anti-HEV IgM Research Articles

Sero-prevalence and risk factors for hepatitis E virus infection among pregnant women in the Cape Coast Metropolis, Ghana.

BackgroundHepatitis E virus is an emerging infection in Africa with poor maternal and foetal outcomes. There is scanty data on the sero-prevalence of HEV infection among pregnant women in Ghana. This study highlighted the prevalence and risk factors associated with HEV infection among pregnant women in Cape Coast Metropolis, Central Region of Ghana.MethodsA multicenter (3 selected sites) analytical cross sectional study involving 398 pregnant women in the Cape Coast metropolis was conducted. HEV (Anti-HEV IgG and Anti-HEV IgM) ELISA was performed. Sero-positive women had liver chemistries done and data collected on maternal and neonatal outcomes. Data analyses were performed using Stata version 13 software (STATA Corp, Texas USA).ResultsMean age was 28.01 (± 5.93) years. HEV sero-prevalence was 12.2% (n = 48) for IgG and 0.2% (n = 1) for IgM with overall of 12.3%. The odds of being HEV sero-positive for women aged 26–35 years was 3.1 (95% CI: 1.1–8.1), p = 0.02 and ≥36 years it was 10.7 (95% CI; 3.4–33.5), p = 0.0001. Living in urban settlement was associated with lowest odds of HEV infection {OR 0.4 (95% CI; 0.2–0.8), p = 0.01}. Factors with no statistical evidence of association include main source of drinking water and history of blood transfusion. The sero-prevalence of HEV IgG increased progressively across trimesters with the highest among women in their third trimester (55.3%). None of the 49 HEV sero-positive women had elevated ALT level. Ten (N = 41) of the neonates born to sero-positive women developed jaundice in the neonatal period. The mean birth weight was 3.1kg (SD 0.4).ConclusionHEV sero-prevalence among pregnant women in the Cape Coast Metropolis is high enough to deserve more attention than it has received so far. It is therefore important to conduct further research on the potential impact on maternal and neonatal mortality and morbidity in Ghana.

Guillain-Barre syndrome caused by hepatitis E infection: case report and literature review

BackgroundHepatitis E infection is a global disorder that causes substantial morbidity. Numerous neurologic illnesses, including Guillain–Barre syndrome (GBS), have occurred in patients with hepatitis E virus (HEV) infection.Case presentationWe report a 58 year-old non-immunocompromised man who presented with progressive muscle weakness in all extremities during an episode of acute HEV infection, which was confirmed by measuring the anti-HEV IgM antibodies in the serum. Both cerebrospinal fluid examination and electrophysiological study were in agreement with the diagnosis of HEV-associated GBS. Following the treatment with intravenous immunoglobulin, the patient’s neurological condition improved rapidly.ConclusionsHEV infection should be strongly considered in patients with neurological symptoms, especially those with elevated levels of liver enzymes.

Prevalence, risk factors and molecular evaluation of hepatitis E virus infection among pregnant women resident in the northern shores of Persian Gulf, Iran.

