Hepatitis E Clinical Presentation

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


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