Hepatitis E

Introduction

Hepatitis E is an infection that causes inflammation of the liver. It is caused by the hepatitis E virus (HEV). Hepatitis E leads to acute illness in most cases that may present with serious symptoms. This infection is contagious and can spread through food or water that has been contaminated by the fecal matter of an infected person. Unlike hepatitis B and C, hepatitis E usually recovers well on its own without any risk of future complications. This infection can be prevented by following proper sanitary measures.

 

Types

The virus has at least four different types: genotypes 1, 2, 3, and 4. Only genotypes 1 and 2 have been discovered in humans. Genotypes 3 and 4 are found in a variety of species, including pigs, wild boars, and deer, and can infect humans occasionally.

 

Causes

Hepatitis E is caused by the hepatitis E virus (HEV), which is usually transmitted by fecal-oral contamination. If you eat or drink something that has been contaminated with the fecal matter of an infected person, you can develop hepatitis E. This type of contamination can happen if you eat prepared food by someone who does not follow a proper hand wash routine or maintain hygiene safety. There are a few other ways of transmission of this virus. One of them is drinking polluted or contaminated water. You may also contract this virus if you eat raw shellfish that have been captured from contaminated water. In rare cases, the virus can also enter your body if you eat meat or products from infected animals. This virus can also spread through vertical transmission, i.e., from mother to her child.

 

Risk Factors and Epidemiology

The risk of hepatitis E is increasing in developing countries where hygiene measures are not followed as strictly as in developed countries. It can also spread if the water supply of a specific region has been contaminated with this virus. Traveling to rural areas where there are active cases of hepatitis E can lead to the spread of this infection. Those who work with non-human primates such as cows, sheep, goats, etc., are also exposed to the risk of contracting this virus if any of the animals get infected. Pregnant females are especially at risk because the infection may spread to their infants and cause serious complications.

Around 20 million people are infected each year by the hepatitis E virus. It is more predominant among adults compared to hepatitis A, which is more common among children. Sporadic cases of hepatitis E occur in Pakistan throughout the year. The percentage of hepatitis E cases is comparatively lower than other forms of hepatitis.

 

Signs and Symptoms

Signs and symptoms of hepatitis E do not develop in every individual. If you get contaminated by this virus, it may take 2 to 6 weeks for the signs and symptoms to become apparent. The symptoms of this infection include fever, abdominal pain, jaundice, fatigue, clay-colored stools, dark urine, nausea or vomiting, loss of appetite, unexplained weight loss, and persistent itching. Most of these symptoms are mild in nature but may develop severity in certain cases.

 

Diagnosis

It is difficult to diagnose hepatitis E on the basis of symptoms alone. Some people may develop symptoms while others don’t. When multiple cases occur in known disease-endemic regions, or when hepatitis A has been ruled out, a diagnosis can often be strongly suspected. Your doctor may require a brief history to identify the possible cause and its route of contamination. A physical examination can be done, including looking for signs of jaundice and abdominal pain. The conformational diagnosis of hepatitis E can be made by running a blood test for the presence of this virus. Identifying specific anti-HEV immunoglobulin M (IgM) antibodies to the virus in a person's blood is usually enough to provide a definitive diagnosis of hepatitis E infection in places where the disease is common. Another test for detecting hepatitis E virus RNA in blood and stool is RT-PCR (Reverse transcriptase-polymerase chain reaction). This test is especially essential in settings where hepatitis E is uncommon and in rare cases of persistent HEV infection.

 

Differential Diagnosis

Hepatitis E should be differentiated from other forms of hepatitis such as hepatitis A, B, C, D, alcoholic hepatitis, and autoimmune hepatitis. It should also be distinguished from other diseases that cause fever, jaundice, abdominal pain, or gastrointestinal issues. Differentiation can be done on the basis of blood tests for this virus.

 

Treatment

There are no particular methods to treat hepatitis E. In majority of the cases, this infection goes away on its own without any complications. The treatment options are mainly focused on improving symptoms. Bed rest is suggested for a few days or weeks, depending on the severity of your symptoms. Drink plenty of water and maintain a balanced diet to speed up the recovery process. Nausea or loss of appetite can make it difficult to eat, so you can try eating small portions of meals frequently throughout the day. Alcohol should be avoided at all costs during the recovery period of this infection. You should also avoid preparing food for others during this period. Pregnant females will most likely be kept under attention to watch for any complications.  

 

Medication

Medications are not required to treat hepatitis E. If you develop any symptoms, talk to your doctor before taking any over-the-counter medicines. Ribavirin, an antiviral drug, has shown efficacy in people with chronic hepatitis E who are immunocompromised. Interferon has also proven to be effective in a few specific situations.

 

Prognosis

It can take 4 to 6 weeks to recover completely from this infection. Rest is recommended during this period until you start to feel better. The risk of complications and fatality is rare, but it may occur among older adults or those with weakened immune systems.

 

Prevention

Vaccines have been made to prevent hepatitis E, but they are not available worldwide yet. The best way to prevent hepatitis E is to follow proper sanitary guidelines. Avoid eating food from endemic areas or places where hygiene is not maintained. Hepatitis E can also be prevented by washing your hands thoroughly before eating, drinking, or preparing food. If you travel to an area with active cases of infection, avoid drinking water from unreliable sources.