BackgroundAlthough Iran is reported to be an endemic country for hepatitis E virus (HEV), data on the prevalence of HEV infection among pregnant women are scarce and the epidemiology of HEV is unknown in most parts of the country. Therefore, this study was conducted to elucidate the prevalence, risk factors and genotypic pattern of HEV infection among pregnant women resident in the northern shores of Persian Gulf. This is the first report on the epidemiology of HEV infection among pregnant women in this territory.MethodsFrom October 2016 to May 2017, 1331 pregnant women participated in this study. The mean age ± SD of participants was 27.93±5.7 years with a range of 14–45 years. Serum samples of pregnant women were screened for the presence of anti-HEV total antibodies, anti-HEV IgG and anti-HEV IgM using commercially available ELISA kits (DIA.PRO, Milan, Italy). All anti-HEV IgG and anti-HEV IgM positive samples were tested for HEV RNA using two independent reverse transcriptase polymerase chain reaction (RT-PCR) assays, targeting ORF2 and ORF3 of HEV genome. In addition, 92 anti-HEV seronegative samples as well as 50 pooled seronegative samples were evaluated by two independent RT-PCR assays for validation of results.ResultsOf the 1331 pregnant women, 84 women (6.3%, 95% CI: 5.1%-7.7%) were positive for anti-HEV antibodies, of which 83 women had anti-HEV IgG, and 11 women (0.83%, 95% CI: 0.47%-1.47%) had anti-HEV IgM. The highest rate of HEV seroprevalence was observed among Afghan immigrants (68.0%), uneducated pregnant women (46.51%) and those residents in Bushehr city (8.75%). All anti-HEV IgG and/or IgM positive samples were found to be negative for HEV RNA. In addition, all of the evaluated anti-HEV seronegative samples were negative for HEV RNA. HEV seropositivity among pregnant women was statistically associated with age, ethnicity, place of residence, number of pregnancies, and level of education. So that, low education levels, Afghan, residence in Bushehr city, age group >34 years, and more parities were risk factors for exposure to HEV. In contrast, HEV seropositivity was not associated with stage of gestation, history of abortion, and time of sampling.ConclusionThe northern shores of Persian Gulf in Iran, with HEV seroprevalence of 6.3%, can be classified as an endemic geographical region for hepatitis E, and residents of Bushehr city, Afghan immigrants and uneducated women are the main at-risk populations in this territory.

A Special Risk Group for Hepatitis E Infection: The First Record of North Cyprus.

Hepatitis E virus (HEV) is transmitted by a fecal oral route from animals to humans following exposure to the body fluids of infected animals. We investigated the seroprevalence of anti-hepatitis E (anti-HEV) antibodies by monitoring IgG and IgM virus antibodies amongst employees in the animal industry in North Cyprus through a cross-sectional study. Samples were taken from individuals without occupational exposure to animals and from those who worked with animals (doing animal husbandry, veterinary work or butchery). Enzyme-linked immunoassays were used to detect anti-HEV IgG and IgM in the blood samples. The prevalence of anti-HEV IgG antibodies was 3.0% (12/400), while the prevalence of anti-HEV IgM antibodies was 0.25% (1/400). The prevalence of anti-HEV IgG amongst the samples received from females was approximately 2.5-fold higher than samples received from males (2.4%). Anti-HEV IgG was detected amongst 7% of animal husbandry workers and amongst 2% of veterinarians and butchers. The current findings represent the first records of HEV surveillance in Cyprus. We investigated the seroprevalence of anti-HEV by monitoring IgG and IgM virus antibodies amongst employees.

Hepatitis E Virus Genotype 1 and Hepatitis A Virus Dual Infection in Pediatric Patients with a Low Socioeconomic Status from Mexico

Objective: We aimed to detect and characterize hepatitis E virus (HEV) RNA in sera samples from a pediatric population infected with the hepatitis A virus (HAV) exhibiting acute hepatitis and to correlate the infection status with the clinical outcome. Methods: Seventy-five ELISA-positive samples from children containing anti-HAV and anti-HEV IgM were used to amplify and characterize partial regions within HEV ORF2. A statistical comparison of clinical data between HEV IgM-positive/HEV RNA-positive patients and HEV IgM-positive/HEV RNA-negative patients was performed. Results: Thirteen out of 75 IgM-positive samples provided amplification of discrete regions of the HEV genome. Nested RT-PCR-based detection and subsequent sequencing of 5 samples confirmed the identity of HEV genotype 1 (G1), which had not been previously reported in Mexico. Though not significant, a trend towards exacerbated clinical manifestations was found in HEV RNA-positive patients relative to HEV RNA-negative patients. Conclusions: An elevated rate of G1 RNA was detected. Hepatitis E seems to be a neglected disease in Mexico and epidemic strains of HEV are likely to play a role as causative agents of acute hepatitis in highly exposed children. Although HAV is endemic in Mexico, an HEV-RNA detection rate of 17% in co-infected samples shows the need for screening for HEV as a part of future vaccination strategies.

