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Neurology. 2014 Feb 11;82(6):491-7. doi: 10.1212/WNL.0000000000000111. Epub 2014 Jan 10.

Guillain-Barré syndrome associated with preceding hepatitis E virus infection.

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From the Departments of Neurology (B.v.d.B., B.C.J.), Viroscience (A.A.v.d.E., S.D.P.), and Immunology (A.P.T.-G., B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Cornwall Gastrointestinal Unit (J.G.H., R.G.M., H.R.D.), Royal Cornwall Hospital Trust, Truro; and European Centre for the Environment and Human Health (J.G.H., R.G.M., H.R.D.), University of Exeter Medical School, Truro, UK.



The aim of the study was to determine whether Guillain-Barré syndrome (GBS) is associated with preceding hepatitis E virus infection.


The frequency of hepatitis E virus (HEV) infections was determined by anti-HEV serology in a cohort of 201 patients with GBS and 201 healthy controls with a similar distribution in age, sex, and year of sampling. Blood samples from patients with GBS were obtained in the acute phase before treatment. In a subgroup of patients with GBS, blood, stool, and CSF samples were tested for HEV RNA.


An increased ratio of anti-HEV immunoglobulin (Ig) M antibodies was found in 10 patients with GBS (5.0%) compared with 1 healthy control (0.5%, odds ratio 10.5, 95% confidence interval 1.3-82.6, p = 0.026). HEV RNA was detected in blood from 3 of these patients and additionally in feces from 1 patient. Seventy percent of anti-HEV IgM-positive patients had mildly increased liver function tests. All CSF samples tested negative for HEV RNA. The presence of anti-HEV IgM in patients with GBS was not related to age, sex, disease severity, or clinical outcome after 6 months.


In the Netherlands, 5% of patients with GBS have an associated acute HEV infection. Further research is required to determine whether HEV infections also precede GBS in other geographical areas.

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