Hepatitis E virus and neurological injury

Abstract

Hepatitis E is hyperendemic in many developing countries in Asia and Africa, and is caused by hepatitis E virus (HEV) genotypes 1 and 2, which are spread via the faecal-oral route by contaminated water. Recent data show that HEV infection is also endemic in developed countries. In such geographical settings, hepatitis E is caused by HEV genotypes 3 and 4, and is mainly a porcine zoonosis. In a minority of cases, HEV causes acute and chronic hepatitis, but infection is commonly asymptomatic or unrecognized. HEV infection is associated with a number of extrahepatic manifestations, including a range of neurological injuries. To date, 91 cases of HEV-associated neurological injury--most commonly, Guillain-Barré syndrome, neuralgic amyotrophy, and encephalitis/myelitis--have been reported. Here, we review the reported cases, discuss possible pathogenic mechanisms, and present our perspectives on future directions and research questions.

Brainstem encephalitis and acute polyneuropathy associated with hepatitis E infection

“…Often, the delineation between CNS and peripheral nervous system (PNS) infection is not clear and patients may present with a mix of symptoms. Other neurological presentations reported in literature include mononeuritis multiplex (asymmetric, asynchronous involvement of non-contiguous nerve trunks, usually painful), myositis, Bell’s palsy and vestibular neuritis1 but, to our knowledge, this is the first reported case worldwide of HEV presenting with a combination of brain stem encephalitis and acute polyneuropathy in an immunocompetent patient.…”

“…All hepatitis E virus (HEV) genotypes have been associated with GBS, neuralgic amyotrophy and encephalitis/myelitis 1. The association between GBS and HEV infection has been demonstrated worldwide with all four genotypes.…”

Hepatitis E virus and neurological disorders

“…Does HEV have a causal role in the neurological syndromes described above or is it just a chance association? Causality is difficult to prove, but our view is that there is a causal relationship, particularly in GBS, neuralgic amyotrophy and meningoencephalomyelitis 24. HEV has been temporally associated with all three of these neurological illnesses from differing geographical areas and with differing genotypes.…”

Hepatitis E: New Clinical and Public Health Problem on the Western World? Review

“…neurological [6,[30][31][32][33][34], including cases of S. GuillainBarrè, neurologic pain amyotrophic, encephalitis, peripheral neuropathy, vestibular neuritis), confi rming that HEV in addition to hepatotropic is also neurotropic.…”

“…More sensible diagnostic exams have shown a high prevalence of the infection through genotype 3 in the eastern hemisphere, with reports of hepatic infection, cirrhosis, and extremely severe systemic [1][2][3] and neurological extra-hepatic manifestations, especially on immunosuppressed patients [4][5][6]. Hepatitis E: an emerging infection in developed countries [7], suggesting the occurrence of a new and important clinical and public health problem [3,8].…”