Heptitis eB17.2

Hepatitis E is an acute inflammation of the liver transmitted by an enteric RNA virus (family Hepeviridae) that causes the typical symptoms of acute viral hepatitis. In most cases the infection proceeds asymptomatically. Fulminant hepatitis (about 3%) and death are rare. Chronic hepatitis is rare. The diagnosis is made by an antibody test. The therapy is symptomatic. Vaccination and previous infection offer protection.

The suspected disease, the illness and death from acute viral hepatitis must be reported by name.

Hepatitis E virus (HEV), RNA virus. The transmission of the pathogen (infection route) occurs through contact or smear infection (faecal-oral: infections in which pathogens excreted with the stool (faecal) are ingested orally, e.g. through contaminated drinking water and/or contaminated food. Further infection through contact with animals (pigs, dogs, sheep) or animal foodstuffs (e.g. insufficiently cooked pork; offal). Parenteral infections through contaminated blood products are very rare but possible.

Incubation period: 5-6 weeks.

So far mainly in India, Asia and Africa and in Central America. Hepatitis E thus also belongs to the travel diseases (see also Hepatitis A). In Germany the seroprevalence is about 17%, in Egypt 85%.

Hepatitis E infections are largely asymptomatic or show signs of mild acute hepatitis (to a lesser extent, analogous to the clinical manifestations of hepatitis A). Icterus is rather rare. Clinical symptoms are malaise, fever, nausea and vomiting.

Extrahepatic manifestations: Guillain-Barré syndrome, glomerulonephritis, meningitis, encephalitis, myopathies, non-specific exanthema, arthralgias, cryoglobulinemia.

Microbiological diagnostics (required material: blood serum (anti-HEV IgG, anti-HEV IgM);

stool (HEV antigen). HEV antigen detection in blood or stool shows a fresh hepatitis E infection. Early diagnosis before clinical manifestation and before detection of specific antibodies.

Anti-HEV IgM: evidence of fresh hepatitis E infection; antibodies are detectable 3-6 months from the onset of disease symptoms.

Anti-HEV-IgG: indicates a fresh or expired infection; antibodies are detectable from the beginning of the disease symptoms, usually persist for life; serve as a parameter for the rate of infestation.

General laboratory:

BSG↑; CRP↑; Liver function tests: Bilirubin mostly elevated: 2-3mg/dl; increase of transaminases (500-3.000U/l); GPT; GOT; cholestasis parameter ↑. Possibly only slight increase of gamma-GT. Furthermore: determination of prothrombin time or INR; increase of serum iron, possibly increase of gamma globulin fraction in electrophoresis. Blood count: possibly lymphocytosis. Virus serology to determine virus type and antigen/antibody status.

Supportive treatment; no specific treatment necessary because not effective. Alcohol should be avoided. Restrictions in diet (avoidance of contaminated animal products) or physical activity including frequently prescribed bed rest are not based on scientific evidence.

After the icterus has subsided, most patients are able to work again, although the transaminases are still elevated.

In cholestatic hepatitis, the administration of colestyramine 8 g p.o. once or twice a day can reduce itching.

Ribavirin in severe courses of disease and in immunocompromised patients.

The clinical symptoms typically subside completely after about 2 months. In rare cases, fulminant hepatitis occurs (up to 3%). No chronic hepatitis. No permanent virus carriers.

In pregnant women (up to 20%) or in patients with chronic liver disease a fulminant course is possible.

Infectivity (HEV excretion) is present from 2 weeks before to 2 weeks after the onset of the disease. For icterus: 1 week after the onset of the icterus.