Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region

Abstract

-Introduction: Hepatitis virus C (HCV) infection is considered a health problem in the State of A c re localized in the Brazilian Amazon which has a prevalence rate of 5.9%. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. Objective: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. Method: A cross sectional study was perf o rmed in patients assisted by a specialized center of infectious diseases in the State of Acre . All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). Results: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51% had at least 8 years of formal education and 96% lived in the capital city of A c re State. Roughly 34% of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1%; IC95% 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1%) patients. Conclusion: Subclinical involvement of peripheral nerves seems common in patients with H C V, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.KEY WORDS: hepatitis virus C, HCV, peripheral neuro p a t h y, nerve conduction studies, Amazon re g i o n , prevalence. N e u ropatia periférica em pacientes com infecção pelo vírus C da hepatite na região amazônica RESUMO -I n t rodução:A infecção pelo vírus da hepatite C (VHC) é considerada um problema de saúde pública no Estado do Acre com uma prevalência de 5,9%. Neuropatia periférica é uma manifestação extrahepática comum em pacientes com VHC. Objetivo: Determinar a prevalência de neuropatias periféricas através de parâmetros clínicos e neuro f i s i o l ó g i c o s . Método: Foi realizado estudo transversal em pacientes atendidos em uma clínica especializada de doenças infecciosas do Estado do Acre. Todos os pacientes foram submetidos a um questionário clínico-epidemiológico, exame físico e eletro n e u romiografia (ENMG). Resultados: Foram estudados 78 pacientes, com idade média de 45,5 anos (10 a 76), dois terços eram do sexo masculino, 51% tinha pelo menos 8 anos de educação formal e 95% moravam na capital do Estado. A p roximadamente 34% dos pacientes se queixaram de parestesias, principalmente nos membros superiores. A ENMG diagnosticou mononeuropatia múltipla em 11 (14,1%, IC95% 7,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)2) pacientes e síndro m e do túnel do carpo em 4 (5,1%). Conclusão: C o m p rometimento dos nervos periféricos é comum em pacientes com VHC, sendo neuropatia múltipla a apresentação mais comumente diagnosticada pela ENMG.

Screening for Electrophysiological Abnormalities in Chronic Hepatitis C Infection: Peripheral Neuropathy and Optic Neuropathy

“…In one case report, a patient with hepatitis C neuropathy had undergone successful operations for superimposed nerve compressions (25). In a study conducted in the Amazon region, in a group comprising 78 HCV patients, the rate of CTS was 5.5%, while that of multiple mononeuropathies was 14.1% (26). In another group of 19 hepatitis C patients with rheumatismal symptoms, eight subjects had CTS (27).…”

Carpal tunnel syndrome in HIV-positive patients coinfected with HCV

“…In a study evaluating the presence of symptoms related to rheumatological manifestations in 114 patients with HCV infection and cryoglobulinemia, CTS was found in 7 (6%) patients (21). In a study to determine the prevalence of peripheral neuropathies in 78 patients with HCV in the Brazilian Amazon, the researchers observed 5.1% of CTS (22). CTS was reported in 42.6% of sixty pa- …”

Neuromuscular Diseases Associated With Chronic Hepatitis C Virus Infection

“…26 Lastly, peripheral neuropathy has also been reported in HCV-infected patients who test persistently negative for mixed cryoglobulinemia. 18,23,[26][27][28][29][30][31] Neuropathy Syndromes HCV-associated neuropathy most frequently manifests as a distal sensory or sensorimotor polyneuropathy followed by mononeuropathy multiplex 21,26,[32][33][34][35] and rarely polyarteritis nodosa. 36 Other types of neuropathy include demyelinating polyneuropathy, 32,37,38 small fiber neuropathy with restless leg syndrome, 35 pure motor axonal neuropathy, 39 and cranial (eg, oculomotor and facial) neuropathy.…”