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Detailed information of HEPATITIS E
HEPATITIS E
DEFINITION:
An infectious disease of the liver caused by the hepatitis E
virus (HEV) resulting in an acute hepatitis lasting several weeks to
months.
EPIDEMIOLOGY:
- incidence: ?
- age of onset:
- rare in children and most common in adults
- risk factors:
- epidemic (water-borne epidemics in China, Asia, Africa,
Mexico, Central America)
- very rare in North America
PATHOGENSIS:
- a single-stranded RNA calcivirus 27-30 nm in diameter
- cloned in 1990
- routes of infection:
- usually fecal-oral
- can be water-borne
- rarely if ever parenteral
2. Hepatitis E
- previously called "enterically-transmitted non-A, non-B
hepatitis"
- secondary attack rate in household contacts is <3%
2. Pathogenesis
- infection -> 2-9 week incubation period -> hepatocellular
damage (elevated ALT) -> hepatitis
CLINICAL FEATURES:
- arthritis and rash are not present
2. Hepatitis
- clinical manifestations and course essentially the same as
for
- Hepatitis A
- acute onset with duration of illness ranging from several
weeks to months
- while the preicteric phase can last up to 5 days, the
icteric phase lasts from days to months
- generally, Hepatitis E is a mild or inapparent infection in
infants and young children
- may be absent in children but last up to 5 days in
adolescents and adults
- ranges from 37.8-40 C
2. Accompanying Signs/Symptoms
- abdominal pain
- anorexia
- headache
- lethargy
- nausea/vomiting
- hepatomegaly (tender)
- lymphadenopathy
- splenomegaly
2. Icteric Phase
- transition to the icteric phase is marked by the
disappearance of preicteric signs/symptoms in young
children but the exacerbation of these signs/symptoms in
older children and adolescents
- accompanied by dark urine (biliuria) +/- clay-coloured
stools
INVESTIGATIONS:
- striking rise in level after the incubation period and
lasts 2-3 weeks
2. Bilirubin
- transient elevation associated with the peak in ALT levels
lasting from one day to longer than one month
3. Serology
- a practical serologic test is not currently available as
of 1992
2. Liver Biopsy
- immune electron microscopy used to identify the virus
MANAGEMENT:
2. Prognosis
- Hepatitis E is generally a benign disease (except in
pregnant women) and complete resolution of the hepatitis usually
occurs - does not result in chronic hepatitis, liver disease, or
a carrier state (thus a very low risk for perinatal
transmission)
- there is increased morbidity and duration of jaundice with
increasing age
- mortality from fulminant hepatitis is:
- 1-2% in the general population
- 10-20% in pregnant women (highest in the 3rd trimester and
lowest in the 1st)
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Pediatric Database - HEPATITIS E
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