An observational cross sectional cohort study to estimate the frequency of hepatitis E virus (HEV) infection in neurological disease of inflammatory/ immune mediated origin and ischemic stroke

Hepatitis E virus genotype 1 and 2 infections are hyperendemic in Africa and
South-east Asia. The virus is transmitted via the fecal-oral route. Mortality
is high in pregnant women. A recent study form Bangladesh concludes to a
mortalty rate of 10%. The incidence of hepatitis E infections is increasing
dramatically in Canada, USA, Europe, New Zealand and Japan. In the developed
world HEV infection is caused by locally acquired genotype 3 which is a
zoonotic with a porcine primary host in contrast to genotype 1 and 2 with a
human host. Our understanding of the clinical range of HEV infection in humans
has undergone a sea-change in recent years, and expands. There is a growing
number of case-reports and case series with respect to the subject. Mainly
neurological disorders like GBS, neuralgic amyotrophy, encephalitis, Bell*s
palsy, transverse myelitis and peripheral neuropathies have been associated
with HEV. In many case-reports of HEV-associated neurological injury the
neurological symptoms and signs dominate the clinical picture and not the
hepatitis. Patients are usual anicteric and liverfunctions are only mildly to
modestly abnormal. In routine clinical practice such patients are unlikely to
be tested for HEV. Thus, the full range of HEV-associated neurological injury
is unknown, and pathogenic mechanisms are uncertain.

To estimate the frequency/ prevalence of acute or active HEV infection in
patients presenting with (sub)acute post-infectious and/or immune-mediated
neurological illness like neuralgic amyotrophy, (idiopathic) Guillain Barre
syndrome, idiopathic facial nerve palsy (Bell*s palsy), vestibular neuritis,
optic neuritis, transverse myelitis, non-infectious encephalitis, and patients
with acute ischemic stroke.

This is an observational cohort pilot study of subjects over 18 years of age
presenting at the Jeroen Bosch Hospital,*s-Hertogenbosch with (sub)acute
post-infectious and/or immune-mediated neurological illness or acute ischemic
stroke. If the patiënt gives informed consent an ELISA (Wantai, Beijing, PR
China) will be performed to detect IgM and IgG antibodies to HEV. Additionally
a validated quantative RT-PCR will be done.

Patients consent to give one blood sample (10 ml) in the far majority if not
in all patients during an already planned venapunction. There is a very small
chance of local hematoma due to venapunction without further risks.