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Severe Acute Hepatitis E in a Woman with an Autoimmune Background

Acta Médica Portuguesa ◽

10.20344/amp.10429 ◽

2020 ◽

Vol 33 (6) ◽

pp. 425

Author(s):

Maria S.J. Nascimento ◽

Madalena Almeida-Santos ◽

Maria Fernandes ◽

Fernando Maltez ◽

Sara Lino ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Hepatic Necrosis ◽

Coagulation Disorder ◽

Genotype 3 ◽

Virus Genotype ◽

Younger Men ◽

Acute Hepatitis E ◽

Severe Acute Hepatitis

Hepatitis E virus genotype 3 infections are normally asymptomatic in immunocompetent individuals. Symptomatic cases of acute icteric hepatitis E are seldom observed among women, younger men and children but are particularly seen in middle-aged/elderly men. We report a case of severe acute hepatitis E caused by genotype 3 in an immunocompetent 40-year-old woman that required prolonged hospitalization. Her medical history included an autoimmune background, namely atrophic gastritis and Graves’ disease. She presented an extensive hepatic necrosis as revealed by the high levels of aminotransferases (ALT 4893 U/L; AST 3138 U/L). She showed also a coagulation disorder (prothrombin time; INR = 1.33). Serological markers for hepatitis viruses A, B and C were negative but serum was positive for hepatitis E virus RNA. Sequencing and phylogenetic analysis revealed that the hepatitis E virus strain belonged to subgenotype 3a. This is suggestive of an association between the severe acute hepatitis E virus genotype 3 infection and the autoimmune background.

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