{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:53:35Z","timestamp":1790834015527,"version":"4.1.0"},"reference-count":97,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>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\u2013Turner syndrome, Guillain\u2013Barr\u00e9 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.<\/jats:p>","DOI":"10.3390\/pathogens10121582","type":"journal-article","created":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T03:10:38Z","timestamp":1638760238000},"page":"1582","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Hepatitis E Virus Infection: Neurological Manifestations and Pathophysiology"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7908-1576","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Lhomme","sequence":"first","affiliation":[{"name":"Infinity, Universit\u00e9 Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France"},{"name":"Laboratoire de Virologie, H\u00f4pital Purpan, CHU Toulouse, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1753-1065","authenticated-orcid":false,"given":"Florence","family":"Abravanel","sequence":"additional","affiliation":[{"name":"Infinity, Universit\u00e9 Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France"},{"name":"Laboratoire de Virologie, H\u00f4pital Purpan, CHU Toulouse, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Cintas","sequence":"additional","affiliation":[{"name":"Service de Neurologie, H\u00f4pital Purpan, CHU Toulouse, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8462-3234","authenticated-orcid":false,"given":"Jacques","family":"Izopet","sequence":"additional","affiliation":[{"name":"Infinity, Universit\u00e9 Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France"},{"name":"Laboratoire de Virologie, H\u00f4pital Purpan, CHU Toulouse, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1126\/science.353.6302.862","article-title":"Europe\u2019s new hepatitis problem","volume":"353","author":"Kupferschmidt","year":"2016","journal-title":"Science"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"a031724","DOI":"10.1101\/cshperspect.a031724","article-title":"Hepatitis E Virus Genome Structure and Replication Strategy","volume":"9","author":"Kenney","year":"2019","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4773","DOI":"10.1073\/pnas.1721345115","article-title":"Origin, antigenicity, and function of a secreted form of ORF2 in hepatitis E virus infection","volume":"115","author":"Yin","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1128\/JVI.00585-21","article-title":"The viral ORF3 protein is required for hepatitis E virus apical release and efficient growth in polarized hepatocytes and humanized mice","volume":"95","author":"Sari","year":"2021","journal-title":"J. Virol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Glitscher, M., and Hildt, E. (2021). Hepatitis E virus egress and beyond\u2014The manifold roles of the viral ORF3 protein. Cell. Microbiol., e13379.","DOI":"10.1111\/cmi.13379"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1073\/pnas.1614955114","article-title":"Hepatitis E virus ORF3 is a functional ion channel required for release of infectious particles","volume":"114","author":"Ding","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nair, V.P., Anang, S., Subramani, C., Madhvi, A., Bakshi, K., Srivastava, A., Nayak, B., Ct, R.K., and Surjit, M. (2016). Endoplasmic Reticulum Stress Induced Synthesis of a Novel Viral Factor Mediates Efficient Replication of Genotype-1 Hepatitis E Virus. PLoS Pathog., 12.","DOI":"10.1371\/journal.ppat.1005521"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1099\/jgv.0.001435","article-title":"Update: Proposed reference sequences for subtypes of hepatitis E virus (species Orthohepevirus A)","volume":"101","author":"Smith","year":"2020","journal-title":"J. Gen. Virol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"a031880","DOI":"10.1101\/cshperspect.a031880","article-title":"Classification and Genomic Diversity of Enterically Transmitted Hepatitis Viruses","volume":"8","author":"Smith","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kenney, S.P. (2019). The Current Host Range of Hepatitis E Viruses. Viruses, 11.","DOI":"10.3390\/v11050452"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/hep.31138","article-title":"Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong: A Clinical and Epidemiological Analysis","volume":"73","author":"Sridhar","year":"2021","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.3201\/eid2412.180937","article-title":"Rat Hepatitis E Virus as Cause of Persistent Hepatitis after Liver Transplant","volume":"24","author":"Sridhar","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1093\/infdis\/jiz025","article-title":"Rat Hepatitis E Virus Linked to Severe Acute Hepatitis in an Immunocompetent Patient","volume":"220","author":"Andonov","year":"2019","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wang, B., Harms, D., Yang, X.