Hepatitis E - Causes, Types, Symptoms, Diagnosis, and Treatment

Introduction:

Hepatitis E is a virus that causes hepatitis E infection in the liver. It causes inflammation or swelling of the liver and results in liver damage. This disease results from consuming water contaminated (mixing of dirty or harmful substances) with human wastes of an infected person, common in developing countries (like Argentina, Brazil, and India), or consuming undercooked meat like pork or deer, common in developed countries (like the USA, Japan, and parts of European countries).

What Is Hepatitis E?

Hepatitis E is a viral disease that infects and damages the liver. It is caused by the virus hepatitis E (HEV).

What Causes Hepatitis E?

• Consuming unclean water mixed up with human waste. Consuming even a very small amount of the infected water can cause hepatitis E. This is common in developing countries like Africa, the Middle East countries, Asia, and Middle American countries.

• Intake of undercooked meats like pork or wild deer. This is common in developed countries like the USA (United States of America), Australia, Japan, and some European countries.

What Are the Types of Hepatitis E?

1. Acute Hepatitis E: Acute hepatitis E occurs in a short duration. This type of infection lasts for a few days to a few weeks in the body. The body’s immune system usually fights this infection, and treatment is not needed.

2. Chronic Hepatitis E: Chronic hepatitis E occurs in patients with a poor immune system. The infection lasts long since the patient has a compromised immune system, and the body cannot fight the virus. This chronic hepatitis E can occur in patients taking immune-suppressing medications after organ transplantation or patients with HIV (human immunodeficiency virus).

What Are the Symptoms of Hepatitis E?

• Mild fever.

• Yellowish discoloration of the skin and eyes (jaundice).

• Feeling weak and tired.

• Poor appetite.

• Dark-colored urine.

• Pale-colored stool.

• Pain in the right upper region above the stomach.

• Skin rashes.

• Joint pain.

• Nausea and vomiting.

What Tests Are Performed to Find Hepatitis E?

• Physical Examination: The doctor will do a physical exam to check for enlarged liver, check eyes and skin for yellowish discoloration, and to check if there is pain in the abdominal (stomach) region.

• Travel History: The doctor will ask for your travel history, like any recent trips to developing countries (Africa, Asia, the Middle East, or Middle America).

• Blood Test: A blood test is performed to screen for the presence of anti-HEV immunoglobulin M (IgM) antibodies. It is also done to look for white blood cell count (WBC).

• Stool Test: A stool sample of the patient is screened to check for the presence of the hepatitis E virus (HEV) in the stool.

• Liver Function Tests: Liver function tests are a group of tests that include the screening of liver enzymes, proteins, and prothrombin time. Liver enzymes like alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transaminase (GGT), and proteins like albumin and globulin are screened for diagnosing liver disease. The changes in the normal values of these enzymes and proteins suggest liver disease.

How Is Hepatitis E Treated?

• Acute Hepatitis E: Treatment is not usually needed for acute hepatitis as the body’s immune system fights the virus and removes it from the body. It will take a few days to a few weeks to recover from the infection. A symptomatic approach to help the patient recover from the illness is as follows:

  • Minimal physical activity, which is tolerable by the patient.

  • Drinking plenty of liquids like water or fresh juices.

  • Following a nutritious diet, like eating proteins, carbohydrates, fibers, and vitamins and minerals in equal proportions.

  • Avoid consuming alcohol.

  • If the patient is dehydrated, hospitalization and fluid therapy will help them recover.

  • Consult a doctor before taking medications like Acetaminophen.

• Chronic Hepatitis E:

  • Antiviral medication (Ribavirin) is prescribed in immunocompromised (patients with a poor immune system) patients for a period of 21-days.

  • Consult a doctor before taking medications like Acetaminophen.

What Are the Complications of Hepatitis E?

• The complications of Hepatitis E are very minimal. However, this can result in liver failure in a short time (when the liver does not function properly), which can be fatal (can cause death) sometimes.

• Pregnant females who get Hepatitis E have an increased risk of severe illness or fatality (causing death).

• Immunocompromised patients who develop acute hepatitis E are at an increased risk of developing chronic hepatitis E.

How Long Does Hepatitis E Virus Remain in an Infected Person?

There is no particular period for the virus to stay in the body. But depending on the virus elimination in the stool, it is estimated that the infection is present from one week before jaundice (yellowish discoloration of the skin and eyes) appears to 30 days after jaundice resolves.

Who Gets Symptomatic Hepatitis E?

A few people do not develop symptoms of hepatitis E. However, some people in developing countries, like young to older adults between 15 to 45 years, develop symptomatic hepatitis E.

When Does the Symptom Appear After Hepatitis E Infection?

The symptoms appear within 15 to 60 days after exposure to the virus.

How Can Hepatitis E Be Prevented?

• Clean your hands with water and soap before eating or drinking, before you cook food, after using a bathroom, or after changing a diaper.

• Do not drink water from bottles that are not sealed, tap water, or water in an unknown or unclean place in developing countries.

• Drink water from a labeled and sealed bottle.

• Do not eat uncooked or undercooked pork or deer meat.

Can Animals Spread Hepatitis E Infection?

Hepatitis E affects mammals (animals that give birth to young ones, they do not lay eggs) like pigs, boar, and deer. Consuming uncooked or undercooked meat of these infected animals can cause hepatitis E infection in humans.

What Is the Prognosis of Hepatitis E?

The prognosis of hepatitis E is good.

Are there Any Vaccinations for Hepatitis E?

There are no FDA-approved vaccinations against hepatitis E. Although a vaccine against hepatitis E is available in China, it was approved in 2012.

Conclusion:

Hepatitis E virus infection causes liver swelling and damage. The virus can be acquired by consuming contaminated water and eating uncooked meats of pork and deer. Proper travel history and physical examination, along with some diagnostic tests, help the doctors rule out the infection. Treatment is usually not required, as the body fights the infection and heals. Since the liver has self-healing properties, the damage to the liver is reversible. Hepatitis E is not fatal except in pregnant females, as it leads to severe illness and fatality. This infection does not generally require treatment, but detecting the infection early and getting appropriate treatment will help the patient recover fast and live a healthy life.