Hepatitis E Virus Infection in Acute Non-Traumatic Neuropathy: A Large Prospective Case-Control Study in China

Neurological manifestations are potently associated with hepatitis E virus (HEV) infection in Europe, mainly attributed to genotype (G) 3 HEV infection. We determined the frequency and causal relationship of HEV in patients with non-traumatic neurological disorders in China, where G4 HEV is prevalent. Consecutive patients diagnosed with neurological illnesses and individuals visiting the physical examination center in a hospital of eastern China were tested for HEV by serology and molecular method. 1117 patients and 1475 healthy controls were enrolled. Anti-HEV IgM antibodies were detectable in 6 (0.54%) of the patients and 10 (0.68%) of the healthy controls (P = 0.651). Serum HEV RNA was detected in all of the 16 individuals. The six patients with positive anti-HEV IgM included two viral encephalitis, two posterior circulation ischemia, one peripheral neuropathy and one Guillian-Barre syndrome. They had no symptoms of acute viral hepatitis except two patients of viral encephalitis had mildly transaminitis. Additional, 39.51% patients and 35.63% controls without acute HEV infection were anti-HEV IgG positive (P = 0.144). Anti-HEV IgG positivity was more frequent in male and elderly in both the patients and control groups, but unrelated to the incidence of any non-traumatic neurological illness, hospital stay or treatment outcome, except linking to better outcome of hemorrhagic stroke disease. These data demonstrate that HEV appears not to contribute to acute neurological disorders in China. Nevertheless, we cannot exclude a possible causative role, suggesting that testing for HEV in this population, especially in situations of unexplained deregulated liver function would be warranted. Funding Statement: This study was supported by National Natural Science Foundation of China (No. 31770186) (to Y. Wang) Declaration of Interests: The authors have declared that no competing interests exist. Ethics Approval Statement: The standard protocol, ethical approvals and registrations of this study were approved by an ethical standards committee of The First People's Hospital of Yancheng City and all patients gave informed consent that allowed future testing of archived bio-samples.

A case of hepatic encephalopathy in an young female due to acute hepatitis e followed by complete recovery: A rare case report

Hepatic encephalopathy is a fatal complication of both chronic liver disease and acute hepatocellular failure. Usually, in such cases, the disease has a rapid progression and fatal prognosis. We report a young female who was admitted in Medical College, Kolkata, India, in 2016 with clinical and biochemical evidence of encephalopathy and coagulopathy (hyperacute liver failure) following an acute hepatitis-like illness. Blood for hepatitis B surface antigen, anti-hepatitis C virus, IgM-hepatitis A virus, and IgM anti-Leptospira all were negative, but anti-hepatitis E virus (HEV) IgM came out to be positive (titer of 6.8 U/ml; whereas 1.1 – positive). IgM anti-HEV was tested using commercially available ELISA kits (Genelabs) using sandwich ELISA technique. The patient was aggressively managed with intravenous fluid, antibiotics, lactulose syrup and enema, and transfusion of fresh frozen plasma along with strict monitoring for other vital organ damage. Symptoms of encephalopathy completely reversed within 5–6 days, and prothrombin time and liver enzymes were normalized gradually. Although acute liver failure with high mortality is common in acute hepatitis E in pregnancy, here, in our case, it happened to a young nonpregnant female followed by complete recovery.

A nationwide serosurvey of hepatitis E virus antibodies in the general population of Portugal.

Evidence has shown that Hepatitis E virus (HEV) genotype 3 is autochthonous in industrialized countries due to zoonotic transmission through direct contact or consumption of raw or undercooked meat from domestic swine or wild boar. As there is lack of data on seroprevalence of HEV in the general Portuguese population, a wide survey was conducted as part of the HEPeCONTROL project (60DT2), under EEA grants funding. Sera from a representative sample of the Portuguese population (n = 1656) at different geographic locations (30 territorial units), and age (0-99 years) were collected between July 2015 and February 2016. The sera were tested for the presence of anti-HEV IgG and IgM by EIA using one of the two most commonly used commercial immunoassays in Europe. The overall HEV IgG seroprevalence was found to be 16.3% increasing with age (P < 0.05) from 0.6% in the 0-9 years group to 30.1% in people older than 70 years. The seroprevalence also varied geographically with generally higher seropositivities (25-30%) in the most rural areas of Portugal. However, the geographical differences were not statistically significant (P > 0.05). Out of 1656 samples, 8 were positive for anti-HEV IgM indicating current of recent HEV infection but no significant differences were found concerning age groups, regions and sex. The present nation-wide survey provides insight in the epidemiology of HEV in Portugal and confirms that HEV is endemic in the Portuguese population.

