Hepatitis E virus as a trigger for Guillain-Barr\xe9 syndrome

Miriam Fritz-Weltin,Marcus Panning,Benedikt Csernalabics,Nora Isenmann,Dominique Endres,Lisa Niedermeier,Benjamin Berger,Tobias Boettler,Estelle Frommherz,Christoph Neumann-Haefelin

doi:10.1186/s12883-021-02334-1

Miriam Fritz-Weltin, Marcus Panning + Show 8 more

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https://doi.org/10.1186/s12883-021-02334-1

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Abstract

BackgroundHepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. An association with neuralgic amyotrophy and Guillain-Barré syndrome (GBS) was previously described. Concerning GBS, studies from other countries found an acute HEV infection in 5–11% of cases. However, HEV prevalence shows considerable regional variations. Therefore, we retrospectively analyzed the frequency of HEV infections in association with GBS in a monocentric cohort in Southwestern Germany.MethodsOverall, 163 patients with GBS treated in our clinic between 2008 and 2018 of whom serum and/or cerebrospinal fluid (CSF) samples were available, were identified. Serum samples were analyzed for anti-HEV immunoglobulin (Ig)M and IgG antibodies by ELISA. Additionally, both serum and cerebrospinal fluid (CSF) samples were tested for HEV RNA by PCR if IgM was positive or patients presented within the first 7 days from GBS symptom onset. A group of 167 healthy volunteers and 96 healthy blood donors served as controls.ResultsAn acute HEV infection was found in two GBS patients (1.2%) with anti-HEV IgM and IgG antibodies. HEV PCR in serum and CSF was negative in these two patients as well as in all other tested cases. Seroprevalences indicated that acute infection did not differ significantly from controls (0.8%). Anti-HEV IgG seroprevalence indicating previous infection was unexpectedly high (41%) and revealed an age-dependent increase to more than 50% in patients older than 60 years.ConclusionIn this study, serological evidence of an acute HEV infection in patients with GBS was rare and not different from controls. Comparing our data with previous studies, incidence rates show considerable regional variations.

Highlights

Guillain-Barré Syndrome (GBS) is an acute inflammatory disorder of the peripheral nervous system (PNS) caused by a cross-reactive immune response following viral or bacterial infections, so-called molecular mimicry
Hepatitis E virus (HEV) is the most common pathogen of acute viral hepatitis worldwide, and genotype 3 is endemic throughout European countries with an agedependent anti-HEV immunoglobulin (Ig)G seroprevalence in Germany of up to 25% in individuals older than 50 years [2]
Highest detection rates of an acute HEV infection were previously found in neuralgic amyotrophy (10– 11%), another presumably post-infectious immunemediated condition of the PNS [5,6,7,8], and in Guillain-Barré syndrome (GBS) [9]

Summary

Introduction

Guillain-Barré Syndrome (GBS) is an acute inflammatory disorder of the peripheral nervous system (PNS) caused by a cross-reactive immune response following viral or bacterial infections, so-called molecular mimicry. Highest detection rates of an acute HEV infection were previously found in neuralgic amyotrophy (10– 11%), another presumably post-infectious immunemediated condition of the PNS [5,6,7,8], and in GBS [9]. With regard to the latter, an associated acute HEV infection was found in 5–11% of cases according to four studies from the Netherlands, Belgium, Japan and Bangladesh [10,11,12,13], respectively.

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