UMR Inserm, U1043; UMR CNRS, U5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, F-31300, France; CHU Toulouse, Hôpital Purpan, Laboratoire de virologie, Centre national de référence du virus de l'hépatite E, Toulouse, F-31300 France.
CHU Toulouse, Hôpital Purpan, Département de Neurologie, Toulouse, F-31300 France.
J Infect. 2018 Sep;77(3):220-226. doi: 10.1016/j.jinf.2018.06.007. Epub 2018 Jul 10.
Hepatitis E virus (HEV) is a major cause of acute hepatitis worldwide. However, our understanding of the source of contamination is incomplete and the frequency of neurological manifestations in still unknown.
200 eligible cases reported to the French National Reference Center from January 2015 to December 2015 were prospectively included in this case-control study (1 case: 1 control, matched for sex, age and area of living) to investigate the risk of infection. We documented the factors associated with their HEV infection and clinical manifestations.
The 200 HEV-infected patients included 137 who were immunocompetent and 63 immunocompromised. The factors associated with an HEV infection were contact with farm animals, eating pork liver sausage and eating unpeeled fruit. The 33 patients (16.5%) who reported neurological symptoms included 14 with neuropathic pain suggesting small fiber neuropathy, 9 with painless sensory disorders, 6 with Parsonage-Turner syndrome, one Guillain-Barre syndrome, one meningitis, one encephalitis and one diplopia. Neurological manifestations were more frequent in immunocompetent patients (22.6% vs 3.2%, p < 0.001).
This study highlights the risk of HEV transmission by the environment in industrialized countries. The higher frequency of neurological disorders in immunocompetent patients suggests pathophysiological mechanisms involving the immune system.
戊型肝炎病毒（HEV）是全球范围内急性肝炎的主要病因。然而，我们对污染来源的了解并不完整，神经系统表现的频率仍不清楚。
本前瞻性病例对照研究纳入了 2015 年 1 月至 2015 年 12 月期间向法国国家参考中心报告的 200 例符合条件的病例，以调查感染风险（1 例病例：1 例对照，按性别、年龄和居住地区匹配）。我们记录了与 HEV 感染及其临床表现相关的因素。
200 例 HEV 感染患者中，137 例为免疫功能正常，63 例为免疫功能低下。与 HEV 感染相关的因素包括与农场动物接触、食用猪肝香肠和食用未削皮水果。33 例（16.5%）报告有神经系统症状的患者中，包括 14 例提示小纤维神经病的神经病理性疼痛、9 例无痛性感觉障碍、6 例 Parsonage-Turner 综合征、1 例格林-巴利综合征、1 例脑膜炎、1 例脑炎和 1 例复视。免疫功能正常的患者中神经系统表现更常见（22.6%比 3.2%，p<0.001）。
本研究强调了在工业化国家中环境传播 HEV 的风险。免疫功能正常患者中神经系统疾病更常见，提示涉及免疫系统的病理生理机制。
