Hepatitis E is a relatively rare acute liver inflammation caused by the hepatitis E virus.The pathogens are transmitted through contaminated drinking water, blood transfusions or food. Usually the infection occurs acutely. Cures in most cases without late sequelae. Hepatitis E disease is a risk for pregnant women, with one in every 5. The infection can even be fatal for infected persons, as the viral disease usually takes a severe course. The disease is also dangerous for HIV-infected persons or persons who have a weakened immune system after transplantation. In these patients, the infection usually takes a chronic course. Hepatitis E can be detected with the help of special laboratory tests.
Frequency of hepatitis E
Worldwide, there are about 20 million new infections of hepatitis E every year, 60.000 people die from it. In Austria, about 2-3% of the adult population has antibodies against hepatitis E, which means that they have already been in contact with the virus at some time. The infection is common in East and Southeast Asia, India, Africa, or Central America; up to 50% of the population in these regions carries antibodies to the hepatitis E virus. Travelers to high-risk areas are therefore particularly at risk. Similar to hepatitis A, hepatitis E infection is usually caused by poor hygiene, such as drinking water or eating raw meat and lettuce in high-risk areas. Hepatitis B and C infections, which are consistently transmitted via the blood, must be distinguished from this. A rather rare hepatitis D infection, on the other hand, always occurs only in conjunction with an infection with the HB virus.
Pathogen of hepatitis E
The hepatitis E virus has several subgroups (genotypes), which occur in different regions. It can infect not only humans, but also pigs, wild boars in Central Europe, monkeys or rodent species. The virus is resistant to chemicals, some disinfectants can destroy it.
Route of infection
The main route of infection is through consumption of contaminated drinking water or food, such as lettuce, undercooked offal or meat, which may contain the pathogen. Hepatitis E infected persons are infectious about 2 weeks before and 2 weeks after the onset of the disease.
Symptoms and course of the disease of hepatitis E
Like hepatitis A, the first stage of infection is usually symptomless. Affected individuals may develop flu-like symptoms, including fatigue, fever, nausea, or yellowing of the skin and urine.
The course of the disease is also similar to that of hepatitis A. However, this infection mainly affects children and adolescents, whereas hepatitis E mainly affects middle-aged adults.
Chronic hepatitis E can occur after organ transplantation.
Hepatitis E and pregnancy
In the third trimester of pregnancy, i.e. from 29. up to 40. If hepatitis E is present during the first week of pregnancy, it is life-threatening for women. In the latter, hepatitis E can cause a so-called "fulminant" infection The course of the disease, jaundice, blood clotting disorders and unconsciousness lead to liver failure in about 20 % of those affected. Pregnant women who have lived in a risk country under inadequate hygienic conditions (z.B. consumption of drinking water, of insufficiently cooked meat) and suffer from flu-like symptoms, as well as yellowing of the skin, should consult a specialized hepatology outpatient clinic to ensure that hepatitis E infection has been ruled out. The mortality rate for pregnant women is highest on the Indian subcontinent.
Hepatitis E once overcome does not protect against a new infection.
The pregnancy complications are not caused by the rare European genotype, but only by the sub- or. tropical genotype causes.
Diagnosis of hepatitis E
Diagnosis is made at specialized hepatological facilities or at a hospital. posed by an experienced hepatologist. This may prompt further laboratory tests, such as:
ELISAA blood test is performed in the laboratory to determine whether HEV antibodies are present in the blood. IgM antibodies are already detectable when the disease breaks out, but disappear again. IgG antibodies are also detectable from the onset of the disease. Can "survive" for years. If the test shows antibodies, although there is no acute infection, a hepatitis E infection has already occurred once in life. PCRWith this method it is possible to directly detect whether the ribonucleic acid of the virus, i.e. the genetic "basic equipment", is present of the pathogen is present. The pathogen can be detected by blood or stool tests. For this purpose, a special PCR (polymerase chain reaction) test is carried out, which makes the pathogen visible in the course of a laboratory examination by means of a chemical reaction. However, this method is not a routine diagnostic procedure, but is carried out only in very special suspected cases. Such a test is recommended especially for immunocompromised persons (HIV patients or transplanted persons). The virus is already present in the stool 1-2 weeks before the onset of the disease. Detectable up to 2 weeks after recovery. Elevated liver values: indicate a disease, the higher they are, the more severe the disease is.
Therapy for hepatitis E
There is currently no effective treatment for hepatitis E. Doctors are pinning their hopes on the active ingredient Ribavarin, which is also used in the treatment of hepatitis C. The active ingredient inhibits viral replication. The active ingredient inhibits viral replication and can u. U. chronic or complicated courses of hepatitis E can also be cured.
Treatment is limited to alleviating symptoms. Above all, bed rest, a light diet and avoidance of physical exertion are appropriate measures. Inpatient treatment is usually not required.
Precaution against hepatitis E
Careful hygiene, especially in high-risk areas:
– Boil drinking water in risk areas – Do not eat uncooked food. The virus is rendered harmless at cooking temperatures of 70 degrees or higher. : stool is the only source of excretion, so special hygiene measures are needed here.