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HEV found among patients with Guillain-Barré syndrome

Researchers found that hepatitis E virus infection was associated with Guillain-Barré syndrome in a Belgian cohort, suggesting it is important to test for other infectious diseases when testing for hepatitis E, per published findings.

“Hepatitis E usually has a benign self-limiting disease course, but both infectious and immune-mediated neurological complications can occur,” Philip Van Damme, MD, PhD, department of neurology, University Hospitals Leuven, Belgium, told Healio.com/Hepatology. “In our study, we confirmed that an acute hepatitis E infection is preceding a Guillain-Barré syndrome in about 5% of cases, especially if elevated liver enzymes are present.”

Van Damme and colleagues conducted a retrospective study with 73 adult patients (44 men; median age, 52 years) with Guillain-Barré syndrome (GBS) or a GBS variant admitted to University Hospital Leuven between January 2007 and November 2015. Their goal was to determine any prevalence of HEV-associated GBS and any difficulties with the diagnosis of acute HEV.

Of all the patients, 8% showed positive reactivity on immunoglobulin M (IgM) assays for HEV. This indicated the possibility of acute HEV infection, per the research. Four of these patients showed more than 1.5 times the upper limit of normal alanine aminotransferase levels (67%). The researchers then studied any contribution of HEV to elevated ALT levels among the entire cohort. Of these, 22 patients had increased ALT levels and four of these showed positive reactivity on HEV IgM assays.

“The range of phenotypes associated with hepatitis E virus infection was very broad ranging from typical GBS, to rare GBS variants, such as acute ataxic neuropathy and pharyngeal-cervical-brachial variant of GBS,” Van Damme said.

Serum samples of two of the six patients who experienced positive reactivity on HEV IgM assays also showed positivity for cytomegalovirus or Epstein-Barr virus. This indicated that 6% of all patients in the cohort had probable acute HEV infection (n = 4). Two of these patients presented with a positive HEV IgM serologic finding. Van Damme said this represented evidence of cross-reactivity and how more testing may be needed for GBS.

“Another striking observation [in our study] was that cross-reactivity with other pathogens can occur (eg, CMV and EVB) and therefore testing of other infectious triggers of GBS is important.”

Van Damme and colleagues wrote that testing for other infections in parallel with HEV is vital due to the cross-reactivity present in the study. They further wrote that RT-PCR for the detection of viral nucleic acids does not always allow for researchers to draw specific conclusions due to the fact tests may be negative because of the short viremia of acute HEV infection.

“Further refinement of the immunoassays will hopefully eliminate the issue of cross-reactivity in the future,” Van Damme said.

Disclosures: Van Damme reports holding a senior clinical investigatorship of Fonds Wetenschappelijk Onderzoek-Vlaanderen. Please see the study for a list of all other researchers’ relevant financial disclosures.