-L., and Bock, C.-T. (2020). Orthohepevirus C: An Expanding Species of Emerging Hepatitis E Virus Variants. Pathogens, 9.","DOI":"10.3390\/pathogens9030154"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/cid\/civ862","article-title":"High Proportion of Asymptomatic Infections in an Outbreak of Hepatitis E Associated with a Spit-Roasted Piglet, France, 2013","volume":"62","author":"Guillois","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3201\/eid1511.091094","article-title":"Hepatitis E Outbreak on Cruise Ship","volume":"15","author":"Said","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/hep.25505","article-title":"The global burden of hepatitis E virus genotypes 1 and 2 in 2005","volume":"55","author":"Rein","year":"2012","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jcv.2008.09.010","article-title":"Acute hepatitis E in south-west France over a 5-year period","volume":"44","author":"Mansuy","year":"2009","journal-title":"J. Clin. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S1473-3099(08)70255-X","article-title":"Hepatitis E: An emerging infection in developed countries","volume":"8","author":"Dalton","year":"2008","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17086","DOI":"10.1038\/nrdp.2017.86","article-title":"Hepatitis E virus infection","volume":"3","author":"Kamar","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1111\/ajt.12253","article-title":"How Should Hepatitis E Virus Infection Be Defined in Organ-Transplant Recipients?","volume":"13","author":"Kamar","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1056\/NEJMc0708687","article-title":"Chronic Hepatitis E with Cirrhosis in a Kidney-Transplant Recipient","volume":"358","author":"Moal","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1002\/lt.21480","article-title":"Chronic hepatitis E virus infection in liver transplant recipients","volume":"14","author":"Haagsma","year":"2008","journal-title":"Liver Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1056\/NEJMoa0706992","article-title":"Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients","volume":"358","author":"Kamar","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/j.1872-034X.2007.00024.x","article-title":"Persistent infection of hepatitis E virus transmitted by blood transfusion in a patient with T-cell lymphoma","volume":"37","author":"Tamura","year":"2007","journal-title":"Hepatol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"430","DOI":"10.7326\/0003-4819-150-6-200903170-00026","article-title":"Chronic Hepatitis After Hepatitis E Virus Infection in a Patient With Non-Hodgkin Lymphoma Taking Rituximab","volume":"150","author":"Ollier","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e15618","DOI":"10.5812\/hepatmon.15618","article-title":"Persistent Hepatitis E Virus Genotype 4 Infection in a Child with Acute Lymphoblastic Leukemia","volume":"14","author":"Geng","year":"2013","journal-title":"Hepat. Mon."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1182\/blood-2013-03-492363","article-title":"Hepatitis E virus: An underestimated opportunistic pathogen in recipients of allogeneic hematopoietic stem cell transplantation","volume":"122","author":"Versluis","year":"2013","journal-title":"Blood"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.3201\/eid\/1706.101067","article-title":"Hepatitis E Virus seroprevalence and chronic infections in patients with HIV, Switzerland","volume":"17","author":"Witteck","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1056\/NEJMc0903778","article-title":"Persistent Carriage of Hepatitis E Virus in Patients with HIV Infection","volume":"361","author":"Dalton","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e675","DOI":"10.1097\/MD.0000000000000675","article-title":"Outcome of Hepatitis E Virus Infection in Patients with Inflammatory Arthritides Treated with Immunosuppressants","volume":"94","author":"Bauer","year":"2015","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pischke, S., Peron, J.-M., Von Wulffen, M., Von Felden, J., Zu Siederdissen, C.H., Fournier, S., L\u00fctgehetmann, M., Iking-Konert, C., Bettinger, D., and Par, G. (2019). Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study. Viruses, 11.","DOI":"10.3390\/v11020186"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3667","DOI":"10.1016\/S0002-9270(00)02202-4","article-title":"Guillain-Barr\u00e9 Syndrome with Acute Hepatitis E","volume":"95","author":"Sood","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.clineuro.2008.09.005","article-title":"Neuralgic amyotrophy associated with hepatitis E virus","volume":"111","author":"Fong","year":"2009","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"395","DOI":"10.3109\/00365540903496551","article-title":"The entire genome sequence of hepatitis E virus genotype 3 isolated from a patient with neuralgic amyotrophy","volume":"42","author":"Rianthavorn","year":"2010","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1111\/j.1600-6143.2010.03068.x","article-title":"Hepatitis E Virus-Induced Neurological Symptoms in a Kidney-Transplant Patient with Chronic Hepatitis","volume":"10","author":"Kamar","year":"2010","journal-title":"Am. J. Transplant."