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Hepatitis E

Last reviewed: 5 Oct 2024
Last updated: 13 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • jaundice/scleral icterus
  • asterixis
Full details

Other diagnostic factors

  • asymptomatic
  • malaise
  • fatigue
  • right upper quadrant tenderness
  • fever
  • anorexia
  • nausea/vomiting
  • arthralgia/arthritis
  • abdominal pain
  • diarrhea
  • neurologic manifestations
  • signs of coagulopathy
Full details

Risk factors

  • born or living in or travel to geographic regions where HEV is endemic
  • immunosuppression
  • infected mother (for fetus)
  • person-to-person transmission
  • occupational exposure
  • blood/blood products transfusion
  • organ transplantation (if organ donor is HEV-positive)
Full details

Diagnostic tests

1st tests to order

  • serum antibody to HEV
  • HEV RNA nucleic acid amplification techniques (NAATs)
  • serologic tests for other causes of viral hepatitis
  • liver biochemistries
  • CBC
  • basic metabolic panel
  • coagulation profile
Full details

Tests to consider

  • abdominal ultrasound
  • CT/MRI
  • liver biopsy
Full details

Treatment algorithm

ACUTE

acute HEV infection

ONGOING

chronic HEV infection: nonpregnant

chronic HEV infection: pregnant

Contributors

Authors

Jawad Ahmad, MD, FRCP, FAASLD

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that he has no competing interests.

Peer reviewers

Scott J. Cotler, MD

Professor of Medicine

Director, Division of Hepatology

Loyola University Medical Center

Maywood

IL

Disclosures

SJC declares that he has no competing interests.

David John Mutimer, MBBS, MD

Professor of Clinical Hepatology

University of Birmingham

Birmingham

UK

Disclosures

DJM declares that he has no competing interests.

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