The Association of Hepatitis E Virus Infection with Guillain-Barré Syndrome: A Systematic Review of Case Studies

Deepthi Arvapally¹, Venkataramana Kandi^2, , Sabitha Vadakedath³ and Sriguna Bannur¹

¹MBBS student Prathima Institute of Medical Sciences, Karimnagar, India

²Department of Microbiology Prathima Institute of Medical Sciences, Karimnagar, India

³Department of Biochemistry Prathima Institute of Medical Sciences, Karimnagar, India

Cite this paper:
Deepthi Arvapally, Venkataramana Kandi, Sabitha Vadakedath and Sriguna Bannur. The Association of Hepatitis E Virus Infection with Guillain-Barré Syndrome: A Systematic Review of Case Studies. American Journal of Infectious Diseases and Microbiology. 2026; 14(2):18-30. doi: 10.12691/ajidm-14-2-1

Abstract

Over 200 recent Guillain-Barré syndrome (GBS) cases in India have raised public health concerns. Infections, notably Campylobacter jejuni and some vaccines, are known risk factors, but causes are still not fully understood. Reports link GBS with Hepatitis E virus (HEV) infection, especially since HEV is common in developing countries like India. This systematic review examines comorbidities, clinical features, and outcomes in GBS patients with HEV infection. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on published case reports of HEV infection in patients later diagnosed with GBS. Google Scholar was used to find relevant studies, including all available full-text reports of GBS after HEV infection. Data were organized in tables and analyzed, and the review protocol was registered with the International Prospective Register of Systematic Reviews (PROSERO: CRD420251102115). After applying selection criteria, 15 case reports from 13 different countries were analyzed. Of the 15 patients (average age 44.6 years), 11 were male (73%). The primary treatment was intravenous immunoglobulin (IVIG), which resulted in complete recovery for 13 cases (87%), while 2 patients (13%) achieved only partial recovery, experiencing residual limb weakness. There were no fatalities reported. This review shows that GBS is a notable extra-hepatic complication of HEV infection. Diagnosing GBS in HEV cases requires thorough cerebrospinal fluid (CSF) analysis and nerve conduction tests. Patients with HEV should be monitored for neurological symptoms, as early detection and intervention can improve outcomes and minimize lasting neurological issues.

Keywords:
Guillain-Barré syndrome (GBS) Hepatitis E virus (HEV) Infection Neurological signs Nerve conduction study Cerebrospinal fluid (CSF)

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