Hepatitis E virus and neurological disorders

Abstract

Hepatitis E is the most common cause of hepatitis worldwide. While originally considered a disease of developing countries, it is increasingly recognised in developed countries, probably related to contaminated pork meat, and where infection is often asymptomatic. However, several non-liver manifestations have become apparent, the most important of which are neurological, including Guillain-Barr e syndrome (acute inflammatory demyelinating polyradiculoneuropathy (AIDP)), neuralgic amyotrophy and meningoencephalitis. We recommend testing all patients with AIDP and neuralgic amyotrophy for hepatitis E and consider testing any patient with an unexplained neurological illness and abnormal liver function tests for the virus.

Acute hepatitis E infection as a cause of unexplained neurological symptoms

“…While only 5% are symptomatic,8 neurological presentation in 7.5% of this cohort indicates that HEV may be responsible for 375 cases of acute neurological illness annually 4. The observation that only ~100 cases of HEV-related neurological illness were reported between 2011 and 2017,2 predominantly within Europe and Asia, highlights the potential scale of undetected or unreported cases. From another perspective, HEV has been associated with 2.4% of non-traumatic neurological presentations,8 including 10.6% of neuralgic amyotrophy cases and 5% of Guillain-Barré syndrome cases 12 14.…”

“…HEV is ordinarily a self-limiting infection in immunocompetent individuals,13 including cases of HEV-associated meningoencephalomyelitis 2. On presentation at the neurology clinic, the patient reported symptomatic improvement, and a decision was made to monitor the patient at follow-up appointments.…”

“…HEV, a virus with a single-stranded positive-sense RNA genome,1 is the most common cause of hepatitis 2. For many years, hepatitis E was considered an inflammatory pathology of foreign origin.…”

“…Acquisition of the virus is widely reported to result from porcine zoonosis 4–7. However, molluscs, crops and other zoonoses remain a possibility 2. Whilst ~95% of cases are asymptomatic,8 7.5% of those with clinical manifestation present with neuropathology 4.…”

“…Whilst ~95% of cases are asymptomatic,8 7.5% of those with clinical manifestation present with neuropathology 4. Indeed, aberrant neurology is the most common extrahepatic manifestation of HEV 2. HEV has been associated with a range of peripheral neuropathies,2 4 9 10 including neuralgic amyotrophy and Guillain-Barré syndrome,11 12 as well as cranial nerve palsies and encephalopathies 2 5 8 10.…”