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3201\/eid1702.100856","article-title":"Hepatitis E Virus and Neurologic Disorders","volume":"17","author":"Kamar","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/apt.15704","article-title":"Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: A multicentre retrospective study","volume":"51","author":"Wallace","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jinf.2018.06.007","article-title":"Acute hepatitis E in French patients and neurological manifestations","volume":"77","author":"Abravanel","year":"2018","journal-title":"J. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e643","DOI":"10.1212\/NXI.0000000000000643","article-title":"Neurologic complications of acute hepatitis E virus infection","volume":"7","author":"Ripellino","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ebiom.2018.08.053","article-title":"Hepatitis E virus infection in acute non-traumatic neuropathy: A large prospective case-control study in China","volume":"36","author":"Wang","year":"2018","journal-title":"EBioMedicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1620\/tjem.236.263","article-title":"Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus","volume":"236","author":"Yazaki","year":"2015","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jhep.2017.07.010","article-title":"Hepatitis E virus infection and acute non-traumatic neurological injury: A prospective multicentre study","volume":"67","author":"Dalton","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/nrneurol.2011.62","article-title":"Clinical and pathophysiological concepts of neuralgic amyotrophy","volume":"7","year":"2011","journal-title":"Nat. Rev. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1212\/WNL.0000000000000112","article-title":"Neuralgic amyotrophy and hepatitis E virus infection","volume":"82","author":"Madden","year":"2014","journal-title":"Neurology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/liv.13557","article-title":"Hepatitis E virus as a cause of acute hepatitis acquired in Switzerland","volume":"38","author":"Fraga","year":"2017","journal-title":"Liver Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1093\/infdis\/jiy128","article-title":"Pathological Cerebrospinal Fluid Findings in Patients With Neuralgic Amyotrophy and Acute Hepatitis E Virus Infection","volume":"217","author":"Fritz","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1212\/WNL.0000000000004297","article-title":"Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy","volume":"89","author":"Dalton","year":"2017","journal-title":"Neurology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.jiph.2019.12.012","article-title":"Screening of hepatitis E in patients presenting for acute neurological disorders","volume":"13","author":"Deroux","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1212\/WNL.0b013e3181cff735","article-title":"Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh","volume":"74","author":"Islam","year":"2010","journal-title":"Neurology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1002\/ana.410270703","article-title":"Guillain-Barr\u00e9 syndrome: Historical aspects","volume":"27","author":"Asbury","year":"1990","journal-title":"Ann. Neurol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1212\/WNL.46.1.96","article-title":"Liver function disturbances in Guillain-Barre syndrome","volume":"46","author":"Oomes","year":"1996","journal-title":"Neurology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0140-6736(96)09095-2","article-title":"Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barre syndrome. Plasma Exchange\/Sandoglobulin Guillain-Barre Syndrome Trial Group","volume":"349","author":"Listed","year":"1997","journal-title":"Lancet"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1056\/NEJM199204233261706","article-title":"The Guillain\u2013Barr\u00e9 Syndrome","volume":"326","author":"Desforges","year":"1992","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1093\/cid\/cit512","article-title":"Hepatitis E and Guillain-Barr\u00e9 Syndrome","volume":"57","author":"GeurtsvanKessel","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1007\/s10072-016-2644-4","article-title":"Guillain\u2013Barr\u00e9 and Miller Fisher syndromes in patients with anti-hepatitis E virus antibody: A hospital-based survey in Japan","volume":"37","author":"Fukae","year":"2016","journal-title":"Neurol. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1212\/WNL.0000000000000111","article-title":"Guillain-Barre syndrome associated with preceding hepatitis E virus infection","volume":"82","author":"Pas","year":"2014","journal-title":"Neurology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1056\/NEJM195607122550201","article-title":"An Unusual Variant of Acute Idiopathic Polyneuritis (Syndrome of Ophthalmoplegia, Ataxia and Areflexia)","volume":"255","author":"Fisher","year":"1956","journal-title":"N. Engl. J. Med."