Fritz-Weltin Miriam, Isenmann Nora, Frommherz Estelle, Niedermeier Lisa, Csernalabics Benedikt, Boettler Tobias, Neumann-Haefelin Christoph, Endres Dominique, Panning Marcus, Berger Benjamin
Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
J Neurol Sci. 2021 Apr 15;423:117387. doi: 10.1016/j.jns.2021.117387. Epub 2021 Mar 8.
Central nervous system (CNS) infections can be caused by a variety of viruses, but in a significant number of patients no viral or other pathogen can be identified using routine diagnostic work-up. Interestingly, several case reports and series described Hepatitis E virus (HEV) as a potential pathogen. However, systematic studies have not been conducted so far.
We identified 243 patients from Southwestern Germany with acute CNS infections of unknown cause treated in our clinic between 2008 and 2018, of which serum and/or cerebrospinal fluid (CSF) samples were available. These patients were retrospectively tested for anti-HEV IgM and IgG antibodies. In addition, HEV PCR was performed in the majority of cases including IgM-negative patients with symptom onset <8 days. 263 healthy individuals served as controls.
Evidence of an acute HEV infection was found in four patients (1.7%). Three had recent HEV infection defined as positive anti-HEV IgM and IgG antibodies, one had current HEV infection defined as (additional) detection of HEV RNA in serum. However, anti-HEV IgM and IgG seroprevalence did not differ significantly from controls, though these had considerably lower IgM levels. Interestingly, anti-HEV IgG seroprevalence was unexpectedly high (30.7%) and revealed an age-dependent increase to more than 50% in patients older than 60 years.
This study supports previous findings that HEV could play a role in acute CNS infections. Therefore, we encourage testing for acute HEV infection if no other pathogen can be identified. However, further studies are necessary to prove a causal role.
中枢神经系统（CNS）感染可由多种病毒引起，但在相当数量的患者中，使用常规诊断检查无法识别病毒或其他病原体。有趣的是，一些病例报告和系列研究将戊型肝炎病毒（HEV）描述为一种潜在病原体。然而，迄今为止尚未进行系统研究。
我们从德国西南部选取了2008年至2018年期间在我们诊所接受治疗的243例病因不明的急性中枢神经系统感染患者，其中有血清和/或脑脊液（CSF）样本。对这些患者进行回顾性检测抗HEV IgM和IgG抗体。此外，在大多数病例中进行了HEV PCR检测，包括症状出现<8天的IgM阴性患者。263名健康个体作为对照。
在4例患者（1.7%）中发现急性HEV感染的证据。3例近期有HEV感染，定义为抗HEV IgM和IgG抗体阳性，1例当前有HEV感染，定义为血清中检测到（额外的）HEV RNA。然而，抗HEV IgM和IgG血清阳性率与对照组相比无显著差异，尽管对照组的IgM水平明显较低。有趣的是，抗HEV IgG血清阳性率出乎意料地高（30.7%），并且在60岁以上患者中显示出随年龄增长增加到超过50%。
本研究支持先前的发现，即HEV可能在急性中枢神经系统感染中起作用。因此，如果无法识别其他病原体，我们鼓励检测急性HEV感染。然而，需要进一步研究来证明其因果作用。
