Abstract
Hepatitis E virus (HEV) is the first cause of viral hepatitis in the world. While the water-borne HEV genotypes 1 and 2 are found in developing countries, HEV genotypes 3 and 4 are endemic in developed countries due to the existence of animal reservoirs, especially swine. An HEV infection produces many extra-hepatic manifestations in addition to liver symptoms, especially neurological disorders. The most common are neuralgic amyotrophy or Parsonage–Turner syndrome, Guillain–Barré syndrome, myelitis, and encephalitis. The pathophysiology of the neurological injuries due to HEV remains uncertain. The immune response to the virus probably plays a role, but direct virus neurotropism could also contribute to the pathophysiology. This review describes the main neurological manifestations and their possible pathogenic mechanisms.
Highlights
Infection: NeurologicalThe hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide, causing2 million infections and 70,000 deaths every year [1]
This study found that 11/464 (2.4%) of them were positive for anti-HEV IgM ± HEV RNA [43]
A replicon system based on the HEV3 Kernow-C1 p6 strain, in which ORF2 is replaced by the Gaussia luciferase and is secreted following RNA replication [85], was used to study the capacity of human neural cell lines to support HEV replication
Summary
The hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide, causing. ORF1 encodes a non-structural protein with enzymatic domains, including a methyltransferase, a papain-like cysteine protease, a helicase, and a RNA-dependent RNA polymerase. There have been recent reports of nine cases of patients infected with Orthohepevirus C HEV [11,12,13], which is surprising because this virus differs genetically from other human pathogenic strains [14]. Extra-hepatic, especially neurological, manifestations have frequently been described in both acutely and chronically HEV infected patients. This review describes these clinical manifestations and discusses the pathogenic mechanisms that might be involved
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