Frequency Of Peripheral Neuropathy in Chronic Hepatitis C Patients Presenting at Liaquat University Hospital, Hyderabad: Peripheral Neuropathy in Chronic Hepatitis C Patients

Syed  Yasir Abbas; Hafsa  Auroj; Arshad  Sattar Lakho; Akbar  Gohar Abro; Ghulam  Shahar Bano; Tahir  Hanif Rajput

doi:10.54393/pbmj.v5i5.473

Authors

Syed Yasir Abbas Dept. of Medicine Combine Military Hospital - Hyderabad
Hafsa Auroj Liaquat University Hospital, Hyderabad
Arshad Sattar Lakho Dept. of Medicine Liaquat University of Medical & Health Sciences, Jamshoro
Akbar Gohar Abro Dept. of Medicine Liaquat University of Medical & Health Sciences, Jamshoro
Ghulam Shahar Bano Liaquat University of Medical & Health Sciences, Jamshoro
Tahir Hanif Rajput General Medicine PNS Shifa, Karachi

DOI:

https://doi.org/10.54393/pbmj.v5i5.473

Keywords:

Chronic liver disease; Hepatitis C; mixed type neuropathy; neurological disorders; peripheral neuropathy

Abstract

Hepatitis C virus (HCV) and its infective pathogenic role leads to the psychiatric and neurological signs and symptoms. Therefore, close monitoring and regular follow-up is warranted. Objective: To find out the frequency of peripheral neuropathy among patients presenting at Liaquat University Hospital, Hyderabad, having Chronic Hepatitis C. Methods: The cross-sectional study included 359 patients with chronic HCV, aged 20 to 70 years, who presented to the Liaquat University Hospital's Hepatitis Clinic and Outpatient Department of General Medicine and Neurology. Non-probability - sequential sampling was used to choose patients. Patients were asked about demographic information and the duration of chronic HCV after giving informed written consent. The clinical examination was performed to see if there were any reduced tendon reflexes in all of the patient's extremities. To diagnose peripheral neuropathy based on nerve conduction velocity, all patients had an electrophysiological test using a simplified nerve conduction study (NCS) methodology (NCV). The research lasted six months, from June 2021 to December 2021. The information was examined via SPSS version 25.0. Results: There were 219 Men (61%) And 140 Females (39%) among the 359 Patients. The average age (SD) of the participants was 42.3 (8.7) years (range 22–70). HCV infection lasted 36 months on average (range 1–156). Out of 359 patients, 61 had clinical peripheral neuropathy (PN) (17%). Electrophysiological evidence of PN was present in all of these patients, electrophysiological investigation revealed subclinical PN in 19 more patients (5.3%). Conclusion: On the basis of the findings from this study, it can be concluded that a high prevalence of peripheral neuropathy is present among the patients with HCV in our locality. However, an electrophysiological examination should always be done to avoid underestimating PN, particularly in older HCV patients.

References

Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med. 2001 Jul 5;345(1): 41-52.doi.org/10.1056/NEJM200107053450107

Lidove O, Cacoub P, Maisonobe T, Servan J, Thibault V, Piette JC et al. Hepatitis C virus infection with peripheral neuropathy is not always associated with cryoglobulinaemia. Ann Rheum Dis. 2001 Mar;60(3):290-2.doi.org/10.1136/ard.60.3.290

Cacoub P, Renou C, Rosenthal E, Cohen P, Loury I, Loustaud-Ratti V et al. Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. The GERMIVIC. Groupe d'Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le Virus de l'Hepatite C. Medicine (Baltimore). 2000 Jan;79(1):47-56.doi.org/10.1097/00005792-200001000-00005

Moretti R, Caruso P, Dal Ben M, Gazzin S, Tiribelli C. Hepatitis C-related cryoglobulinemic neuropathy: potential role of oxcarbazepine for pain control. BMC Gastroenterol. 2018 Jan 25;18(1): 19.doi.org/10.1186/s12876-018-0751-9

Monaco S, Ferrari S, Gajofatto A, Zanusso G, Mariotto S. HCV-related nervous system disorders. Clin Dev Immunol. 2012; 236148.doi.org/10.1155/2012/236148

Carvalho-Filho RJ, Narciso-Schiavon JL, Tolentino LH, Schiavon LL, Ferraz ML, Silva AE. Central nervous system vasculitis and polyneuropathy as first manifestations of hepatitis C. World J Gastroenterol. 2012 Jan 14;18(2): 188-91.doi.org/10.3748/wjg. v18.i2.188

Chin RL, Sander HW, Brannagan TH 3rd, De Sousa E, Latov N. Demyelinating neuropathy in patients with hepatitis C virus infection. J Clin Neuromuscul Dis. 2010 Jun;11(4):209-12. doi: 10.1097/CND.0b013e3181b701c1.

