In children, Hepatitis E infection does not produce symptoms. It mostly affects adults as this disease mimics hepatic illness with features such as fatigue, jaundice, nausea, emesis, fever, anorexia, hepatomegaly, and abdominal pain. The duration is 1 to 2 weeks. Rarely does this infection cause acute liver failure.

• Fever

  The prevalence rates of prodromal fever, fatigue, loss of appetite, and jaundice were 25.6%, 85.6%, 83.8%, and 92.8%, respectively. [ncbi.nlm.nih.gov]

  This disease used to be called "break-bone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. Health experts have known about dengue fever for more than 200 years. [niaid.nih.gov]

  School Exclusion Policy Children with fever should be excluding from school or childcare until fever free for 24 hours without the use of fever suppressing medications. [dshs.texas.gov]

  Blood specimens were tested for alternative acute infectious hepatitis etiologies, specifically yellow fever and viral hemorrhagic fevers. All eight were negative for these alternative etiologies. [cdc.gov]

  However, like any acute hepatitis, symptoms of hepatitis E are usually flu-like causing fever, abdominal pain, nausea, muscle and joints aches and loss of appetite. [verywellhealth.com]

• Malaise

  A non-pregnant Canadian woman returning from India presented with a 1-week history of jaundice and malaise. Subsequently, she developed fulminant hepatic failure caused by hepatitis E virus (HEV). [ncbi.nlm.nih.gov]

  Hepatitis E is caused by an enterically transmitted RNA virus and causes typical symptoms of viral hepatitis, including anorexia, malaise, and jaundice. Fulminant hepatitis and death are rare, except during pregnancy. [msdmanuals.com]

• Weight Loss

  Symptoms may include: abdominal pain loss of appetite weight loss nausea (and sometimes vomiting) fever and chills mild headache tiredness dark urine and pale faeces yellow skin and eyes (jaundice) (see image). [sahealth.sa.gov.au]

  They include: fatigue flu-like symptoms dark urine pale stool abdominal pain loss of appetite unexplained weight loss yellow skin and eyes, which may be signs of jaundice Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle [healthline.com]

• Splenomegaly

  Histopathological features were a non-specific chronic hepatitis similar to those described in BLS and hepatitis-splenomegaly syndrome. [ncbi.nlm.nih.gov]

  [Google Scholar] ) and hepatitis-splenomegaly syndrome (HSS) in North America (Shivaprasad, 2003 Shivaprasad, H.L. 2003. “ Hepatitis splenomegaly syndrome ”. [doi.org]

• Orthopnea

  We report a 52-year-old man who presented with neck and shoulder pain followed by orthopnea and left arm weakness. Electrodiagnostic testing showed left phrenic neuropathy and denervation in bilateral C5 and C6 myotomes. [ncbi.nlm.nih.gov]

• Nausea

  Hepatitis E Hepatitis E virus Specialty Infectious disease Symptoms Nausea, jaundice Parvez, Mohammad Khalid (2013-01-01). "Chronic hepatitis E infection: risks and controls". Intervirology. 56 (4): 213–216. doi:10.1159/000349888. ISSN 1423-0100. [en.wikipedia.org]

  However, like any acute hepatitis, symptoms of hepatitis E are usually flu-like causing fever, abdominal pain, nausea, muscle and joints aches and loss of appetite. [verywellhealth.com]

  Symptoms of hepatitis E infection include nausea, mild flu-like symptoms, abdominal pain, vomiting and aching joints and muscles, jaundice and fatigue. [news-medical.net]

  When symptoms occur they may include mild fever, nausea/vomiting, abdominal pain and jaundice. Most infections get better without treatment. [fitfortravel.nhs.uk]

• Vomiting

  Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4-7.9) than controls; possibly due to selection bias. [ncbi.nlm.nih.gov]

  Because of this, symptoms of hepatitis E infection could include vomiting and diarrhea. [verywellhealth.com]

