Comments
INITIAL SYMPTOMS:
Fever, jaundice, fatigue, anorexia, and abdominal pain; [CDC Travel]
FINDINGS:
The clinical course is similar to hepatitis A. Genotypes 1 and 2 are associated with developing countries: high rates of jaundice and chronic infections not reported. Genotypes 3 and 4 are associated with developed countries: low rates of jaundice and infections may become chronic. [CCDM, p, 270] Most acute liver failure in the tropics is caused by hepatitis viruses (40% by HEV). HBV and HEV are the most common causes of subacute hepatic failure with progressive jaundice, ascites, coagulopathy, renal failure, and encephalopathy. [Guerrant, p. 978] Pregnant women are at risk for liver failure after infection. Immunosuppressed patients (solid organ recipients) may develop chronic infections. [CDC Travel, p. 198]
EPIDEMIOLOGY:
Hepatitis E is transmitted by the fecal-oral route. Mortality may be as high as 20% in pregnant women infected during the third trimester. Natural infections occur in pigs, deer, elk, sheep, cattle, rats, and rabbits. [CCDM, p, 271] Epidemics of hepatitis E are largely waterborne. It is also transmitted by ingestion of raw meat, offal, liver, and shellfish. Figatellu in France (sausage from raw pig liver) and inadequately cooked venison or boar meat are reported causes of infection. [CDC Travel, p. 198]
For updated text and symptoms of infectious diseases, see iddx.com.