Hepatitis E virus (HEV): seroprevalence and HEV RNA detection in subjects attending a sexually transmitted infection clinic in Brussels, Belgium.

Men who have sex with men (MSM) have an increased incidence of pathogens transmitted by the oro-fecal route. Hepatitis E virus (HEV) is an emerging cause of acute hepatitis and fecal shedding is observed during primary infection. We investigated whether MSM are at increased risk of HEV infection. Subjects who attended a sexually transmitted infection clinic in Brussels and had an HIV test performed between 1 June 2014 and 15 January 2016 were identified. A total of 576 samples were retrospectively screened for both total HEV IgG and HEV RNA. Samples positive for IgG were tested for IgM. MSM proportion was 31·1% (179/576). Overall HEV IgG prevalence was 9·03% (52/576) and was identical in MSM and heterosexual subjects. Among the IgG positive samples, 2/52 (3·84%) samples (both women) were positive for anti-HEV IgM. No sample was positive for HEV RNA. Age over 35 was the only risk factor significantly associated with HEV seropositivity (OR 2·07; 95% CI 1·16-3·67). In conclusion, MSM were not found to have an increased prevalence of HEV as previously reported in other European countries suggesting distinct dynamics of HEV infection in this group across Europe and increased age was associated with a higher risk of seropositivity.

Serological and molecular markers of hepatitis E virus infection in HIV-infected patients in Brazil.

In Brazil, the circulation of hepatitis E virus (HEV) has been demonstrated in distinct groups of individuals and some animals, but its prevalence among individuals with human immunodeficiency virus (HIV) infection is unknown. This study aimed to assess the frequency of serological and molecular HEV markers in individuals infected with HIV from São Paulo, Brazil. Serum and plasma samples of 354 HIV-infected patients collected between 2007 and 2013 were included. All samples were tested for anti-HEVIgG and IgM antibodies and HEV RNA. Anti-HEV IgG and IgM antibodies were detected in 10.7% (38/354) and 1.4% (5/354) of the samples, respectively. Both antibodies were detected simultaneously in only two samples. HEV RNA was not detected in any sample. There was no significant correlation of anti-HEV serological status (positivity to anti-HEV IgG and/or IgM) with sex, age, CD4+ T cell count, HIV viral load, antiretroviral therapy, liver enzyme levels, or coinfection with hepatitis B virus and/or hepatitis C virus. Our study provides serological evidence of past and recent HEV infections in HIV-infected patients from São Paulo, Brazil. However, the occurrence of ongoing HEV infection appears be a rare event in this population.

Seroprevalence of Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV) Co-infection in the Patients Presenting with Acute Viral Hepatitis Attending a Tertiary Care Hospital in North India

Introduction: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are both transmitted enterically, resulting in acute viral hepatitis (AVH) in developing countries like India. HAV has a world-wide distribution and affects infants and young children in developing countries, and its epidemics are not very common. HEV is restricted to tropical countries and affects older children and young adults, and its epidemics are common. Co-infection with both viruses may lead to serious complications. Aim: This study was done to determine prevalence of HAV and HEV in patients presenting with AVH and the co-infection of HAV and HEV in these patients. Materials and Methods: A cross-sectional study of one year’s duration was conducted in the Department of Microbiology, Dr. Ram Manohar Lohia Hospital, New Delhi. 1230 patients presenting with AVH were considered in the study. Serum samples were analyzed for IgM anti-HAV and IgM anti-HEV for the detection of HAV and HEV infection, respectively, using commercially available ELISA kits. Results: The seroprevalence of HAV- and HEV-positive patients was 15.5% and 27.2%, respectively. The seroprevalence of both HAV and HEV in patients with acute viral hepatitis was 5.1%. The prevalence of HAV and HEV among males (14.6% and 29.8%) was higher than in females (16.6% and 23.4%). These infections were predominantly seen during end of monsoons and beginning of winter. Conclusion: The prevalence of HEV is much higher than that of HAV; co-infection rate of 5.1% mandates the screening for HEV which will be of immense importance in pregnant women and improving levels of personal hygiene among lower socio-economic population.

