Hepatitis E

Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). The virus primarily infects humans, although it can also be found in certain animals such as pigs, wild boars, and deer, which may act as reservoirs without showing disease symptoms.

EPIDEMIOLOGY

• Hepatitis E is most prevalent in East and South Asia, contributing to nearly 60% of global cases and 65% of deaths.
• In South Asia, despite high endemicity, only about 25% of young adults show antibodies, indicating limited exposure in early life. In India, seroprevalence increases with age, reaching around 40% in young adults.
• The disease commonly affects young adults and usually follows a self-limiting course, similar to Hepatitis A.
• The mortality rate ranges from 0.5–4%, but it is significantly higher in pregnant women (15–20%), especially during the third trimester, where it may also lead to fetal complications.
• HEV has four genotypes:
  • Genotype 1 & 2 → Asia and Africa
  • Genotype 3 → Worldwide
  • Genotype 4 → China and Japan

INCUBATION PERIOD

The incubation period typically ranges from 15 to 60 days.

MODE OF TRANSMISSION

Hepatitis E is mainly transmitted through the fecal-oral route, commonly due to ingestion of contaminated food or water, similar to Hepatitis A.

CLINICAL MANIFESTATIONS

The disease generally progresses in two phases:

• 1.Prodromal Phase (Early Phase)
  This phase is usually short and presents with:

  • Muscle pain (myalgia)
  • Joint pain
  • Mild to moderate fever
  • Loss of appetite (anorexia)
  • Nausea and vomiting
  • Weight loss (around 2–4 kg)
  • Dehydration
  • Pain in the right upper abdomen, which may worsen with activity

• 2.Icteric (Jaundice) Phase
  This phase may last from a few days to several weeks and includes:

  • Jaundice (yellow discoloration of eyes and skin)
  • Elevated bilirubin levels (>3 mg/dL)
  • Dark-colored urine
  • Pale or clay-colored stools
  • Itching (pruritus)

COMPLICATIONS

Hepatitis E can sometimes lead to serious complications, such as:

• Acute-on-chronic liver failure
• Neurological complications
• Chronic hepatitis (rare cases)

Acute-on-chronic liver failure presents with rapid worsening of liver function, leading to confusion, altered consciousness, or coma.

DIAGNOSIS

Laboratory Findings

• Elevated liver enzymes (ALT > AST)
• Mild increase in alkaline phosphatase
• Serum bilirubin levels typically between 5–20 mg/dL
• Possible leukopenia or changes in white blood cells
• Prolonged prothrombin time and low albumin indicate severe liver damage

Serological Test

• Detection of anti-HEV IgM antibodies confirms acute infection

MANAGEMENT

• There is no specific antiviral treatment for acute Hepatitis E.
• The condition is generally self-limiting, and most patients recover within 4 weeks.
• Management focuses on:
  • Adequate rest
  • Proper hydration
  • Nutritional support
• Consultation with a hepatologist is important for monitoring disease progression.
• Pregnant women and patients with pre-existing liver disease require urgent medical attention due to higher risk of complications.