Hepatitis E Virus and Neurologic Disorders

Abstract

Information about the spectrum of disease caused by hepatitis E virus (HEV) genotype 3 is emerging. During 2004–2009, at 2 hospitals in the United Kingdom and France, among 126 patients with locally acquired acute and chronic HEV genotype 3 infection, neurologic complications developed in 7 (5.5%): inflammatory polyradiculopathy (n = 3), Guillain-Barré syndrome (n = 1), bilateral brachial neuritis (n = 1), encephalitis (n = 1), and ataxia/proximal myopathy (n = 1). Three cases occurred in nonimmunocompromised patients with acute HEV infection, and 4 were in immunocompromised patients with chronic HEV infection. HEV RNA was detected in cerebrospinal fluid of all 4 patients with chronic HEV infection but not in that of 2 patients with acute HEV infection. Neurologic outcomes were complete resolution (n = 3), improvement with residual neurologic deficit (n = 3), and no improvement (n = 1). Neurologic disorders are an emerging extrahepatic manifestation of HEV infection.

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

“…A similar concept has been proposed for neurologic manifestations such as Guillain Barré syndrome and Neuralgic Amyotrophy in association with HEV infection [26,27].…”

Hepatitis E: Epidemiology and Natural History

“…87 Another unusual feature of HEV infection in these areas is the occurrence of a wide variety of neurological syndromes in association with genotype 3 HEV infection. 88,89 However, these syndromes are not seen in patients with acute infection due to genotype 1 or 2 HEV infection in high-endemicity areas.…”

Chronic Hepatitis E Virus Infection and Treatment

“…Neurological symptoms occur in an estimated 5.5% of HEV patients. 99 Interestingly, HEV RNA has been detected in the cerebrospinal fluid (CSF) of four patients with chronic HEV infection. 99 Clonal HEV sequences in the serum and CSF of a kidneytransplant patient with chronic hepatitis and neurological symptoms showed quasispecies compartmentalization, which suggests that neurological symptoms could be linked to the emergence of neurotropic variants.…”

“…99 Interestingly, HEV RNA has been detected in the cerebrospinal fluid (CSF) of four patients with chronic HEV infection. 99 Clonal HEV sequences in the serum and CSF of a kidneytransplant patient with chronic hepatitis and neurological symptoms showed quasispecies compartmentalization, which suggests that neurological symptoms could be linked to the emergence of neurotropic variants. 100 In addition, cases of anti-ganglioside GM1-positive and anti-GM2-positive Guillain-Barre syndrome, caused by HEV infection, have been reported.…”