Hepatitis E (patient information)
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Hepatitis E |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S; João André Alves Silva, M.D. [2]
Overview
Hepatitis E is a liver disease caused by the hepatitis E virus. The hepatitis E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4–6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death.
What are the symptoms?
The incubation period following exposure to the hepatitis E virus ranges from three to eight weeks, with a mean of 40 days.
The incidence of hepatitis E is highest in adults between the ages of 15 and 40. Though children often contract this infection as well, they less frequently become symptomatic.
Typical signs and symptoms of hepatitis include:
- Fever
- Jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools)
- Malaise
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Fever
- Hepatomegaly
- Other less common features include diarrhea, arthralgia, pruritus, and urticarial rash
Some patients have asymptomatic infection.
Diagnosis
Cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis.
Diagnosis of hepatitis E infection is, therefore, usually based on:
- Detection of specific IgM and IgG antibodies to the virus in the blood
- Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA in blood and/or stool, but this assay may require specialized laboratory facilities.
Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded.
The following tests are done to identify and monitor liver damage from hepatitis B:
Transmission
The hepatitis E virus is transmitted mainly through the fecal-oral route due to fecal contamination of drinking water.
Other transmission routes have been identified, including:
- Foodborne transmission from ingestion of products derived from infected animals
- Transfusion of infected blood products
- Vertical transmission from a pregnant woman to her fetus
- Ingestion of raw or uncooked shellfish has also been identified as the source of sporadic cases in endemic areas.
Although humans are considered the natural host for the hepatitis E virus, antibodies to the hepatitis E virus or closely related viruses have been detected in primates and several other animal species.
Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks.
The risk factors for hepatitis E are related to poor sanitation in large areas of the world and shedding of the hepatitis E virus in faeces.
Treatment options
Hepatitis E usually resolves on its own over several weeks to months.
Possible Complications
Chronic hepatitis, Liver failure
What to expect (Outlook/Prognosis)?
Mortality rates are generally low, for Hepatitis E is a “self-limiting” disease, in that it usually goes away by itself and the patient recovers. In rare cases, acute hepatitis E can result in fulminant hepatitis (acute liver failure) and death.
Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20% among pregnant women in their third trimester.
Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people.
Prevention
Improving sanitation is the most important measure, which consists in proper treatment and disposal of human waste, higher standards for public water supplies, improved personal hygiene procedures and sanitary food preparation. Thus, prevention strategies of this disease are similar to those of many others that plague developing nations, and they require large-scale international financing of water supply and water treatment projects. A vaccine based on recombinant viral proteins has been developed
Diseases with similar symptoms
Sources
http://digestive.niddk.nih.gov/ddiseases/pubs/viralhepatitis/#hepe World Health organization