Assuntos
Vírus da Hepatite E/genética , Hepatite E/complicações , Leucemia Linfoide/complicações , Genótipo , Hepatite E/diagnóstico , Vírus da Hepatite E/classificação , Vírus da Hepatite E/isolamento & purificação , Humanos , Itália , Leucemia Linfoide/tratamento farmacológico , Leucemia Linfoide/virologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , RNA Viral , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. RESULTS: Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all genotype 3). Fifty-one of 57 HEV-NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12-2,961 IU/L); in 6 cases, liver function tests were normal. HEV-NA cases were more likely to have bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between the 2 groups at 12 months. CONCLUSIONS: Patients with HEV-NA are usually anicteric and have a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Involvement outside the brachial plexus is more common in HEV-NA. The relationship between HEV and NA is likely to be causal, but is easily overlooked. Patients presenting with NA should be tested for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV-NA are warranted.
Assuntos
Neurite do Plexo Braquial/fisiopatologia , Vírus da Hepatite E , Hepatite E/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/fisiopatologia , Neurite do Plexo Braquial/diagnóstico por imagem , Neurite do Plexo Braquial/tratamento farmacológico , Neurite do Plexo Braquial/patologia , Europa (Continente) , Feminino , Anticorpos Anti-Hepatite/sangue , Hepatite E/tratamento farmacológico , Hepatite E/patologia , Hepatite E/virologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Fenótipo , RNA Viral/sangue , RNA Viral/líquido cefalorraquidiano , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Telemedicina/métodos , Tuberculose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sensibilidade e Especificidade , Ultrassonografia , Comunicação por Videoconferência , Adulto JovemRESUMO
Prevalence and impact of occult HBV infection in HIV positive patients is controversial. The aims of this study were to determine the prevalence of occult HBV infection and its impact on histological and virological parameters. 52 HIV/HCV (but HBsAg-negative) co-infected patients, 29 HBsAg and anti-HCV negative chronic hepatitis, and 20 HBsAg positive chronic hepatitis controls were studied. DNA was extracted from frozen biopsies and amplified with primers for S, C and X regions, and for (ccc) HBV-DNA. Sera were tested for HBV-DNA with two quantitative assays (Cobas Amplicor HBV Monitor, and the real-time COBAS (r) Taqman HBV Test, Roche Diagnostics, UK). Occult HBV infection was detected in 7 (13.4%) liver biopsies of the study group, and in none case of the non viral chronic hepatitis group (p=0.04). All serum samples were HBV-DNA negative with Cobas Amplicor HBV monitor assay, while 3 cases were found positive with real time PCR. Statistical analysis didn't show any impact of occult HBV infection on liver histology, CD4+ cells count, HIV and HCV load, and ALT levels. Occult B infection is relatively frequent in HIV/HCV co-infected patients, and is underestimated by common HBV-DNA serological assays. However, it doesn't seem to exert a relevant impact.