},{"key":"ref_59","first-page":"e1048","article-title":"A Case of Miller Fisher Syndrome and Literature Review","volume":"9","author":"Bukhari","year":"2017","journal-title":"Cureus"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1001\/jamaneurol.2016.3541","article-title":"Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus\u2013Associated Guillain-Barr\u00e9 Syndrome","volume":"74","author":"Stevens","year":"2017","journal-title":"JAMA Neurol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e0038221","DOI":"10.1128\/Spectrum.00382-21","article-title":"Limited Value of Single Sampling for IgM Antibody Determination as a Diagnostic Approach for Acute Hepatitis E Virus Infection","volume":"9","author":"Pineda","year":"2021","journal-title":"Microbiol. Spectr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/liv.14332","article-title":"Higher seroprevalence of hepatitis E virus in autoimmune hepatitis: Role of false-positive antibodies","volume":"40","author":"Llovet","year":"2019","journal-title":"Liver Int."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/nrneurol.2015.234","article-title":"Hepatitis E virus and neurological injury","volume":"12","author":"Dalton","year":"2016","journal-title":"Nat. Rev. Neurol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"ofx121","DOI":"10.1093\/ofid\/ofx121","article-title":"Hepatitis E Virus\u2013Associated Meningoencephalitis in a Lung Transplant Recipient Diagnosed by Clinical Metagenomic Sequencing","volume":"4","author":"Murkey","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jcv.2014.01.026","article-title":"Association between hepatitis E and neurological disorders: Two case studies and literature review","volume":"60","author":"Deroux","year":"2014","journal-title":"J. Clin. Virol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e236922","DOI":"10.1136\/bcr-2020-236922","article-title":"Severe acute hepatitis E infection presenting with acute abdomen and meningoencephalitis","volume":"13","author":"Gynthersen","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Sarkar, P., Morgan, C., and Ijaz, S. (2015). Transverse myelitis caused by hepatitis E: Previously undescribed in adults. BMJ Case Rep., 2015.","DOI":"10.1136\/bcr-2014-209031"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.3201\/eid2111.141789","article-title":"Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E","volume":"21","author":"Perrin","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1111\/apt.12986","article-title":"Extra-hepatic manifestations of autochthonous hepatitis E infection","volume":"40","author":"Woolson","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1177\/0036933015572093","article-title":"Hepatitis E virus infection presenting with paraesthesia","volume":"60","author":"Bennett","year":"2015","journal-title":"Scott. Med. J."},{"key":"ref_71","first-page":"418","article-title":"Hepatitis E infection with Bell\u2019s palsy","volume":"54","author":"Dixit","year":"2006","journal-title":"J. Assoc. Physicians India"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/S0973-6883(12)60082-6","article-title":"Association of Bell\u2019s Palsy with Hepatitis E Virus Infection: A Rare Entity","volume":"2","author":"Jha","year":"2012","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1002\/mus.24959","article-title":"Hepatitis E-induced severe myositis","volume":"53","author":"Mengel","year":"2015","journal-title":"Muscle Nerve"},{"key":"ref_74","first-page":"1510","article-title":"Neurologic Disorders and Hepatitis E, France, 2010","volume":"17","author":"Despierres","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e12784","DOI":"10.1111\/tid.12784","article-title":"Transfusion-acquired hepatitis E infection misdiagnosed as severe critical illness polyneuromyopathy in a heart transplant patient","volume":"19","author":"Belliere","year":"2017","journal-title":"Transpl. Infect. Dis."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Rahmig, J., Grey, A., Berning, M., Schaefer, J., Lesser, M., Reichmann, H., Puetz, V., Barlinn, K., and Siepmann, T. (2020). Disseminated inflammation of the central nervous system associated with acute hepatitis E: A case report. