Hepatitis E virus

Background

Microbiology

• Member of the Hepeviridae family of RNA viruses
• Gour genotypes, g1 through g4

Epidemiology

• g1 and g2 are more common in developing countries
  • Cause epidemic hepatitis
  • Transmitted fecal-orally
  • Associated with contaminated water and poor sanitation
• g3 and g4 more common in the North America and Europe
  • Zoonoses associated with pigs; humans are incidental hosts
  • Most severe infections in pregnant women

Clinical Manifestations

• Incubation period of about 4 to 6 weeks
• Flu-like prodrome lasting 1 to 10 days with a low-grade fever, followed by hepatitis
• May develop pale stools, dark urine, and jaundice
• Hepatomegaly and sometimes splenomegaly
  • Cholestasis more common in pregnant women
• Liver enzyme abnormalities, over 1000 initially, and hyperbilirubinemia
• Can progress to fulminant hepatitis
• Particularly high mortality rate in pregnant women (25% in third trimester)