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

There is a significant risk of fulminant hepatic failure from hepatitis E virus (HEV) infection, particularly in pregnant women and immunocompromised individuals. HEV is endemic in many regions of Asia, Africa, the Middle East, and Central America, where large outbreaks can occur.

About Hepatitis E Virus (HEV)

• HEV is a non-enveloped, positive-sense, single-stranded RNA virus.
• Associated with fulminant liver failure in 1% of adults and 20% of pregnant women.

Aetiology

• Primarily a waterborne disease seen in developing countries.
• Transmitted via the faecal-oral route, often linked to poor sanitation.
• Endemic in regions such as Asia, South America, and Africa.

Clinical Presentation

• Symptoms are similar to hepatitis A virus (HAV) infection:
  • Nausea, vomiting, and aversion to cigarettes.
  • Jaundice, anorexia, and fever.
• Fulminant hepatitis occurs in 0.5%-4% of cases in the general population.
• Mortality rate for fulminant hepatitis in pregnant women is 20%, particularly in the third trimester.

Investigations

• Anti-HEV Antibodies: Detection of IgM antibodies indicates a recent or ongoing infection; IgG antibodies suggest past exposure.
• HEV RNA Test: Identifies viral RNA in blood or stool, confirming active infection.
• Liver Function Tests: Elevated liver enzymes (ALT, AST) indicate liver inflammation.

Management

• There is no specific antiviral treatment for hepatitis E; management is supportive:
  • Rest and Hydration: Essential for recovery.
  • Avoiding Alcohol: Reduces additional stress on the liver.
  • Nutritional Support: A balanced diet supports recovery.
  • Symptomatic Medications: May be given for nausea and vomiting relief.
• Pregnant Women: At higher risk for fulminant hepatitis (acute liver failure) with a high mortality rate.
• Immunocompromised Individuals: Such as transplant recipients or those with HIV, may develop chronic hepatitis E, potentially leading to more severe liver damage.