Immunohistochemical Detection of HCV in nerves and muscles of patients with HCV associated Peripheral Neuropathy and Myositis

Background: Chronic hepatitis C Virus [HCV] infection may be associated with numerous extrahepatic manifestations, such as mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, sicca syndrome. Cryoglobulinaemia [CG] is a condition characterized by the presence of serum proteins that reversibly precipitate in the cold. The objective of the present work was to study the histopathological changes in neuromuscular biopsies in patients with HCV associated peripheral neuropathy, or myopathy; with and without cryoglobulinemia, and to assess the presence of HCV in nerve and muscle tissues of those patients which might clarify some pathogenetic mechanisms for neuropathy, and myopathy associated with HCV

Methods: The study was conducted on 17 cases of HCV infected patients with peripheral neuropathy and myositis. All patients were subjected to thorough laboratory investigations, neurological examination, electrophysiologic studies including nerve conduction, and needle EMG studies

Results: Histopathological examination of nerve biopsies showed features of vascultis in 2/10 cases, interstitial inflammatory infiltrates in 5/10. Muscle biopsies showed intense inflammatory reaction, degenerative changes in the muscles of 3/10 cases diagnosed as myositis. Immunohistochemical results, showed in nerve biopsies, 7/10 cases with positive reaction for HCV with nuclear and perinuclear staining.. Two patients showed positive reaction in the epineural, and endoneural blood vessels and a negative reaction in nerve bundles, while in five patients, reaction was only positive in the nerve bundles. In muscle biopsies, 7/10 cases showed positive reaction for HCV in the nuclei of the muscle fibers, including the cases presented with myositis

Conclusion: The presence of HCV particles in nerve and muscle biopsies of patients with peripheral neuropathy suggests a virus triggered immune mediated mechanism

Immunohistochemical detection of HCV in nerves and muscles of patients with HCV associated peripheral neuropathy and myositis

Chronic hepatitis C Virus [HCV] infection may be associated with numerous extrahepatic manifestations, such as mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, sicca syndrome, Cryoglobulinaemia [CG] is a condition characterized by the presence of serum proteins that reversibiy precipitate in the cold. The objective of the present work was to study the histopathological changes in neuromuscular biopsies in patients with HCV associated peripheral neuropathy, or myopathy; with and without cryoglobulinemia, and to assess the presence of HCV in nerve and muscle tissues of those patients which might clarify some pathogenetic mechanisms for neuropathy, and myopathy associated with HCV. The study was conducted on 17 cases of HCV infected patients with peripheral neuropathy and myositis. All patients were subjected to thorough laboratory investigations, neurological examination, electrophysiologic studies including nerve conduction, and needle EMG studies. Histopathological examination of nerve biopsies showed features of vascultis in 2/10 cases, interstitial inflammatory infiltrates in 5/10. Muscle biopsies showed intense inflammatory reaction, degenerative changes in the muscles of 3/10 cases diagnosed as myositis. Immunohistochemical results, showed in nerve biopsies, 7/10 cases with positive reaction for HCV with nuclear and perinuclear staining. Two patients showed positive reaction in the epineural, and endoneural blood vessels and a negative reaction in nerve bundles, while in five patients, reaction was only positive in the nerve bundles. In muscle biopsies, 7/10 cases showed positive reaction for HCV in the nuclei of the muscle fibers, including the cases presented with myositis. The presence of HCV particles in nerve and muscle biopsies of patients with peripheral neuropathy suggests a virus triggered immune mediated mechanism

intervention study for prevention of HCV infection in some hemodialysis units in Alexandria

This study was conducted aiming to compare between strict adherence to the universal precautions and anti HCV seropositive patients isolation as a preventive measure. To fulfill this aim, 80 anti HCV seronegative patients and 44 staff members working in three hemodialysis units were included in the study. A predesigned questionnaire was filled for all patients that included history of hepatitis risk factors, which are related, or not to dialysis process. Another questionnaire was filled for all medical and paramedical staff in the studied units, which included their knowledge, attitude and practice [KAP] as regard HCV. Pretest was done, followed by health education program [HEP]. A post test was performed after one month and every 6 months for 18 months. An observational sheet was filled by one of the researchers to describe the hemodialysis units environment and to record the practice of the staff in the studied units. Blood samples were collected from the study subjects at baseline, every 3 months for patients and every 6 months for the staff. Sera were separated and tested for anti HCV seropositivity using enzyme linked immunosorbent assay [ELISA] test third generation. Marked increase in staff's knowledge was evident one month after HEP and decreased gradually throughout the follow up period. The attitude was slightly elevated and remained nearly unchanged throughout the follow up. Only in unit A the mean preventive score was markedly increased 6 months after HEP and remained high throughout the follow up period. The incidence rate of anti HCV seroconversion decreased in unit A from [10% to 0%], where universal precautions was applied, and in unit C from [24.4% to 10%], where isolation of anti seropositive patients was done in the first and third 6 months of the follow up period respectively. It increased in unit B, where no measure was taken, from 10.5% to 16.7%