The entire genome sequence of hepatitis E virus genotype 3 isolated from a patient with neuralgic amyotrophy

Abstract

We report the case of a Thai male patient with neuralgic amyotrophy, presenting with acute and severe pain in the upper extremities, followed by patchy muscle weakness, associated with hepatitis E virus (HEV) infection. The entire HEV genome was sequenced and subjected to phylogenetic analysis and found to be genotype 3. Data on the most common HEV genotypes circulating in Thailand are scarce. The origin of infection and the mode of HEV transmission in this patient remained inconclusive; however, this study provides essential baseline data as a reference for further genetic analysis of HEV.

Hepatitis E Virus Infection

“…Neurological symptoms have been described for HEV1 and acute and chronic HEV3 infections (26). The neurological manifestations observed in HEV patients are Guillain-Barré syndrome (27-35), Bell's palsy (36), neuralgic amyotrophy (37,38), acute transverse myelitis (39), and acute meningoencephalitis (29,40). In a retrospective analysis of 126 patients with HEV infection, neurological symptoms were observed in 7 patients (5.5%), including 3 immunocompetent patients with acute HEV3 infection, 3 solid organ transplant (SOT) recipients, and 1 HIV-positive individual with chronic infection (21).…”

Chronic Hepatitis E Virus Infection and Treatment

“…During the acute phases of HEV genotype-1 and -3 infections, neurological manifestations, such as GuillainÀBarre syndrome, 48,[86][87][88][89][90][91][92][93] Bell's palsy, 94 neuralgic amyotrophy, 95,96 acute transverse myelitis, 97 and acute meningoencephalitis 90,98 have been reported. Neurological symptoms occur in an estimated 5.5% of HEV patients.…”

Association of Bell's Palsy with Hepatitis E Virus Infection: A Rare Entity

“…1 Neurologic involvement in HEV is distinctly rare and approximately 24 cases have been described so far. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Reports of 22 cases are summarized in Table 1. 1,[6][7][8][9][10][11][13][14][15][16][17][18][19][20] Guillain-Barré syndrome, 1,6 (Table 1).…”

“…However, a case of genotype 3 HEV infection associated with neuralgic amyotrophy has been described from Asia (Thailand) too. 21 Therefore, the relationship between the neurologic involvement and genotype appears to be debatable.…”