Hepatitis E

Background

  • Nonenveloped, RNA virus
  • Fecal-oral transmission
  • Common in Southeast Asia, but different genotypes found globally across Asia, Africa, Latin America[1]

Clinical Features

  • Incubation period 2-10 weeks, usually 5-6
  • Acute infection typically presents similar to hepatitis A
  • Liver failure rare except in pregnant women
    • Pregnant women tend to have more severe disease, higher risk of fulminant hepatitis and liver failure, increased risk of fetal loss
    • Mortality of HEV infection in 3rd trimester: 20-25%[2]

Differential Diagnosis

Acute hepatitis

Evaluation

  • Clinically indistinguishable from other viral hepatitides, no serologic test available[3]
  • LFTs
  • INR
    • Coagulopathy correlates w/more severe liver dysfunction
  • Acute hepatitis panel
    • Hep A Ab IgM
    • Hep B cAb IgM
    • Hep B sAg
    • Hep B sAb
    • Hep C Ab
Anti-hepatitis A, IgM Hepatitis B surface antigen Anti-hepatitis B core, IgM Anti-hepatitis C Interpretation
Positive Negative Negative Negative Acute hepatitis A
Negative Positive Positive Negative Acute hepatitis B
Negative Positive Negative Negative Chronic hepatitis B infection
Negative Negative Positive Negative Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect
Negative Negative Negative Positive Acute or chronic hepatitis C; additional tests are required to make the determination


Management

  • Supportive
    • Antiemetics
    • Oral or IV hydration
    • Avoid hepatotoxic medications
  • Patients with fulminant hepatic failure may be considered for liver transplant

Disposition

  • Typically discharge, admit if:
    • Pregnant
    • INR >2
    • Unable to tolerate PO
    • Intractable pain
    • Bilirubin >30
    • Hypoglycemia
    • Significant comorbidity/immunocompromised

See Also

External Links

References

  1. Chaudhry SA et al. Hepatitis E infection during pregnancy. Can Fam Physician. 2015 Jul; 61(7): 607–608.
  2. WHO fact sheet https://www.who.int/news-room/fact-sheets/detail/hepatitis-e
  3. https://www.cdc.gov/hepatitis/hev/hevfaq.htm#c1

Authors:

Claire