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Guillain-Barre syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review.

ABSTRACT: Hepatitis E is a serious public health problem in developing countries. Most of the patients with Hepatitis E virus (HEV) infection present with typical acute hepatitis symptoms. However, in few patients it may lead to complications such as liver failure and extrahepatic symptoms. One of the rare extrahepatic presentations of this infection is neurological complications such as Guillain-Barré syndrome (GBS) which is observed in 5.5% of HEV infected patients (mainly in developed countries). Moreover, only genotype (gt) 3 HEV was found in association with GBS among patients in developed countries whereas molecular characterisation of HEV cases detected from developing countries have not been reported till now. Here, we are reporting a case of GBS as an extrahepatic complication of HEV associated with gt1 identified by molecular characterization by performing PCR of open-reading frame 2 (ORF2) region of HEV. Phylogenetic analysis by maximum likelihood method revealed that HEV gt1 case reported in this paper rooted closely with other HEV gt1 samples from South-Asian countries with high bootstrap values indicative of fully resolved tree.

SUBMITTER: Choudhary MC

PROVIDER: S-EPMC6409121 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review.

Choudhary Manish Chandra MC Bajpai Vijeta V Anand Lovkesh L Gupta Ekta E

Intractable & rare diseases research 20190201 1

Hepatitis E is a serious public health problem in developing countries. Most of the patients with Hepatitis E virus (HEV) infection present with typical acute hepatitis symptoms. However, in few patients it may lead to complications such as liver failure and extrahepatic symptoms. One of the rare extrahepatic presentations of this infection is neurological complications such as Guillain-Barré syndrome (GBS) which is observed in 5.5% of HEV infected patients (mainly in developed countries). Moreo ...[more]

PMID: 30881857

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Project description:BackgroundMalaria is an infectious disease caused by Plasmodium parasites, transmitted to humans by infected female Anopheles mosquitoes. Five Plasmodium species infect humans: P. vivax, P. falciparum, P. ovale, P. malariae, and P. knowlesi. Guillain-Barré Syndrome (GBS) is an inflammatory condition that can lead to paralysis, autonomic dysfunction, respiratory failure, and sensory symptoms. GBS typically follows an infection with Campylobacter bacteria, commonly found in undercooked poultry, but is rarely associated with malaria.Clinical presentationA 16-year-old female patient presented to our emergency department with a 1-day history of altered mentation. She had experienced a severe global headache and fever for 3 days prior to presentation. The patient tested positive for falciparum malaria and was admitted to the ward, where she received IV artesunate and other supportive management. After 3 days of admission, she noticed weakness and numbness in her lower extremities. Subsequently, the weakness progressed upward to involve her upper extremities. After extensive workup, the patient was managed with consideration of Guillain-Barré Syndrome (GBS), and she made a complete recovery after 12 weeks.DiscussionGuillain-Barré Syndrome (GBS) is an acute paralytic illness often triggered by infections, particularly viral ones. It is the leading cause of sudden muscle weakness, typically following respiratory or gastrointestinal infections, with Campylobacter jejuni being the most common cause. This patient's neurological symptoms pointed to paralysis of the lower motor neurons. Guillain-Barré Syndrome is also suggested by elevated protein levels and a lack of cells in the cerebrospinal fluid. This clinical picture emerged following a Plasmodium falciparum infection. Although the specific subtype (demyelinating or axonal) was not determined in this case due to the absence of a nerve conduction study, demyelinating subtypes have been found in GBS following Plasmodium infection.ConclusionIn conclusion, while malaria is an exceptionally rare cause of Guillain-Barré Syndrome (GBS), it should be considered in patients with recent malaria infection who present with symptoms of lower motor neuron lesions.

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Guillain-Barre syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review.

Publications

Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review.

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