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World J Gastroenterol. May 14, 2021; 27(18): 2090-2104
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2090
Neurological manifestations of hepatitis E virus infection: An overview
Ashish Kumar Jha, Gaurav Kumar, Vishwa Mohan Dayal, Abhay Ranjan, Arya Suchismita
Ashish Kumar Jha, Gaurav Kumar, Vishwa Mohan Dayal, Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
Abhay Ranjan, Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
Arya Suchismita, Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, Basant Kunj 110070, New Delhi, India
Author contributions: Jha AK wrote the manuscript, and prepared the figures and tables; Kumar G performed the data acquisition; Dayal VM, Ranjan A, and Suchismita A provided input to the writing of this paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashish Kumar Jha, MBBS, MD, DM, Associate Professor, Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna 800014, India. ashishjhabn@yahoo.co.in
Received: January 3, 2021
Peer-review started: January 3, 2021
First decision: January 23, 2021
Revised: February 27, 2021
Accepted: April 5, 2021
Article in press: April 5, 2021
Published online: May 14, 2021
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.

Keywords: Hepatitis E virus, Acute hepatitis E, Extrahepatic manifestations, Neurological manifestations, Neuralgic amyotrophy, Guillain-Barré syndrome

Core Tip: Neurological involvement in patients with hepatitis E virus (HEV) infection is rare. There is a paucity of data on HEV-related neurological manifestations. This review comprehensively describes the mechanisms of pathogenesis, clinico-demographic profile, and outcomes of HEV-related neurological disorders. Nerve root and plexus disorder were the most commonly reported diseases followed by meningoencephalitis. These patients can present with normal liver function tests, which can often be misleading for physicians.