  Symptoms of hepatitis E infection include nausea, mild flu-like symptoms, abdominal pain, vomiting and aching joints and muscles, jaundice and fatigue. [news-medical.net]

  When symptoms occur they may include mild fever, nausea/vomiting, abdominal pain and jaundice. Most infections get better without treatment. [fitfortravel.nhs.uk]

• Abdominal Pain

  However, like any acute hepatitis, symptoms of hepatitis E are usually flu-like causing fever, abdominal pain, nausea, muscle and joints aches and loss of appetite. [verywellhealth.com]

  Symptoms of hepatitis E infection include nausea, mild flu-like symptoms, abdominal pain, vomiting and aching joints and muscles, jaundice and fatigue. [news-medical.net]

  When symptoms occur they may include mild fever, nausea/vomiting, abdominal pain and jaundice. Most infections get better without treatment. [fitfortravel.nhs.uk]

  Symptoms Usually symptoms appear 2 to 9 weeks after exposure to the virus and include fever, fatigue, lack of appetite, abdominal pain, and jaundice. Treatment includes supportive care of symptoms. [iamat.org]

• Loss of Appetite

  The prevalence rates of prodromal fever, fatigue, loss of appetite, and jaundice were 25.6%, 85.6%, 83.8%, and 92.8%, respectively. [ncbi.nlm.nih.gov]

  Hepatitis E causes typical symptoms of viral hepatitis, including loss of appetite, a general feeling of illness, and jaundice. Doctors diagnose hepatitis E based on blood tests. [msdmanuals.com]

  However, like any acute hepatitis, symptoms of hepatitis E are usually flu-like causing fever, abdominal pain, nausea, muscle and joints aches and loss of appetite. [verywellhealth.com]

  Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea [hepfi.org]

  Symptoms of the virus can include feeling flu-like, yellowing of the skin and eyes, tiredness, fever, vomiting and loss of appetite. In rare cases it can cause liver failure and prove fatal. [theguardian.com]

• Diarrhea

  Children with diarrhea should be excluding from school or childcare until after diarrhea free for 24 hours without the use of diarrhea suppressing medications. [dshs.texas.gov]

  Shigella causes roughly 500,000 cases of diarrhea in the United States each year. [niaid.nih.gov]

  The general symptoms of hepatitis E can be: Fatigue Abdominal pain and tenderness Nausea, vomiting Loss of appetite Diarrhea Dark coloured urine Pale feces Jaundice in some cases (yellow discoloration of the skin and sclera of the eyes) People who have [bccdc.ca]

  Because of this, symptoms of hepatitis E infection could include vomiting and diarrhea. [verywellhealth.com]

  If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition. The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. [healthline.com]

• Dysgeusia

  Following the initiation of treatment with intravenous immunoglobulin, his paralysis and dysgeusia rapidly improved. This case suggests that HEV-associated GBS may rarely be complicated by dysgeusia. [ncbi.nlm.nih.gov]

• Jaundice

  Histories of jaundice and jaundice-related death were also obtained. For the seroprevalence survey, a random sample of residents was identified from the list created during the census. [doi.org]

  Acute jaundice syndrome (AJS) cases, by surveillance week — Jamam, Gendrassa, and Yusuf Batil refugee camps, South Sudan, 2012–2013 Alternate Text: The figure above shows acute jaundice syndrome (AJS) cases by surveillance week in the Jamam, Gendrassa [cdc.gov]

  METHODS: A total of consecutive 267 pregnant women with jaundice were recruited. The jaundiced patients were classified as acute viral hepatitis (AVH) or acute liver failure (ALF). [ncbi.nlm.nih.gov]

  For patients from whom sera were collected 1–16 days after onset of jaundice, the geometric mean IgG titer (GMT) was 1:47,000; the GMT increased to 1:70,710 30–40 days after onset of jaundice and decreased to 1:1,778 3–4 months after the onset of jaundice [dx.doi.org]

