Guillain–Barré and Miller Fisher syndromes in patients with anti-hepatitis E virus antibody: a hospital-based survey in Japan

Abstract

There have been reports from several countries that hepatitis E virus (HEV) infection is frequently associated with Guillain-Barré syndrome (GBS). This study aimed to determine the frequency of HEV infection associated with GBS in Japanese patients, and to clarify the clinical characteristics of these patients. Sera obtained from 63 patients with GBS or Miller Fisher syndrome (MFS) and 60 control subjects were examined for both HEV-IgM and HEV-IgG. Of the 63 patients, three were positive for both HEV-IgM and elevated hepatic enzymes: Two had GBS, and one had MFS. No control subjects were positive for HEV-IgM. Our study demonstrated that 4.8 % of patients with GBS or MFS from our institution had associated acute HEV infection. There were no clinical differences between GBS with HEV infection and other GBS cases. To our knowledge, this is the first survey in Japan of HEV-associated GBS or MFS.

Hepatitis E virus and neurological disorders

“…In the HEV-associated cases of GBS, HEV RNA was isolated from the blood in 30%, none of the patients were jaundiced, and 70% showed mildly abnormal liver function tests. There were similar findings in studies in Bangladesh,20 Japan21 and Belgium 22. There appears to be no difference in the clinical manifestations and course or outcomes of HEV-related and non-HEV-related AIDP.…”

Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review

“…To the authors knowledge, this is the first case report of neurological complications (GBS) associated with acute HEV gt1 infection in an Indian patient. Among GBS-HEV cases reported so far, most of them were treated with intravenous immunoglobulin (IVIG) or ribavirin (13,14). This treatment may prolong clinical and neurological recovery in patient up to 18 months.…”

Non-traumatic neurological injury and hepatitis E infection

“…Fifty HEV infection is found in 5%-11% of cases of GBS, significantly higher than in controls [13][14][15]. Over 70 cases of HEVassociated NA have been documented almost exclusively from Europe with HEV gt3.…”