title: Guillain-Barré syndrome associated with preceding hepatitis E virus infection.
abstract: OBJECTIVE
  The aim of the study was to determine whether Guillain-Barré syndrome (GBS) is associated with preceding hepatitis E virus infection.
  
  
  METHODS
  The frequency of hepatitis E virus (HEV) infections was determined by anti-HEV serology in a cohort of 201 patients with GBS and 201 healthy controls with a similar distribution in age, sex, and year of sampling. Blood samples from patients with GBS were obtained in the acute phase before treatment. In a subgroup of patients with GBS, blood, stool, and CSF samples were tested for HEV RNA.
  
  
  RESULTS
  An increased ratio of anti-HEV immunoglobulin (Ig) M antibodies was found in 10 patients with GBS (5.0%) compared with 1 healthy control (0.5%, odds ratio 10.5, 95% confidence interval 1.3-82.6, p = 0.026). HEV RNA was detected in blood from 3 of these patients and additionally in feces from 1 patient. Seventy percent of anti-HEV IgM-positive patients had mildly increased liver function tests. All CSF samples tested negative for HEV RNA. The presence of anti-HEV IgM in patients with GBS was not related to age, sex, disease severity, or clinical outcome after 6 months.
  
  
  CONCLUSIONS
  In the Netherlands, 5% of patients with GBS have an associated acute HEV infection. Further research is required to determine whether HEV infections also precede GBS in other geographical areas.
authors.affiliation: From the Departments of Neurology (B.v.d.B., B.C.J.), Viroscience (A.A.v.d.E., S.D.P.), and Immunology (A.P.T.-G., B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Cornwall Gastrointestinal Unit (J.G.H., R.G.M., H.R.D.), Royal Cornwall Hospital Trust, Truro; and European Centre for the Environment and Human Health (J.G.H., R.G.M., H.R.D.), University of Exeter Medical School, Truro, UK.
authors.forename: Bianca
authors.initials: B
authors.lastname: van den Berg
authors.forename: Annemiek A
authors.initials: AA
authors.lastname: van der Eijk
authors.forename: Suzan D
authors.initials: SD
authors.lastname: Pas
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Richie G
authors.initials: RG
authors.lastname: Madden
authors.forename: Anne P
authors.initials: AP
authors.lastname: Tio-Gillen
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: Bart C
authors.initials: BC
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005243:Feces / Q000821:virology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006508:Hepatitis Antibodies / Q000276:immunology*; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D012367:RNA, Viral / Q000032:analysis* / Q000134:cerebrospinal fluid
chemical_list: D006508:Hepatitis Antibodies; D007075:Immunoglobulin M; D012367:RNA, Viral