Guillain-Barré syndrome associated with preceding hepatitis E virus infection

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


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

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Cohort Studies
  • Feces / virology
  • Female
  • Guillain-Barre Syndrome / epidemiology*
  • Guillain-Barre Syndrome / immunology
  • Guillain-Barre Syndrome / virology
  • Hepatitis Antibodies / immunology*
  • Hepatitis E / diagnosis
  • Hepatitis E / epidemiology*
  • Hepatitis E / immunology
  • Hepatitis E virus / genetics
  • Hepatitis E virus / immunology*
  • Humans
  • Immunoglobulin M / immunology
  • Logistic Models
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Odds Ratio
  • RNA, Viral / analysis*
  • RNA, Viral / cerebrospinal fluid


  • Hepatitis Antibodies
  • Immunoglobulin M
  • RNA, Viral