Hepatitis E Clinical Presentation

Updated: Mar 13, 2019
  • Author: Prospere Remy, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History

The incubation period ranges from 15-60 days. The course of infection has two 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 [30, 31] :

  • 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. [32]

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.

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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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