Hepatitis E Virus and Guillain-Barré Syndrome

Guillain-Barré Syndrome has been abundantly in the news as a potential side-effect of an infection with the dreaded Zika virus[1], but a recent infection with the Hepatitis E Virus may be a cause of Guillain-Barré syndrome (GBS), especially in patients with elevated liver enzymes, researchers reported[2].

Of 73 patients diagnosed with GBS, retrospective study in Belgium, six (8%) tested positive on IgM assays for Hepatitis E Virus. Given the possibility of cross-reactivity with other GBS candidates like cytomegalovirus or Epstein-Barr virus, however, the researchers concluded that 4 patients in the cohort (6%) had GBS likely due to Hepatitis E Virus infection.

Along with related studies from the Netherlands and Japan, this latest study suggest that acute Hepatitis E Virus infection is associated with approximately 5% to 8% of cases of Guillain-Barre syndrome.

Classic Guillain-Barré syndrome and acute inflammatory demyelinating polyneuropathy were the most common clinical and electrophysiologic variants[3]. Neither this study nor the reports from the Netherlands and Japan observed any significant features in terms of patient age, sex, severity or duration of illness, electrophysiological findings or response to therapy (typically intravenous immunoglobulin) to differentiate between cases of GBS that were or were not associated with Hepatitis E Virus infection, the researchers said[4].

More study is needed "to better define the role of this epidemiologically important, and in many areas ubiquitous, agent in neurological diseases," the researchers wrote.

Although it is interesting to know which infection could have triggered GBS in a given patient, there are currently no therapeutic implications.

[1] Uncini et al: Zika virus infection and Guillain-Barré syndrome: a review focused on clinical and electrophysiological subtypes in Journal of Neurology, Neurosurgery and Psychiatry – 2016
[2] Stevens et al: Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus–Associated Guillain-Barré Syndrome in Journal of the American Medical Association – 2016. See here.
[3] Cornblath: Electrophysiology in Guillain-Barré syndrome in Annals of Neurology - 1990 

[4] Van den Berg et al: Guillain-Barré syndrome associated with preceding hepatitis E virus infection in Neurology – 2014