Hepatitis E is a liver lesion of an infectious nature. The infection has a fecal-oral transmission mechanism, proceeds acutely, cyclically and is quite dangerous for pregnant women. The incubation period of viral hepatitis E can last up to 2 months. The clinical picture of the disease has a lot of similarities with the symptoms of viral hepatitis A. Differential diagnosis is carried out by identifying specific viral antigens by PCR. In parallel, the liver condition is examined (ultrasound, hepatic biochemical tests, MRI of the liver). Treatment includes diet therapy, symptomatic and detoxification treatment.
Hepatitis E virus belongs to the genus Calicivirus, is RNA-containing, has less resistance to environmental influences than hepatitis A virus. The pathogen remains viable at 20 ° C or less, when frozen and thawed, it dies, is well inactivated by chlorine and iodine–containing disinfectants. The reservoir and source of hepatitis E virus are sick people and carriers of infection. The period of human contagiousness has not been sufficiently studied, but presumably contagiousness occurs at the same time as in hepatitis A.
Hepatitis E virus is transmitted via the fecal-oral mechanism mainly by water. In rare cases (when dishes, household objects are contaminated with a virus), a contact-household transmission path is implemented. Food contamination is possible when eating raw shellfish. The predominance of the waterway of the spread of infection is confirmed by its low foci, the occurrence of epidemics due to seasonal precipitation, changes in the groundwater level. The highest natural susceptibility is in pregnant women after 30 weeks of pregnancy. The transferred infection presumably leaves persistent lifelong immunity.
Hepatitis e symptoms
The clinical course of viral hepatitis E is similar to that of infection with viral hepatitis A. The incubation period ranges from 10 to 60 days, averaging 30-40 days. The onset of the disease is usually gradual. In the pre-jaundice period of the disease, patients note weakness, general malaise, decreased appetite, nausea and vomiting occur in a third of cases. Most patients complain of pain in the right hypochondrium and upper abdomen, often quite severe. In some cases, abdominal pain is the first sign of infection. Body temperature usually remains within the normal range or rises to subfebrile values. Arthralgia, rashes are usually not noted.
The duration of the pre-jaundice period can be from one to nine days, after which there are signs of functional disorders of the liver: urine becomes dark, feces discolors, first the sclera, and then the skin becomes yellow (in some cases very intense). A biochemical blood test during this period notes an increase in the level of bilirubin and the activity of hepatic transaminases. Unlike viral hepatitis A, with this infection, with the development of jaundice syndrome, there is no regression of intoxication symptoms. Weakness, lack of appetite and abdominal pain persist, itching of the skin may join (associated with a high concentration of bile acids in the blood). There is an increase in the liver (the edge of the liver may protrude from under the costal arch by more than 3 cm).
After 1-3 weeks, clinical manifestations begin to regress, a period of recovery begins, which can last 1-2 months until the complete normalization of the body’s condition (according to laboratory tests). Sometimes there is a more prolonged course of infection. Severe hepatitis E is characterized by the development of hemolytic syndrome, accompanied by hemoglobinuria, hemorrhage, acute renal failure. Hemoglobinuria occurs in 80% of patients with severe viral hepatitis E and in all cases of developed hepatic encephalopathy.
Hemorrhagic symptoms can be very pronounced, characterized by massive internal (gastric, intestinal, uterine) bleeding. The condition of patients and the severity of hepatitis directly depends on the concentration of plasma coagulation factors. A decrease in their number, as well as a decrease in the activity of plasma proteases, contributes to a noticeable aggravation of the patient’s condition and aggravation of clinical symptoms up to the threat of the development of hepatic encephalopathy.
Pregnant women infected with viral hepatitis E are usually extremely difficult to tolerate the infection, which develops mainly after 24 weeks of pregnancy. It is characterized by a sharp deterioration of the condition immediately before childbirth or spontaneous termination of pregnancy. Hemorrhagic syndrome is pronounced, intense bleeding is noted during childbirth, hepatic encephalopathy develops rapidly up to hepatic coma (the progression of symptoms often occurs in 1-2 days). Intrauterine fetal death, renal-hepatic syndrome is not uncommon.
Complications of viral hepatitis E are acute liver failure, hepatic encephalopathy and coma, internal bleeding. In 5% of patients, viral hepatitis E contributes to the development of cirrhosis of the liver.
The specific diagnosis of viral hepatitis E is based on the detection of specific antibodies (immunoglobulins M and G) using serological techniques and the detection of virus antigens using PCR.
The remaining laboratory diagnostic measures are aimed at clarifying the functional state of the liver and identifying the threat of complications. These include: coagulogram, liver tests, liver ultrasound, MRI, etc.
Hepatitis e treatment
Treatment of mild and moderate forms of patients with viral hepatitis E is carried out in the infectious departments of the hospital, a diet is prescribed (table No. 5 according to Pevsner is shown – a sparing diet with a low content of fatty acids and rich in fiber), abundant drinking. Symptomatic therapy (antispasmodic, antihistamines) according to indications. If necessary, oral detoxification with a solution of 5% glucose is performed.
In severe cases, patients are treated in the intensive care unit, infusion detoxification therapy is performed (salt solutions, glucose, electrolyte mixtures), protease inhibitors, prednisone is administered according to indications. If there is a threat of hemorrhagic syndrome, pentoxifylline, ethamzylate is prescribed. With massive internal bleeding, plasma and platelet mass are transfused.
Special attention is paid to the treatment of pregnant women. The issue of premature delivery is decided individually, measures are often taken for emergency termination of pregnancy.
Most often, viral hepatitis E ends in recovery, but the severe form of the disease threatens the development of life-threatening complications: renal and hepatic insufficiency, hepatic coma. Mortality among patients with viral hepatitis E is 1-5%, this figure among pregnant women reaches 10-20%. In the case of infection with viral hepatitis E of persons suffering from hepatitis B, the prognosis worsens markedly, death with this combination occurs in 75-80% of cases.
The general prevention of viral hepatitis E is to improve the living conditions of the population and control the condition of water sources. Individual prevention implies compliance with sanitary and hygienic standards, the use of high-quality water from reliable sources. It is advisable to pay special attention to the prevention of viral hepatitis E to pregnant women traveling to epidemiologically disadvantaged regions (Uzbekistan, Tajikistan, North Africa, India and China, Algeria and Pakistan).