Hepatitis E is caused by an enteric transmitted RNA virus and causes the typical symptoms of viral hepatitis, including anorexia, nausea and jaundice. Fulminant hepatitis and death are rare, except during pregnancy. The diagnosis is made by an antibody test. The treatment is symptomatic.
See also causes of hepatitis and overview of the acute viral hepatitis.)
Hepatitis E is caused by an enteric transmitted RNA virus and causes the typical symptoms of viral hepatitis, including anorexia, nausea and jaundice. Fulminant hepatitis and death are rare, except during pregnancy. The diagnosis is made by an antibody test. The treatment is symptomatic. See also causes of hepatitis and overview of the acute viral hepatitis.) There are four genotypes of the hepatitis E virus (HEV). All can cause acute viral hepatitis. The genotypes 1 and 2 usually cause outbreaks caused by drinking water, which are connected with fecal contamination of water supply and fecal-oral human-to-human transmission. In China, India, Mexico, Pakistan, Peru, Russia and Central and North Africa there have been outbreaks. These outbreaks have epidemiologic character as the hepatitis A virus epidemics. Sporadic cases may also occur. No outbreaks have been reported in the United States and Western Europe. Most cases in the developed world occur among tourists who have returned from a developing country, but it has also been sporadic cases are not related to travel in connection reported. Genotypes 3 and 4 typically cause sporadic cases rather than outbreaks. Transmission is by food and eating uncooked or undercooked meat can include; Cases have been associated with the consumption of pork, deer and crustaceans. HEV was not originally assumed that it causes chronic hepatitis, cirrhosis or chronic carrier state; but it is reported about chronic hepatitis E genotype 3 exclusively in immunocompromised patients (including organ donation recipients, patients undergoing chemotherapy for cancer and HIV-infected patients). Symptoms and complaints Typical manifestations of viral hepatitis occur: loss of appetite, malaise, nausea and vomiting, and fever, followed by jaundice. Hepatitis E can be serious, especially in pregnant women; with them the risk of fulminant hepatitis and death are increased. Diagnostic IgM antibody test (if available) should therefore be the viral hepatitis differential diagnosis, distinguished from other diseases that cause jaundice in the early diagnosis of acute hepatitis (Simplified diagnostic approach to potential acute viral hepatitis.). If an acute viral hepatitis is suspected, the following tests to screen for hepatitis viruses A, B and C are carried out: IgM antibody to hepatitis A virus (anti-HAV) hepatitis B surface antigen (HBsAg) IgM antibodies against hepatitis B core (anti-HBc IgM) antibody to hepatitis C virus (anti-HCV) If tests for hepatitis a, B and C are negative, but the patient has typical manifestations of viral hepatitis and has recently been in a corresponding endemic area should for IgM antibodies against HEV (IgM anti-HEV) are examined when the test is available. Therapy Supportive treatment in chronic hepatitis E, may ribavirin No specific treatment softens the course of acute hepatitis, including hepatitis E. Preliminary studies suggest that the antiviral efficacy of ribavirin in the treatment of chronic hepatitis E. Alcohol should be avoided because it increases the liver damage. Restrictions in diet or physical activity incl. The often prescribed bed rest have no scientific basis. Most patients can resume safe to work after the jaundice has subsided, even if the transaminases are still increased. In the cholestatic hepatitis, the administration of cholestyramine can be 8 g p.o. 1 to 2 times reduce the itching daily. The presence of a viral hepatitis is reportable. Prevention Good personal hygiene and standardized general precautions can help prevent the FEKÁL oral transmission of hepatitis E. boil water seems to reduce the risk of infection. Since the transmission from human to human is rare, the isolation of infected patients is not indicated. A vaccine for hepatitis E is now available in some countries; in the US it is not available. The vaccine appears to be an efficacy of up to 95% in preventing symptomatic infection in men to have and is safe. The effectiveness for other groups, the duration of protection and the effectiveness of the prevention of asymptomatic infections are unknown. Important points transmission of hepatitis E is fecal-oral route, as a rule. Most patients recover spontaneously, but pregnant women have an increased risk of fulminant hepatitis and death. Genotype 3 can cause chronic hepatitis in immunocompromised patients. Suspect Hepatitis E to endemic areas with travelers; do IgM anti-HEV tests, if available. Treatment of patients supportive; pull treatment with ribavirin in chronic hepatitis E. considered. A vaccine is available in certain countries. For Germany, the surveillance of the Robert Koch Institute should be noted from the can be seen, the areas in which Germany is a threat. Due to the spread of TBE in more northerly areas of Germany, the vaccination recommendations are adjusted annually.