Hepatitis E virus

Hepatitis E virus

Hepatitis E virus (HEV) is a RNA virus belonging from a family Hepadna viridae under Genus Hepevirus and causes acute liver infection. The virus has at least 4 different types: genotypes 1, 2, 3 and 4. Genotypes 1 and 2 have been found only in humans. Genotype 3 and 4 viruses circulate in several animals (including pigs, wild boars, and deer) without causing any disease, and occasionally infect humans.

Clinical presentation

Prodromal phase symptoms

• Myalgia

• Arthralgia

• Fever with mild temperature elevations

• Anorexia

• Nausea/vomiting

• Weight loss

• Dehydration

• Right upper quadrant pain

Icteric phase symptoms

Symptoms may last days to several weeks and include:

• Jaundice

• Dark urine

• Light-colored stool

• Pruritus

Other clinical features

• Malaise (most common)

• Arthritis

• Pancreatitis

• Aplastic anemia

• Thrombocytopenia

• Neurologic symptoms of polyradiculopathy

• Guillain–Barré syndrome

• Bell palsy

• Peripheral neuropathy

• Ataxia

• Mental confusion

• Membranoproliferative glomerulonephritis

• Membranous glomerulonephritis

Investigations

Serological testing

• Serology assays for HEV immunoglobulin titres:

  • IgM is diagnostic for acute infection.

  • IgG is diagnostic for post exposure/chronic infections.

Molecular testing

• Real time PCR for HEV RNA in serum and particularly in stool is confirmatory.

Treatment

There is no specific treatment for cure or reversing the course of acute hepatitis E. The disease is usually self-limiting; hospitalization is generally not required except for patients with fulminant hepatitis or for symptomatic pregnant women where severity of infection is usually high and associated with high rates of fetal loss and mortality especially in third trimester.