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.

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 ].…”

Hepatitis E virus infects brain microvascular endothelial cells, crosses the blood–brain barrier, and invades the central nervous system

“…HEV-associated nerve root and plexus sequelae, such as Guillain–Barré syndrome and neuralgic amyotrophy, have been reported in a significant proportion of HEV-infected individuals worldwide ( 20 , 21 ). Additionally, HEV-associated central nervous system (CNS) disorders, such as encephalitis, myelitis, cerebral ischemia, and seizures, have also been reported in HEV-infected patients ( 22 – 27 ). These neurological diseases are almost exclusively associated with zoonotic genotype 3 HEV infection, and to a lesser extent zoonotic genotype 4 HEV infection ( 28 , 29 ).…”