The serological markers of acute infection with hepatitis A, B, C, D, E and G viruses revisited.

Viral hepatitis is a liver infection caused by one of the six hepatitis viruses: hepatitis A, B, C, D, E, and G virus (HAV to HEV and HGV). These agents differ in their biological, immunological, pathological and epidemiological characteristics. They cause infections that, when symptomatic, lead to clinical manifestations and laboratory findings that are not specific to a particular virus, often making differential diagnosis difficult, especially when no knowledge is available regarding the patient's medical history or the epidemiological background. A number of acute-phase serological markers, such as anti-HAV, anti-HBc, anti-HDV and anti-HEV IgM antibodies, are able to provide a clear indication of an infection caused by HAV, HBV, HDV or HEV. Anti-HCV antibodies and HGV/RNA are used for the diagnosis of HCV and HGV infections. The importance of each of these markers will be reviewed, and different factors that can interfere with the diagnosis of acute infections caused by these viruses will be described.

Hepatitis E virus as a cause of acute hepatitis acquired in Switzerland.

Autochthonous hepatitis E is increasingly recognized as zoonotic infection in western countries. Serological assays have varying sensitivity and specificity. We implemented molecular testing to identify and characterize acute hepatitis E acquired in Switzerland. Ninety-three cases of mostly symptomatic acute hepatitis E acquired in Switzerland were documented by PCR between November 2011 and December 2016. Median HEV RNA was 7.5x104 IU/mL (range, 5.3 to 4.7x107 IU/mL). HEV genotyping was successful in 78 patients, revealing genotype 3 in 75 and genotype 4 in three patients. Phylogenetic analyses revealed a few limited geographical and temporal clusters. Of the 91 patients with available anti-HEV IgM serology, four were negative; three of these were also IgG-negative, likely as a result of immunosuppression, and one was IgG-positive, a constellation compatible with HEV reinfection. Median age of the patients was 58years (range, 20-80years); 71 (76.3%) were men and 49 of these (69.0%) were ≥50years old. The clinical course was particularly severe in patients with underlying chronic liver disease, with fatal outcome in two patients. Six patients (6.5%) presented with neuralgic amyotrophy. Nucleic acid-based diagnosis reveals HEV as a relevant cause of acute hepatitis in Switzerland. Middle-aged and elderly men constitute the majority of symptomatic patients. Testing for HEV should be included early in the diagnostic workup of acute hepatitis and of neuralgic amyotrophy, a typical extrahepatic manifestation of HEV genotype 3 infection.

Hepatitis E seroprevalence and associated factors in rural settlers in Central Brazil.

Prevalence of hepatitis E virus (HEV) infection and associated factors were investigated in rural settlements in Central Brazil. A total of 464 settlers were interviewed, and serum samples were tested for anti-HEV IgG/IgM. Positive samples were tested for HEV RNA. Sixteen participants (3.4%; 95% CI 2.0-5.7) were positive for anti-HEV IgG. None was positive for anti-HEV IgM. HEV RNA was not detected. Dwelling in a rural settlement for >5 years was associated with HEV seropositivity. The results revealed the absence of acute infection and a low prevalence of previous exposure to HEV.