Adinolfi LE, Nevola R, Lus G, Restivo L, Guerrera B, Romano C, et al. Chronic hepatitis C virus infection and neurological and psychiatric disorders: an overview. World J Gastroenterol. 2015 Feb 28;21(8):2269-80. doi: 10.3748/wjg. v21.i8.2269.

Zampino R, Marrone A, Restivo L, Guerrera B, Sellitto A, Rinaldi L, et al. Chronic HCV infection and inflammation: Clinical impact on hepatic and extra-hepatic manifestations. World J Hepatol. 2013. October 27;5(10): 528-40.doi.org/10.4254/wjh. v5. i10.528

Ghoneimy ATE, Hasanien A, Ramzy GM, Youssof AM, Elsayed M, Shalaby NM, et al. Hepatitis C virus and peripheral neurological complications in Egyptian patients. Arab J Gastroenterol. 2009. September;10(3):82-6.doi.org/10.1016/j.ajg.2009.09.002

El Fatah Al kafrawy Nabil Abd, El-Aziz Kora Mahmoud Abd, Dala Ashraf Gharib, Sultan Walaa Khalil Mohamed Ali. Study of microvascular complications of chronic hepatitis C virus in nondiabetic patients. Wolters Kluwer Health-Medknow. 2014;27(2): 458-64.doi.org/10.4103/1110-2098.141727

Al soud Atef Abo, ELlehleh Ayman, El-Kapany Rasha, El-Hagary Heba. Study of peripheral neuropathy in Chronic Hepatitis C patients. J Am Sci. 2011;7(4):282-8.

Santoro L, Manganelli F, Briani C, Giannini F, Benedetti L, Vitelli E et al. Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population. J Neurol Neurosurg Psychiatry. 2006 May;77(5):626-9.doi.org/10.1136/jnnp.2005.081570

Aly Abdel Khalek M, El-barbary AM, Elkalla FS, Essa SA-M. Prevalence of peripheral neuropathy in Egyptian hepatitis C virus patients: Correlation to some clinical and laboratory parameters. Egypt Rheumatol. 2012. July;34(3):91-8.doi.org/10.1016/j.ejr.2012.04.001

Mapoure NY, Budzi MN, Eloumou SAFB, Malongue A, Okalla C, Luma HN. Neurological manifestations in chronic hepatitis C patients receiving care in a reference hospital in sub-Saharan Africa: A cross-sectional study. PLoS One. 2018 Mar 7;13(3): e0192406.doi.org/10.1371/journal.pone.0192406

Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014;24(1):49-65. doi: 10.1016/j.nic.2013.03.023

Ripault M P, Borderie C, Dumas P et al. Peripheral neuropathies and chronic hepatitis C: a frequent association? Gastroenterol Clin Biol 199822891-896.

Cacoub P, Renou C, Rosenthal E et al. Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. The GERMIVIC. Groupe d'Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le Virus de l'Hepatite C. Medicine (Baltimore) 20007947-56.

England J D, Gronseth G S, Franklin G et al. Distal symmetrical polyneuropathy: definition for clinical research. Muscle Nerve 200531113-123.

Zaltron S, Puoti M, Liberini P, Antonini L et al. High prevalence of peripheral neuropathy in hepatitis C virus infected patients with symptomatic and asymptomatic cryoglobulinaemia. Ital J Gastroenterol Hepatol 199830391-395.

Agnello V, Abel G. Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia. Arthritis Rheum 1997402007-2015.

Bonetti B, Invernizzi F, Rizzuto N et al. T‐cell‐mediated epineurial vasculitis and humoral‐mediated microangiopathy in cryoglobulinemic neuropathy. J Neuroimmunol 199773145-154.

Authier F J, Bassez G, Payan C et al. Detection of genomic viral RNA in nerve and muscle of patients with HCV neuropathy. Neurology 2003, 60808-812.doi.org/10.1212/01.WNL.0000044399. 71601.EA

Cacoub P, Poynard T, Ghillani P, et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum 1999422204-2212.