Hepatitis E

Endemic in India, South East and Central Asia, Middle east, North Africa, Mexico
15- 40 years, enteric transmission, waterborne, uncommon to have person to
person spread
Mean IP -40 days. High mortality 15-25 % in pregnant, Hepatic decompensation
more with compensated liver disease
HEV self-limited generally. In chronic liver disease patients and immune suppressed
patients like HIV and transplant recipients, and chemotherapy patients a chronic
hepatitis and rapid progression to cirrhosis reported.
Test for anti HEV IgM, (sensitivity and specificity highly variable) serum or stool PCR
Treatment in immunosuppressed patients with chronic HEV where
immunosuppression cannot be reversed -PEGylated interferon alone or with
Ribavirin shown to be effective. In acute severe hepatitis, some role of Ribavirin
shown.( SE of Ribavirin is hemolytic anemia )