Hepatitis E virus infection as a promoting factor for hepatocellular carcinoma in Cameroon: Preliminary Observations

ObjectivesTo determine the seroprevalence of hepatitis E virus (HEV) infection in patients with chronic hepatitis and/or hepatocellular carcinoma (HCC) and to assess its potential consequences for disease progression. MethodsWe conducted a prospective case-control study on patients with HCC hepatitis B or C related and non-HCC patients including patients with CLD and patients without clinical evidence of liver disease. Anti-HEV IgG and IgM were tested by ELISA using commercially available kits. Liver damage was assessed by alanine aminotransferase, aspartate aminotransferase, platelets and prothrombin measurements. ResultsWe observed a significant anti-HEV IgG carriage in HCC patients compared to non-HCC subjects with CLD (41.8% vs 12.6%; P=9.1 E-6; OR=4.8, 95%CI: 2.3-10.6). HCC patients with HEV infection display more profound alterations of circulating liver enzymes, platelets count and prothrombin time than HCC patients without sero-reactivity to HEV. ConclusionOverall, this study indicates a high prevalence of HEV infection in Cameroonian patients with CLD and HCC. These data suggest either that patients with liver tumors are more susceptible to hepeviral infection or that, in a tropical context, HEV might promote the progression of liver diseases towards tumor.

Risk Factors Associated with Blood Exposure for Sporadic Hepatitis E in Dhaka, Bangladesh.

.Fecal contamination of drinking water is associated with large hepatitis E virus (HEV) outbreaks of genotypes 1 and 2 in endemic areas. Sporadic transmission of HEV genotypes 3 and 4 in high-income countries has been associated with exposure to blood and animal contact. The objective of the study was to identify the risk factors for hepatitis E and the genotype(s) causing sporadic hepatitis E in Dhaka, Bangladesh. We selected, from a diagnostic center in Dhaka between November 2008 and November 2009, cases presenting with jaundice and anti-HEV IgM antibodies and age-matched controls were defined as those with no history of jaundice and normal blood test results. Serum samples were tested for HEV RNA using real-time reverse transcriptase polymerase chain reaction followed by a sequencing and phylogenetic analysis. A total of 109 cases and 109 controls were enrolled. The cases were more likely to be male (adjusted matched odds ratios [mOR] 2.2, 95% CI: 1.2–3.9; P = 0.01), or have reported contact with another person’s blood or blood product, or contact with blood-contaminated sharp instruments (adjusted mOR 2.1, 95% CI: 1.1–4.1; P = 0.03) than controls. There were no significant differences between the cases and the controls in terms of reported high-risk sexual intercourse, consumption of undercooked meat, or contact or drinking fecally-contaminated water. The sera from three cases carried HEV RNA, all belonging to genotype 1. Findings from this study suggest that contact with human blood and sharing sharp instruments may transmit sporadic hepatitis E in Dhaka, Bangladesh. Efforts to prevent the transmission of blood-borne pathogens may also prevent sporadic HEV transmission in this endemic setting.

A cross-sectional study among Polish hunters: seroprevalence of hepatitis E and the analysis of factors contributing to HEV infections

Hepatitis E virus (HEV) is known as zoonotic agent. The main reservoirs of HEV in Europe are pigs, wild boars, and deer. Hunting activity is considered to be a risk factor for HEV infection. We conducted a cross-sectional study among 1021 Polish hunters. To understand socio-demographic characteristics of this population and to gather information on potential exposures, all participants completed a questionnaire. Commercial immunoassays were employed to estimate seroprevalence anti-HEV. Samples with confirmed positive result of anti-HEV IgM were examined for HEV RNA. Anti-HEV IgG were identified in 227 people, 22.2% of the studied group. Seroprevalence among the studied hunters was associated with age ≥65 [adjusted prevalence ratio (aPR) 1.6, p = 0.037), living in a house (aPR 1.54, p = 0.013), professional contact with farm animals (aPR 1.09, p = 0.01), and consumption of stewed offal (aPR 1.61, p = 0.00). Washing hands after disembowelment was linked to lower seroprevalence (aPR 0.53; p = 0.00). Lower prevalence of anti-HEV IgG among hunters living in cities was associated with age: 35–49 (aPR 0.52, p = 0.011) and 50–64 (aPR 0.93, p = 0.58), living in a house (aPR 1.58, p = 0.002) and owning a cat (aPR 0.58, p = 0.042). Among hunters living in rural areas, seropositivity was associated with contact with farm animals (aPR 1.66, p = 0.013) and consumption of stewed offal (aPR 1.81; p = 0.001). Contrary to initial assumptions, it was concluded that hunting was of significantly lesser importance than other factors. Due to the high level of HEV seroprevalence identified, we recommend conducting a large-scale study in the general population of Poland.

Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy.

To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all genotype 3). Fifty-one of 57 HEV-NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12-2,961 IU/L); in 6 cases, liver function tests were normal. HEV-NA cases were more likely to have bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between the 2 groups at 12 months. Patients with HEV-NA are usually anicteric and have a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Involvement outside the brachial plexus is more common in HEV-NA. The relationship between HEV and NA is likely to be causal, but is easily overlooked. Patients presenting with NA should be tested for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV-NA are warranted.

Hepatitis A and E seropositivity and nucleic acid detection among chemical bombardment survivors in Iraqi Kurdistan Region

The current study was carried out to determine the percentage rates of anti-hepatitis A and E (HAV and HEV) IgG and IgM seropositivity and RNA among chemical bombarded survivors in different regions in Iraqi Kurdistan. Blood samples were collected randomly from 92 chemical bombed exposures and 45 non-exposures -controls- from July to November 2013. ELISA and conventional, nested PCR techniques were followed todetect anti-hepatitis A and E IgG, IgM and RNA respectively. Lymphocyte counting also was done for all tested exposures and controls. It was observed that the percentage rates of hepatitis A seropositivity were higher than hepatitis E. All tested exposures (100%) were seropositive for anti- HAV IgG, whereas 61.79% were positive for anti-HEV IgG. Similarly, anti-HAV IgM seropositivity was higher (8.9%) than that of anti- HEV (1.089%). Current results revealed that there were significant differences between exposures and controls regarding anti-HAV and anti-HEV IgG (p= 0.0001 and 0.0002),whereas no significant differences were observed between the two tested groups concerning anti-HAV and anti-HEV IgM seropositivity (p= 0.621 and 0.56). Moreover, significant differences were found among anti-HAV IgG and IgM as well as anti-HEV IgG and IgM seropositivity among exposures themselves (p= 0.000 and 0.0055) respectively. The percentage rate of hepatitis A RNA positivity was 15.68%, whereas no positive results were seen for HEV. Geographical distribution of exposures was appeared to be significantly effective on all obtained results (seropositivity and RNA detection) (p ‹ 0.05). It was noticed that lymphocytes were significantly different between HAV- seropositive and seronegative exposures (p ‹ 0.05). A high percentage rate of exposures with positive results for anti-HAV, anti-HEV, and PCR positive results, were suffering from lymphopenia. The highest lymphocyte abnormalities were among exposures with anti-HAV IgM followed by anti-HAV IgG then anti-HEV IgG seropositive exposures.

Etiological characterizations of sporadic viral hepatitis in north east part of Bangladesh

These retrospective study was done to see common viral etiology of sporadic acute viral hepatitis in North East Part of Bangladesh. Consecutive patients attending in private chambers with acute or recent onset of jaundice with biochemical evidence of hepatocellular injury from January 2011 to December 2013 were enrolled. Epidemiological features and reports of viral markers i.e. HBsAg, Anti-HBc IgM, anti-HAV-IgM, Anti-HEV IgM, and Anti-HCV were retrieved. Data of 256 cases (male 195 and female 61, age ranging from 6 years to 89 years with mean 29.44 years were analyzed. Both HBsAg and anti-HBc-IgM were found positive in 98 (38.67%) cases (male 77 and female 21). Of them 39 were in 16-25 years age group. Anti-HAV IgM was found positive in 41 (16%) cases (male 30, female 11) and 27 of them were in the less than 16 years group. Anti HEV IgM was positive in 116 (45.31%) cases (male 87 and female 29). Majority (85 cases ) of HEV infection was found in 16 to 40 years age group. In this study HEV is the most frequent agent for acute sporadic viral hepatitis among adults followed by HBV. HAV is more prevalent cause of sporadic acute viral hepatitis among children.Bangladesh Med J. 2016 Sep; 45 (3): 138-140