Hepatitis E

Question 1

How many different genotypes are there for HEV?
Which genotypes are associated with the developed and developing world?
What is the most common route of transmission?

Answer 1

4 types
1,2,4= endemic areas
3= non-endemic areas

Developing world= 1,2
Developed= 3,4

Spread via faeco-oral route due to faecally contaminated drinking water
HEV3= uncooked pork/game meat and shellfish (needs cooking about 71 for virus to be killed)

Very rare in UK

Question 2

How might someone with HEV present?

Answer 2

Tends to be much milder condition which can clear within 1 month without treatment
-60-75% of patients present with jaundice

No chronic infections

Self-limiting and rarely needs treatment

Question 3

When can chronic HEV infections occur?

Answer 3

Occurs mainly with HEV3 genotype in immunocompromised patients

Question 4

What are extra-hepatic manifestations of HEV?

Answer 4

Guillain-Barre syndrome
Bell’s palsy
Acute transvere myelitis

Kidney problem i.e. membranous glomerulonephritis

Pancreatits w/ HEV1

Thrombocytopenia

Aplastic anaemia

Question 5

What serological markers can be used to determine the point in HEV disease course?

Answer 5

Virus in stool during incubation period

Significant raised ALT between 4-6 weeks

IgM anti-HEV 3-4 months post infection

IgG anti-HEV= persist for life i.e. indication of past infection

Question 6

What can be done to prevent HEV?

Answer 6

Sanitiation and clean water
Avoid eating undercooked meat
Vaccines

Question 7

What is the treatment of chronic HEV in immunocompromised patients?

Answer 7

Ribavirin= antiviral (also used on treatment of HCV_