Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus-Associated Guillain-Barré Syndrome.
OBJECTIVE
Hepatitis E virus (HEV) recently has been shown to be an antecedent infection in Guillain-Barré syndrome (GBS), but the clinical spectrum of HEV-associated GBS is not yet documented, and diagnosing acute HEV infection can be a challenge.


OBJECTIVE
To determine the prevalence of HEV-associated GBS in a Belgian cohort, study the clinical spectrum of HEV-associated GBS, and discuss difficulties in diagnosing acute HEV infection.


METHODS
This single-center, retrospective cohort study was conducted between January 1, 2007, and November 1, 2015. All patients with GBS or a GBS variant who presented to the adult neurology department of the University Hospital Leuven were identified via a search of the electronic medical records. Hepatitis E virus IgM and IgG reactivity was determined. In a subgroup, polymerase chain reaction for HEV was performed.


METHODS
Hepatitis E virus IgM and IgG reactivity.


RESULTS
Of 73 eligible patients (mean [SD] age, 52 [18] years; 29 females and 44 males), 6 (8%) showed positive reactivity on IgM assays for HEV, indicating a possible acute HEV infection. Four of the 6 patients (67%) had increased alanine aminotransferase levels of more than 1.5 times the upper limit of normal, while 4 of 22 patients (18%) with increased alanine aminotransferase levels showed positive reactivity on HEV IgM assays. Serum samples of 2 of 6 patients with positive reactivity on HEV IgM assays also revealed positive test results for cytomegalovirus or Epstein-Barr virus, indicating possible cross-reactivity. Thus, 4 patients (6%) in our cohort had probable acute HEV infection. Two of these patients presented with an infrequent GBS variant.


CONCLUSIONS
Acute HEV infection was frequently associated with GBS in our cohort. Abnormal alanine aminotransferase levels at admission can indicate the presence of an associated HEV infection. When HEV testing is considered, it is important to test for other infectious agents in parallel, as cross-reactivity can occur. Further studies are required to guide neurologists in their workup of underlying triggers of GBS.
Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
Olivier
O
Stevens
Department of Neurology, University Hospitals Leuven, Leuven, Belgium2Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium.
Kristl G
KG
Claeys
Laboratory for Molecular Neurobiomarker Research, KU Leuven, Leuven, Belgium4 Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
Koen
K
Poesen
Laboratory for Molecular Neurobiomarker Research, KU Leuven, Leuven, Belgium4 Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
Veroniek
V
Saegeman
Department of Neurology, University Hospitals Leuven, Leuven, Belgium2Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium5VIB, Vesalius Research Center, Leuven, Belgium.
Philip
P
Van Damme
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000209:etiology* / Q000821:virology; D016751:Hepatitis E / Q000097:blood / Q000150:complications* / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged
D007075:Immunoglobulin M; D000410:Alanine Transaminase