Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E

Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection

Clinical phenotype and outcome of hepatitis E virus associated neuralgic amyotrophy; an international retrospective comparative cohort study

International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Amsterdam, NETHERLANDS, APR 19-23, 2017International audienc

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

Item does not contain fulltextOBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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

4303020001 Основы медицинских знаний 2015

This practical manual, written by well-known experts, reviews current indications for the use of IgG concentrates and some other modern immunomodulators and provides fundamental information on present-day immunomodulation in patients (and mice). The book opens by tracing the transition from IgG substitution to IgG immunomodulation and providing expert updates on immunomodulatory indications in autoimmune and inflammatory disorders, including hematologic, neurologic, dermatologic, and other diseases. Basic aspects of IgG concentrates, including methods of production, safety, currently available products, and mechanisms of action, are then discussed. An entire chapter is devoted to the different aspects of immunomodulatory IgG treatment in the bleeding disorder immune thrombocytopenia (ITP). Finally, the transition from polyclonal to monoclonal antibody (mAb) treatment is addressed in detail, covering mAb development, methods, mechanisms of action, adverse effects, and more. Particular attention is paid to the example of anti-CD20 (B-cell) antibody