• Hepatomegaly

  Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea [hepfi.org]

  It mostly affects adults as this disease mimics hepatic illness with features such as fatigue, jaundice, nausea, emesis, fever, anorexia, hepatomegaly, and abdominal pain. The duration is 1 to 2 weeks. [symptoma.com]

  Patients who develop symptoms tend to present with non-specific symptoms that are not clinically distinguishable from other types of acute viral hepatitis, including: Jaundice; Malaise; Anorexia; Nausea; Vomiting; Abdominal pain; Hepatomegaly; Pruritus [pharmaceutical-journal.com]

  Right upper quadrant abdominal tenderness and hepatomegaly may be present. [ncbi.nlm.nih.gov]

  Symptoms include nausea, vomiting, abdominal pain, and hepatomegaly (11, 12). Jaundice is present in 75% of cases affected by these genotypes (11) compared to 40% for genotypes 1 and 2 (12). [frontiersin.org]

• Shoulder Pain

  We report a 52-year-old man who presented with neck and shoulder pain followed by orthopnea and left arm weakness. Electrodiagnostic testing showed left phrenic neuropathy and denervation in bilateral C5 and C6 myotomes. [ncbi.nlm.nih.gov]

• Dark Urine

  Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea [hepfi.org]

  Hepatitis E affects an estimated 20 million people around the world each year, with typical symptoms including jaundice, dark urine and pale stools, abdominal pain and tenderness, nausea and vomiting, fever, and an enlarged, tender liver. [reuters.com]

  They include: yellowing of the skin (jaundice) dark urine joint pain a loss of appetite pain in the abdomen liver enlargement acute liver failure nausea vomiting fatigue fever Most cases of hepatitis E are caused by drinking water contaminated by fecal [healthline.com]

  Symptoms The signs and symptoms of Hepatitis E are similar to those of other types of acute viral hepatitis: fever, fatigue, jaundice (skin or whites of eyes turning yellow), loss of appetite, nausea, vomiting, abdominal pain, dark urine and clay colored [dshs.texas.gov]

• Headache

  We report the case of a 62-year-old Caucasian woman who was admitted with urinary retention and lower limb paraesthesia following a week's prodromal illness of headache and malaise. [ncbi.nlm.nih.gov]

  Symptoms may include: abdominal pain loss of appetite weight loss nausea (and sometimes vomiting) fever and chills mild headache tiredness dark urine and pale faeces yellow skin and eyes (jaundice) (see image). [sahealth.sa.gov.au]

  People infected with the seasonal flu virus feel miserable with fever, chills, muscle aches, coughing, congestion, headache and fatigue for a week or so. [niaid.nih.gov]

  Clinical features can include fever, chills, jaundice, dark urine, anorexia, nausea, vomiting, abdominal pain, headache, myalgia, and arthralgia ( 1 – 3 ). In general, HEV infection is more likely to be subclinical in children ( 1 ). [doi.org]

  These medications are generally well tolerated with few side effects, though they may cause headache, nausea, or diarrhea. Doses may vary depending on the individual situation as determined by the prescriber. [medicinenet.com]

• Polyradiculoneuropathy

  As an electrophysiological examination showed acute demyelinating polyradiculoneuropathy, the patient was diagnosed as HEV-associated GBS. [ncbi.nlm.nih.gov]

• Flaccid Paralysis

  Over 48 hours, he accrued multiple cranial nerves palsies and progressed to a flaccid paralysis necessitating admission to an intensive care unit.Cerebrospinal fluid (CSF) study showed 20 lymphocytes and raised protein. [ncbi.nlm.nih.gov]

The clinical assessment consists of the patient's history including recent travel, a physical exam, and the appropriate laboratory studies.

Laboratory tests

Severe presentations warrant comprehensive laboratory studies such as a complete blood count (CBC), blood cultures, and a complete metabolic panel (CMP) which includes liver function tests (LFTs). Measurements of the latter reveal that levels of serum alanine aminotransferase (ALT) are higher than the serum aspartate aminotransferase (AST), with both measuring at least 10 times the upper limit of normal. These distinct findings are indicative of acute viral hepatitis.

