PO025 Hepatitis e virus infection and acute non-traumatic neurological injury: an international prospective pilot study

Background Hepatitis E virus (HEV) is a common zoonotic infection associated with pigs which is endemic in many developed countries. Most infections are asymptomatic, with only a minority causing clinically evident hepatitis. Numerous extra-hepatic manifestations are associated with HEV, most commonly neurological injury. The aim of the study was to explore the relationship between HEV and acute neurological illness. Methods 464 consecutive patients presenting to 4 centres in the UK, France and the Netherlands with acute non-traumatic neurological illnesses were prospectively tested for HEV by serology and PCR. Findings 11/464 patients (2.4%) had evidence of current/recent HEV infection. Neurological cases in which HEV infection was found included neuralgic amyotrophy (n=3, all PCR positive); cerebrovascular event (n=4); seizure (n=2); encephalitis (n=1); and an acute combined facial and vestibular neuropathy (n=1). Symptoms of hepatitis were mild and no patients were clinically jaundiced. Interpretation The 3 cases of HEV associated neuralgic amyotrophy had similarities with other previously described HEV-associated cases; all were middle-aged males with bilateral involvement of the brachial plexus. This observation supports a causal relationship between HEV and neuralgic amyotrophy. To further understand the relevance of HEV infection in patients with acute neurological illnesses, case control studies are warranted.