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home - Liver - Various Viruses - Hepatitis E Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Hepatitis E

Written by Dr Sebastian Zeki Time course of HEV infection 13 weeks Time Start of symptoms Jaundice (of around 3-4 weeks duration HEV in stool (of around 3-4 weeks duration HEV in blood (of around 1-2 weeks duration) Titre of antibody or ALT (arbitrary units) IgM antiHEV IgG antiHEV ALT The incubation period after oral exposure is four to five weeks. Can also use IgG and IgM After solid organ transplantation Can develop chronicityThis is assoc. with lower counts of lymphocytes and of CD2, CD3, and CD4 T cells. Diagnosis:Detection of HEV in serum or stool by PCR or IgM antibodies to HEV can be used.PCR is better for HEV detection as IgM detection lacks sensitivity. PathologyFocal necrosis, ballooned hepatocytes, and acidophilic degeneration of hepatocytes. Perinatal transmission —HEV infection can be transmitted from mother to newborn with substantial perinatal morbidity and mortality. TransmissionThis is by faecally contaminated water in endemic areas.Transmission can occur by blood transfusion, particularly in endemic areas.Hepatitis E can infect pigs and rodents and some cases are due to consumption of under-cooked deer meat, wild boar meat, and internal organs of animals.Rodents appear to serve as a reservoir in some regions. EpidemiologyThis similar to that of hepatitis A virus (HAV).The highest incidence of HEV infection is in Asia, Africa, Middle East, and Central America.HEV is the second most common cause of sporadic hepatitis in North Africa and the Middle East.Usually occurs in 15-40 years of age.Low secondary attack rates as low person-to-person transmission rates. Viraemia can persist for up to 4mIgM anti-HEV appears during early phase of clini-cal illness and disappears rapidly over 4-5mThe IgG response appears shortly after the IgM response, and its titer increases throughout the acute phase into the convalescent phase, remain-ing high from 1 -14 years after the acute phase. Faeco-oral transmission Passes out in diges-tive tract Replica-tion in liver Passes out in stool Hepatitis E HEV can be detected in stool 1w before the onset of illness and persists for as long as 2w thereafter.Because HEV is enterically transmitted, patients are infectious during fecal shedding. Natural HistoryIllness is usually self-limiting and never chronic.Incubation period is from 15-60 d.Signs and symptoms are similar to other viral hepatitis.Prolonged cholestasis occurs in up to 60 % of patients.Jaundice is usually accompanied by malaise, anorexia, nausea, vomiting, abdominal pain, fever, and hepatomegaly.Other less common features include diarrhea, arthralgia, pruritus, and urticarial rash.Some patients are asympto-matic.Fulminant hepatitis can occur, resulting in an overall case fatality rate of 0.5 to 3 %Resolution of the abnormal biochemical tests generally occurs within 1-6 weeks after the Clinical ManifestationsPregnancy has a mortality rate of 20% esp in the 3rd trimester- pregnancy predisposes to increased viral replication.Preexisting liver disease and those who are malnourished —Infection with HEV can lead to hepatic decompensation in patients with preexisting liver disease and those who are malnourished. HEV is an icosahedral, nonenveloped single stranded RNA virus that is 27 to 34 nm in diameter Is a member of the hepevirus4 genotypes exist- Prevention And TreatmentVaccines are in development.Pre- or post-exposure immune globulin (IG) prophylaxis is of no proven benefit.For prevention, avoid drinking water of unknown purity, uncooked shellfish, and uncooked fruits or vegetables.Treatment of infection remains support-

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