Ominous signs suggestive of liver failure are prolonged prothrombin time (PT), hyperbilirubinemia, and hypoalbuminemia.

Confirmatory tests

Diagnosis of this infection is confirmed by the presence of anti-HEV immunoglobulin M (IgM), which increases about a month post-infection [7]. Another test, reverse transcriptase polymerase chain reaction (RT-PCR), detects the HEV RNA in blood and stool [2].

Imaging

Abdominal ultrasonography may be performed to exclude extra hepatic pathologies.

• Hyponatremia

  Intravenous dextrose and saline fluid were alternated to prevent hypoglycemia and hyponatremia, respectively, when enteral feeding was not feasible. Adjunctive haloperidol for agitation and vitamin K for coagulopathy were provided. [cdc.gov]

In patients with no underlying disease, the treatment of acute infection is symptomatic with adequate hydration and electrolyte replacement. However, severe cases may be treated with ribavirin, which causes improvement in LFTs [8].

Furthermore, ribavirin is also used in patients with chronic hepatitis E infection that persists after the reduction of immunosuppression [9]. Additionally, therapy with pegylated interferon alpha-2b in liver transplant recipients can successfully clear the viral RNA [10] [11]. However, this drug is associated with serious side effects such as organ rejection in transplant patients.

This self-limited infection is usually benign in immunocompetent non-pregnant individuals. However, in the obstetric population, the mortality rate is 20% with a high risk for liver failure.

The main group that is susceptible to chronic infection is comprised of liver transplant recipients undergoing immunosuppressive treatment [5] [6].

The HEV is a member of the Hepeviridae family. Transmission of this virus occurs through the feco-oral route as contaminated water supplies are responsible for the majority of all infections. In industrialized countries, undercooked pork is a source of infection [1]. This virus is not spread through sexual or casual contact.

Hepatitis E is prevalent worldwide especially in regions with poor sanitation. Specifically, developing areas surrounding the equator exhibit higher rates of this infection. Factors that lead to outbreaks include rainy weather, floods, and overpopulation. Additionally, in endemic areas the disease affects mostly adults in the 15 to 40 years age group [2].

HEV is a small, non-enveloped, single-stranded RNA virus [3] that is transmitted as a water-borne pathogen in endemic regions whereas it is spread as a foodborne organism in developed countries [3] [4].

Preventive strategies such as good personal hygiene should be practiced. All individuals should wash their hands properly especially after using the restroom and prior to handling food. Additionally, meat should be cooked thoroughly. Very importantly, endemic areas should enforce sanitary standards for public water.

China has approved a vaccine [12] for prevention of Hepatitis E.

Hepatitis E is a self-limiting, acute infection that is usually benign in healthy and non-pregnant individuals. It is caused by the hepatitis E virus (HEV), which is transmitted mainly through the fecal-oral route. The diagnosis is achieved through a detailed evaluation of the history, physical exam, and laboratory studies. Most patients are treated symptomatically while certain individuals will require treatment.

What is Hepatitis E?

This is an infection caused by the Hepatitis E a virus. This is spread through the fecal-oral route, especially in underdeveloped areas with poor sanitation.

What are the symptoms?

• Fatigue
• Fever
• Yellow skin
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• In pregnant women, this can cause liver failure and death

How is it diagnosed?

There is a blood test that looks for antibodies to the virus and another test that measures the virus,

How is it treated?

This usually resolves on its own. Individuals who have had liver transplants are treated with a drug called ribavirin.

How can it be prevented?

• Practice good hygiene by washing hands thoroughly
• Cook meat well
• If traveling, only drink water from a closed bottle

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2. Hepatitis E. World Health Organization. http://www.who.int/mediacentre/factsheets/fs280/en/. Accessed October 19, 2016.
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