Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

Volume 17, Number 8—August 2011


Neurologic Disorders and Hepatitis E, France, 2010

Laura-Anne Despierres, Elsa Kaphan, Shahram Attarian, Stephan Cohen-Bacrie, Jean Pelletier, Jean Pouget, Anne Motte, Rémi N. Charrel, René Gerolami, and Philippe ColsonComments to Author 
Author affiliations: Author affiliations: Centre Hospitalo-Universitaire Timone, Marseille, France (L.-A. Despierres, E. Kaphan, S. Attarian, S. Cohen-Bacrie, J. Pelletier, J. Pouget , A. Motte, R. Charrel, P. Colson); Université de la Méditerranée, Marseille (S. Cohen-Bacrie, R. Charrel, P. Colson); Centre Hospitalo-Universitaire Conception, Marseille (R. Gerolami)

Main Article

Table A1

Clinical features and laboratory findings for neurologic disorders associated with hepatitis E infection*

Reference and year Country Age, y/sex Neurologic symptoms ALT, IU/L CSF Other infectious etiologies excluded by serologic or molecular testing Serum CSF Treatment/outcome
Leukocytes, cells/mm3 Protein, g/L Anti-HEV IgM Anti-HEV IgG HEV RNA Anti-HEV IgM Anti-HEV IgG HEV RNA
Cases from this study
Case 1, 2010 France 54/F Meningitis with neuralgic pain: headaches, photophobia, diffuse paresthesia, and pain of upper and lower limbs 566 74 1.03 Serum: HAV, HBV, HCV, HIV, measles virus, rubella virus, HSV, VZV, EBV, parvovirus B19, dengue virus, Leptospira spp., Brucella spp., Coxiella burnetii, Rickettsia conorii, R. typhi, R. felis + + + Genotype 3 + NT + Genotype 3 Total recovery in 2 wk
CSF: CMV, HSV, VZV, EBV, HHV6, Toscana virus, mumps virus, measles virus, Listeria monocytogenes, Mycobacteria spp., Mycoplasma spp., all bacteria (16S ribosomal RNA detection)
Case 2, 2010 France 49/M Polyradiculoneuropathy: Proximal muscle weakness, paresthesia, and pain of upper and lower limbs 78 10 1.02 Serum: HAV, HBV, HCV, HIV, EBV, CMV, VZV, parvovirus B19, mumps virus, brucellosis, Bartonella henselae, Bartonella quintana + + + Genotype 3 NT Clinical recovery in 2 wk
CSF: EBV, HSV, VZV, enterovirus, Toscana virus, WNV, Borrelia burgdorferi, all bacteria (16S ribosomal RNA detection)
Cases reported in the literature
Guillain-Barré syndrome:
(6), 2000 India 50/M Generalized paresthesia, weakness of the lower limbs, hypotonia, areflexia 114 <5 1.86 Serum: HAV, HBV, HCV + NT NT NT NT NT Improvement 2 wk after neurologic onset; total recovery within 1 mo
(7), 2002 India 35/M Weakness of upper and lower limbs and of respiratory muscles 752 NT NT Serum: HAV, HBV, HCV, HDV, HIV + NT NT NT NT NT IVIG; total recovery within 2 wk
(8), 2005 India 58/F Muscular weakness, diffuse areflexia, left infranuclear facial palsy 1,448 <2 0.80 Serum: HAV, HBV, HCV + NT NT NT NT NT IVIG, plasmapheresis; total neurologic recovery in 2 wk; tiver biochemistry normalized after about 5 wk
(3), 2008 United Kingdom 42/M Paresthesia and weakness in lower limbs 632 NA NA NA + NA + Genotype 3 NT NT Total recovery after 3 mo
(9), 2009 Belgium 66/M Progressive ataxia; weakness and paresthesia of legs, with ataxia and neuropathic pain 1,813 <5 1.72 Serum: HAV, HBV, HCV, HIV, VZV, CMV, EBV, HSV, adenovirus, Campylobacter spp. + NT NT NT NT NT IVIG; progressive improvement of walking perimeter and pain within 4 mo
(10), 2010 Czech Republic 65/M Loss of strength in upper limbs and partially in lower limbs; pain in both shoulders 1,920 7 0.7 Serum: HSV, EBV, CMV, HAV, HBV, HCV, enterovirus, inflluenza A/B virus, parainfluenza viruses 1–3, adenovirus, tick-borne encephalitis virus, Borrelia burgdorferi, Anaplasma phagocytophilum,Chlamydia pneumoniae, Mycoplasma spp. + +† NT NT NT NT Persistence of residual tetraparesis 19 mo after onset (chronic demyelinating polyneuropathy); improvement after IVIG
CSF: VZV,HSV, enterovirus, A. phagocytophilum,C. pneumoniae, Mycoplasma spp. B. burgdorferi.
(11), 2010 Ireland 40/M Progressive weakness of the legs; paresthesia of hands and feet, then quadriplegia, repiratory insufficiency, and facial weakness 57 <5 0.38 Serum: HAV, HBV, HCV, HIV, CMV, EBV +‡ NA NT NT NT NT IVIG, followed by plasmapheresis; total recovery within 6 mo
(4), 2010 France 44/M Peripheral nerve involvement; proximal muscular weakness of the joints of the 4 limbs; bilateral pyramidal syndrome 105 7 0.76 Serum: HBV, HCV, HIV, CMV, EBV + + + Genotype 3 + Genotype 3 IVIG; no improvement; death 1 mo later from decompensated cirrhosis
CSF: CMV, HSV, VZV, JC virus, Cryptococcus antigen, Toxoplasma gondii, Candida spp
Other neurologic diagnosis
(1), 2001 India 28/F Meningoencephalitis: nuchal rigidity; drowsiness; desorientation; bilateral Babinski reflex and seizure 1,890 12 1.10 Serum: HAV, HBV, HCV, HIV, EBV, Treponema pallidum + + at mo 6 NT NT NT NT Improvement of neurologic symptoms in 3 wk
(12), 2006 India 12/F Acute transverse myelitis: weakness of lower limbs with sphincter dysfunction, pyramidal syndrome NA NA NA Serum: HAV, HBV, HCV, measles virus, rubella virus, HSV + NA NT NT NT NT Total recovery within 10 d without treatment
(2), 2006 India 32/M Bell palsy: right-sided lower motor neuron facial palsy 1,000 NA NA Serum: HAV, HBV, HIV, T. pallidum + NT NT NT NT NT Total recovery in 3 wk
(13), 2009 United Kingdom 44/M Bilateral neuralgic amyotrophy of upper limbs 2,547 NT NT Serum: HAV, HBV, HCV, Borrelia burgdorferi, Treponema pallidum, HTLV + NT NT NT NT NT Resolution of pain 6 wk after onset; total recovery of sensory motor deficiency in 2 y

*ALT, alanine aminotransferase level; CSF, cerebrospinal fluid; HEV, hepatitis E virus; Ig, immunoglobulin; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HSV, herpes simplex virus; VZV, varicella zoster virus; EBV, Epstein-Barr virus; +, positive; NT, not tested; CMV, cytomegalovirus; HHV6, human herpes virus 6; –, negative; HDV, hepatitis D virus, WNV, West Nile virus; HDV, hepatitis D virus; IVIG, intravenous immunoglobulin; NA, not available; HTLV, human T-lymphotropic virus.
†Two weeks after first anti-HEV IgM detection.
‡Weakly positive.

Main Article

Top of Page The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO