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Hepatitis E Clinical Presentation

  • Author: Prospere Remy, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Jul 14, 2016
 

History

The incubation period ranges from 15-60 days. The course of infection has 2 phases, the prodromal phase and the icteric phase. The prodromal phase usually is of short duration.

Prodromal-phase symptoms include the following:

  • Myalgia
  • Arthralgia
  • Fever with mild temperature elevations (25-97%)
  • Anorexia (66-100%)
  • Nausea/vomiting (30-100%)
  • Weight loss (typically 2-4 kg)
  • Dehydration
  • Right upper quadrant pain that increases with physical activity (abdominal pain is reported in 35-80% of patients)

Icteric-phase symptoms may last days to several weeks and include the following:

  • Jaundice - May be difficult to see with some patients’ natural skin color; serum bilirubin level is usually higher than 3 mg/dL; scleral icterus is present; usually occurs between the fifth and eighth week after infection
  • Dark urine
  • Light-colored stools (20-40%)
  • Pruritus (50%)

Other features include the following[28, 29] :

  • Malaise (most common)
  • Arthritis
  • Pancreatitis
  • Aplastic anemia
  • Thrombocytopenia
  • Neurologic symptoms of polyradiculopathy, Guillain–Barré syndrome, Bell palsy, peripheral neuropathy, ataxia, and mental confusion
  • Membranoproliferative glomerulonephritis and membranous glomerulonephritis

In nonendemic (autochthonous) type of acute hepatitis E infection, the majority of patients have subclinical manifestations and mild symptoms, especially in women and young persons.[13] One report of an outbreak of hepatitis E on a cruise ship revealed only 7 of 33 patients had jaundice (21%) and most cases occurred in elderly men.[30]

Autochthonous hepatitis E also has a striking spectrum of serious complications, including “acute-on-chronic” liver failure, neurologic disorders, and chronic hepatitis. Acute-on-chronic disease refers to hepatitis with a rapid appearance of signs of liver failure ascites and encephalopathy in a person with preexisting liver disease.[13]

When or how long the patient is infectious cannot be determined, but infectivity may relate to the presence of the virus in the stool.

Next

Physical Examination

Physical examination should focus on the following:

  • Icteric sclera
  • Right upper quadrant tenderness
  • Possible enlarged liver (palpable edges; hepatomegaly is noted in 10-85% of patients)
  • Possible signs of advanced chronic liver disease - Spider angiomata, splenomegaly, ascites, prominent collateral veins over the abdominal wall, palmar erythema
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Contributor Information and Disclosures
Author

Prospere Remy, MD Assistant Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Internal Medicine, Bronx-Lebanon Hospital Center

Prospere Remy, MD is a member of the following medical societies: American College of Physicians, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

David Widjaja, MD Attending Physician, Department of Medicine (Gastroenterology), Bronx Lebanon Hospital Center

David Widjaja, MD is a member of the following medical societies: American College of Physicians, Indonesian Medical Association

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Kenneth D Flora, MD Adjunct Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Oregon Health Sciences University School of Medicine; Consulting Staff, Department of Gastroenterology, The Oregon Clinic

Kenneth D Flora, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Kenneth Ingram, PAC Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Jonathan M Schwartz, MD Associate Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Sciences University School of Medicine

Jonathan M Schwartz, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and American Hepato-Pancreato-Biliary Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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