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-01952-5"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s11845-010-0635-7","article-title":"Anti-glycolipid GM2-positive Guillain\u2013Barre syndrome due to hepatitis E infection","volume":"180","author":"Cronin","year":"2010","journal-title":"Ir. J. Med. Sci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s15010-011-0185-6","article-title":"First case of anti-ganglioside GM1-positive Guillain\u2013Barr\u00e9 syndrome due to hepatitis E virus infection","volume":"40","author":"Maurissen","year":"2012","journal-title":"Infection"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.3748\/wjg.15.1645","article-title":"Guillain-Barr\u00e9 syndrome following hepatitis E","volume":"15","author":"Loly","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Abravanel, F., Nicot, F., Lhomme, S., Cazabat, M., Drumel, T., Velay, A., Latour, J., Belliere, J., Cintas, P., and Kamar, N. (2021). Hepatitis E Virus Quasispecies in Cerebrospinal Fluid with Neurological Manifestations. Vaccines, 9.","DOI":"10.3390\/vaccines9101205"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e939","DOI":"10.1212\/NXI.0000000000000939","article-title":"Evidence for Independent Hepatitis E Virus Replication in the Brain","volume":"8","author":"Drijver","year":"2021","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1111\/jvh.12557","article-title":"Evidence of Hepatitis E virus breaking through the blood-brain barrier and replicating in the central nervous system","volume":"23","author":"Shi","year":"2016","journal-title":"J. Viral Hepat."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3389\/fcimb.2019.00052","article-title":"Brain Infection by Hepatitis E Virus Probably via Damage of the Blood-Brain Barrier Due to Alterations of Tight Junction Proteins","volume":"9","author":"Tian","year":"2019","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1093\/infdis\/jix079","article-title":"Hepatitis E Virus Infects Neurons and Brains","volume":"215","author":"Zhou","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"5697","DOI":"10.1128\/JVI.00146-12","article-title":"Adaptation of a Genotype 3 Hepatitis E Virus to Efficient Growth in Cell Culture Depends on an Inserted Human Gene Segment Acquired by Recombination","volume":"86","author":"Shukla","year":"2012","journal-title":"J. Virol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/jvh.12515","article-title":"Extra-hepatic replication and infection of hepatitis E virus in neuronal-derived cells","volume":"23","author":"Drave","year":"2016","journal-title":"J. Viral Hepat."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1016\/S0140-6736(05)67665-9","article-title":"Guillain-Barr\u00e9 syndrome","volume":"366","author":"Hughes","year":"2005","journal-title":"Lancet"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jhep.2015.11.013","article-title":"Stem cell-derived hepatocytes: A novel model for hepatitis E virus replication","volume":"64","author":"Helsen","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines on hepatitis E virus infection. J. Hepatol., 68, 1256\u20131271.","DOI":"10.1016\/j.jhep.2018.03.005"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1080\/14787210.2019.1613889","article-title":"Screening, diagnosis and risks associated with Hepatitis E virus infection","volume":"17","author":"Lhomme","year":"2019","journal-title":"Expert Rev. Anti-infect. Ther."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/S0140-6736(00)02737-9","article-title":"Duration of viraemia and faecal viral excretion in acute hepatitis E","volume":"356","author":"Aggarwal","year":"2000","journal-title":"Lancet"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Huang, S., Zhang, X., Jiang, H., Yan, Q., Ai, X., Wang, Y., Cai, J., Jiang, L., Wu, T., and Wang, Z. (2010). Profile of Acute Infectious Markers in Sporadic Hepatitis E. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0013560"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7326\/0003-4819-153-2-201007200-00257","article-title":"Brief Communication: Case Reports of Ribavirin Treatment for Chronic Hepatitis E","volume":"153","author":"Mallet","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1053\/j.gastro.2010.08.002","article-title":"Ribavirin Therapy Inhibits Viral Replication on Patients with Chronic Hepatitis E Virus Infection","volume":"139","author":"Kamar","year":"2010","journal-title":"Gastroenterology"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMoa1215246","article-title":"Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients","volume":"370","author":"Kamar","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1093\/cid\/ciz953","article-title":"Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study","volume":"71","author":"Kamar","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jhep.2011.01.009","article-title":"Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: A role for ribavirin?","volume":"54","author":"Dalton","year":"2011","journal-title":"J. Hepatol."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/12\/1582\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:39:38Z","timestamp":1760168378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/12\/1582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,3]]},"references-count":97,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["pathogens10121582"],"URL":"https:\/\/doi.org\/10.3390\/pathogens10121582","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,3]]}}}