Neurological manifestations of hepatitis E virus infection: An overview

Abstract

Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.

Neurological manifestation of HEV infection: still a rare disease entity?

“…In our patients, five cases of extrahepatic neurological manifestation of HEV infection could be detected. The described disease entities neuralgic amyotrophy/plexus neuritis ( n = 4) and encephalitis ( n = 1) were consistent with previous reports in the literature, as these are reported to be the most common neurological manifestations of HEV [ 11 , 19 , 21 , 22 ]. While it might not be surprising that two cases of HEV-associated neuralgic amyotrophy/plexus neuritis were missed in clinical routine, interestingly, these cases accounted for 40% of patients diagnosed with neuralgic amyotrophy/plexus neuritis.…”

“…In case of neuralgic amyotrophy caused by HEV, administration of cortisone and intravenous immunoglobulins is described to have a positive effect on the course of disease [ 5 ]. Except of case report series, no data on positive effects of treatment with apheresis are available [ 11 , 12 ].…”

Hepatitis E - epidemiology and clinical course in the largest cohort in the Czech Republic

“…There have been several cohort and case studies of neurological injuries in patients with HEV infection [ 1 , 10 – 12 ]. In our study, 8 of 173 patients (4.6%) presented with neurological symptoms.…”

Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice

“…Extra-hepatic manifestations such as membranoproliferative glomerulonephritis and cryoglobulinemia are not rare in HEV infected patients[ 13 ] and it was suggested that in severely immunocompromised patients HEV could be implicated in development of hepatic cancer[ 36 ]. Also, common neurological disorders in the course of HEV infection were found such as nerve root, plexus disorders and meningoencephalitis[ 37 , 38 ].…”