Hepatitis E and Guillain-Barré Syndrome

Extract

To the Editor—Hepatitis E virus (HEV) infection is the most common cause of acute hepatitis worldwide. Whereas in developed countries it usually presents as a self-limiting disease caused by genotype 3, genotype 1 and 2 infections in resource-limited countries are associated with considerable morbidity and mortality [1]. Besides liver disease, neurologic manifestations may occur, such as Guillain-Barré syndrome (GBS) and brachial neuritis [2]. GBS is the most common cause of acute neuromuscular paralysis in countries where poliomyelitis has been eliminated [3]. GBS patients frequently report preceding gastrointestinal or respiratory illnesses, such as those caused by Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae [4], but in many developing countries antecedent infections have not been investigated. Recent reports on the global burden of HEV infection prompted us to perform a case-control study among GBS patients in Bangladesh, where both HEV genotype 1 infection and GBS are commonly diagnosed [3, 5].

A prospective case-control study was conducted between July 2006 and June 2007 enrolling 100 consecutive GBS cases from Dhaka Medical College Hospital, Bangabandhu Sheikh Mujib Medical University, and Dhaka Central Hospital in Dhaka, Bangladesh. Two controls per case were recruited: one among the family members of the patient living in the same household (family control [FC]); and one was an age-, sex-, and day-matched patient hospitalized in the same ward with another neurologic disease not related to recent infections (other neurological disease control [ONDC]). Written informed consent was obtained from all patients and controls. The project protocol was reviewed and approved by the institutional review board and the ethical committees at Dhaka Medical College and Hospital, Bangladesh.