Neurological manifestations of hepatitis E virus infection: An overview

Table 3 Hepatitis E virus-related neurological manifestations

Diseases	n (%)	Geographic distribution	Mean age in yr	M:F ratio	Serological diagnosis	Serum HEV-RNA	Genotype	CSF HEV-RNA	Elevated bilirubin, n	Median (range) ALT in IU/L	Use of anti-viral	Recovery
Nerve root and plexus disorders
Neuralgic amyotrophy[13,15-17,28-56]	64 (39)	Europe: 62; SEAR: 1; United States: 1	45.7	6.5:1	51	44	GT3: 28	0	4	1007 (22-2579)	9	CR: 9; PR: 47; NM: 8
Guillain-Barré syndrome[13,15,16,20,36,58-85]	61 (37)	SEAR: 21; Europe: 30; China/Hong Kong: 5; Japan: 4; Iraq: 1	51.16	2.42:1	46	20	GT3: 10; GT4: 1; GT1: 2	3	11	1950 (57-4502)	1	CR: 23; PR: 14; Died: 1; NM: 23
Central nervous system disorder
Meningoencephalitis[17,20,35,86,87]	6 (4)	Europe: 2; China: 2; SEAR: 1; United States: 1	44	1:1	6	5	GT 3: 2	2	0	142 (20-479)	1	CR: 5; NM: 1
Cerebral ischemia[17,20]	5 (3)	Europe: 3; China: 2	66	4:1	5	4	GT3: 2	0	0	18 (8-28)	0	CR: 3; PR: 2
Seizures[17]	2 (1)	Europe	71	1:1	2	1	GT3: 1	0	0	19 (10-28)	0	CR: 2
Transverse myelitis[88]	1 (0.6)	Europe	62	0:1	1	1	GT3: 1	1	0	1152	0	PR: 1
Neuropathy
Mononeuritis multiplex[36]	6 (4)	Europe	53.16	1:1	6	4	GT3: 3	0	1	188 (118-3641)	1	CR: 5; PR: 1
Peripheral neuropathy[16,20,89]	5 (3)	Europe: 4; China: 1	57.4	3:2	5	5	GT3: 2	2	1	285 (30-1606)	1	CR: 2; PR: 3
Cranial neuropathy
Cranial neuropathy[16,17,90-92]	5 (3)	SEAR: 2; Europe: 2; Japan: 1	53	4:1	2	2	GT3: 1; GT4: 3; ND	0	0	1200 (60-3866)	0	CR: 5
Neuromuscular junction and muscle disorders
Myositis[93]	1 (0.6)	Europe	57	1:0	1	1	ND	0	1	1030	1	CR:1
Myasthenia gravis[18]	1 (0.6)	Europe	33	0:1	1	1	GT3: 1	0	0	190	1	NM: 1
Others neurological disorders
Meningoradiculitis[36,94,95]	6 (4)	Europe	53.33	1:1	6	6	GT3: 5	4	1	406 (40-822)	1	CR: 5; Died: 1
Total cases, n (%)
Total	163	Europe: 120 (74); WHO SEAR: 25 (15); China/Hong Kong: 10 (6), Japan: 4; United States: 2; Iraq: 1	53.9	2.84:1	132 (81)	94 (58)	GT3: 56 (90); GT4: 4; GT1: 2	12 (7)	19 (12)	345.5 (16-4502)	Ribavirin: 16 (10)	CR: 60 (46); PR: 68 (53) Died:2; NM 33 (20)

ALT: Alanine aminotransferase; CR: Complete recovery; CSF: Cerebrospinal fluid; GT: Genotype; HEV: Hepatitis E virus; M:F ratio: Male to female ratio; NM: Not mention; PR: Partial recovery; SEAR: South-East Asia Region; WHO: World Health Organization.