Acute Hepatitis E: Two Sides of the Same Coin

Abstract

The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis

“…If patients present late, an undetectable HEV‐RNA does not necessarily exclude recent infection . Although faecal testing would be more accurate for the diagnosis, blood testing gains wider applicability in daily practice . When HEV‐RNA is undetectable, acute hepatitis E is diagnosed by the presence of anti‐HEV IgM which appears at the end of the incubation period or at the onset of jaundice, and remains detectable for 4‐5 months .…”

A Rare Association between Left Lobe Secondary Biliary Cirrhosis and Budd-Chiari Syndrome Secondary to Hepatocellular Carcinoma in the Non-Cirrhotic Right Liver Lobe

“…The incidence of autochthonous HEV infection in highincome countries has risen in the past few years, mainly caused by genotypes 3 and 4, transmitted by infected pork meat, while genotypes 1 and 2 are endemic in the tropics and are transmitted by contaminated drinking water [15]. Although it is a common cause of self-limited acute viral infection, HEV infection is often unrecognized or misdiagnosed with drug-induced liver injury [16].…”

Hypopituitarism and Hepatitis E Genotype 3 Infection - First Case Report and Review on Immunocompetence in Hypopituitarism

“…the tropical HEV genotypes 1 and 2 are mainly transmitted fecalorally by contaminated drinking water [1]. In the Middle East and North African regions, the seroprevalence of HEV in the general population ranged from 2.0 to 37.5% and was higher in males than in females [2].…”

“…That said, the consumption of raw or undercooked pork meat and liver is the most common cause of hepatitis E infection in these regions. In the vast majority of patients, the infection is either clinically silent or has a benign self-limiting course [1]. However, immunosuppressed individuals, such as transplant recipients or patients with human immunodeficiency virus [HIV]-infection, are at risk for developing a fulminant course of chronic hepatitis E, that may eventually lead to liver fibrosis and cirrhosis [1].…”

“…In the vast majority of patients, the infection is either clinically silent or has a benign self-limiting course [1]. However, immunosuppressed individuals, such as transplant recipients or patients with human immunodeficiency virus [HIV]-infection, are at risk for developing a fulminant course of chronic hepatitis E, that may eventually lead to liver fibrosis and cirrhosis [1]. The rise in hepatitis E infection in industrialized countries will lead to an increased number of infections in patients with other comorbidities, some of them with a negative impact on immune function and thus, at risk for a more complicated course of HEV infection.…”