Makindo Medical Notes

Related Subjects: |Chronic liver disease |Liver Function Tests |Ascites Assessment and Management |Budd-Chiari syndrome |Alcoholism and Alcoholic Liver Disease |Liver Transplantation

⚠️ Hepatitis E carries a significant risk of fulminant hepatic failure, especially in pregnant women (mortality ~20% in the 3rd trimester) and in immunocompromised patients. It is endemic in parts of Asia, Africa, the Middle East, and Central America, where large outbreaks occur.

About Hepatitis E Virus (HEV)

• 🦠 Non-enveloped, positive-sense, single-stranded RNA virus.
• Often presents as a self-limiting hepatitis, but much more severe in pregnancy.
• Fulminant liver failure risk: ~1% in healthy adults, up to 20% in pregnancy.

Aetiology & Transmission

• 💧 Waterborne infection – contaminated drinking water in areas with poor sanitation.
• Common in Asia, Africa, South America, Middle East.
• Rare zoonotic transmission (e.g., undercooked pork or wild game) reported in developed countries.
• Transmitted by the faeco-oral route.

Clinical Presentation

• ⏱️ Incubation period: 2–8 weeks.
• Symptoms resemble hepatitis A:
  • Nausea, vomiting, malaise, anorexia.
  • 🟡 Jaundice and dark urine.
  • Aversion to cigarettes (classic viral hepatitis clue).
  • Fever and abdominal pain may occur.
• ⚠️ Fulminant hepatitis:
  • Occurs in 0.5–4% of the general population.
  • 20% mortality in pregnant women (esp. 3rd trimester).
• Immunocompromised (e.g., transplant, HIV): may progress to chronic HEV.

Investigations

• Anti-HEV IgM: confirms recent infection.
• Anti-HEV IgG: indicates past exposure or immunity.
• HEV RNA PCR: confirms active infection (blood or stool).
• 📈 LFTs: ALT/AST typically markedly raised, bilirubin may be elevated.

Management

• 🤲 Supportive only – no specific licensed antivirals:
  • Rest and hydration.
  • Avoid alcohol and hepatotoxic drugs (paracetamol, NSAIDs).
  • Nutritional support and anti-emetics if required.
• Pregnant women: require close monitoring and often hospital admission due to high risk of fulminant hepatitis.
• Immunocompromised patients: chronic infection may need antivirals such as ribavirin (off-label, under specialist guidance).

Prevention

• 🚰 Safe water and sanitation are key to preventing outbreaks.
• Hepatitis B vaccination indirectly prevents HDV but NOT HEV (no widely available HEV vaccine except in some regions of China).
• Food safety: avoid undercooked meat, particularly pork and shellfish in endemic areas.