Skip to main content
SpringerLink
Log in

Clinical Manifestations of Hepatitis E

  • Chapter
  • First Online:
Hepatitis E Virus

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1417))

Abstract

The clinical manifestations of hepatitis E are similar to those of other types of viral hepatitis. While acute hepatitis E is usually self-limited, pregnant women and chronic liver disease patients suffering from acute hepatitis E usually present with severe clinical manifestations that may develop into fulminant hepatic failure. Chronic HEV infection is typically seen in organ transplant patients; most HEV cases are asymptomatic and rarely display jaundice, fatigue, abdominal pain, fever, fatigue, or ascites. The clinical manifestations of HEV infection in neonates are diverse and have varied clinical signs, biochemistry, and virus-biomarkers. Lastly, the extrahepatic manifestations and complications of hepatitis E are in need of further study.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ALT:

Alanine aminotransferase

AP:

Acute pancreatitis

EBV:

Epstein–Barr virus

ELISA:

Enzyme-linked immunosorbent assay

GBS:

Guillain–Barré syndrome

HIV:

Human immunodeficiency virus

HSV:

Herpes simplex virus

RT-PCR:

Reverse transcriptase polymerase chain reaction

References

  1. Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST (2012) The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology 55(4):988–997

    Article  PubMed  Google Scholar 

  2. Fujiwara S, Yokokawa Y, Morino K, Hayasaka K, Kawabata M, Shimizu T (2014) Chronic hepatitis E: a review of the literature. J Viral Hepat 21(2):78–89

    Article  CAS  PubMed  Google Scholar 

  3. Liu L, Liu Y (2011) Analysis of acute to chronic hepatitis E: 6-10 year follow-up. Hepato-Gastroenterology 58(106):324–325

    PubMed  Google Scholar 

  4. Navaneethan U, Al Mohajer M, Shata MT (2008) Hepatitis E and pregnancy: understanding the pathogenesis. Liver Int 28(9):1190–1199

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bose PD, Das BC, Kumar A, Gondal R, Kumar D, Kar P (2011) High viral load and deregulation of the progesterone receptor signaling pathway: association with hepatitis E-related poor pregnancy outcome. J Hepatol 54(6):1107–1113

    Article  CAS  PubMed  Google Scholar 

  6. Srivastava R, Aggarwal R, Sachdeva S, Alam MI, Jameel S, Naik S (2011) Adaptive immune responses during acute uncomplicated and fulminant hepatitis E. J Gastroenterol Hepatol 26(2):306–311

    Article  CAS  PubMed  Google Scholar 

  7. Kamar N, Selves J, Mansuy JM, Ouezzani L, Peron JM, Guitard J et al (2008) Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 358(8):811–817

    Article  CAS  PubMed  Google Scholar 

  8. Gerolami R, Moal V, Picard C, Colson P (2009) Hepatitis E virus as an emerging cause of chronic liver disease in organ transplant recipients. J Hepatol 50(3):622–624

    Article  PubMed  Google Scholar 

  9. Pischke S, Wedemeyer H (2010) Chronic hepatitis E in liver transplant recipients: a significant clinical problem? Minerva Gastroenterol Dietol 56(2):121

    CAS  PubMed  Google Scholar 

  10. Kamar N, Bendall RP, Peron JM, Cintas P, Prudhomme L, Mansuy JM et al (2011) Hepatitis E virus and neurologic disorders. Emerg Infect Dis 17(2):173–179

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dalton HR, Bendall RP, Keane FE, Tedder RS, Ijaz S (2009) Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med 361(10):1025–1027

    Article  CAS  PubMed  Google Scholar 

  12. Ollier L, Tieulie N, Sanderson F, Heudier P, Giordanengo V, Fuzibet JG et al (2009) Chronic hepatitis after hepatitis E virus infection in a patient with non-Hodgkin lymphoma taking rituximab. Ann Intern Med 150(6):430–431

    Article  PubMed  Google Scholar 

  13. Geng Y, Zhang H, Huang W, Geng K, Li Z et al (2014) Persistent hepatitis e virus genotype 4 infection in a child with acute lymphoblastic leukemia. Hepat Mon 14(1):e15618

    PubMed  PubMed Central  Google Scholar 

  14. Geng Y, Zhao C, Huang W, Harrison TJ, Zhang H, Geng K et al (2016) Detection and assessment of infectivity of hepatitis E virus in urine. J Hepatol 64(1):37–43

    Article  PubMed  Google Scholar 

  15. Naik A, Gupta N, Goel D, Ippagunta SK, Sharma RK, Aggarwal R (2013) Lack of evidence of hepatitis E virus infection among renal transplant recipients in a disease-endemic area. J Viral Hepat 20(4):e138–e140

    Article  CAS  PubMed  Google Scholar 

  16. Zhou X, de Man RA, de Knegt RJ, Metselaar HJ, Peppelenbosch MP, Pan Q (2013) Epidemiology and management of chronic hepatitis E infection in solid organ transplantation: a comprehensive literature review. Rev Med Virol 23(5):295–304

    Article  CAS  PubMed  Google Scholar 

  17. Gerolami R, Moal V, Colson P (2008) Chronic hepatitis E with cirrhosis in a kidney-transplant recipient. N Engl J Med 358(8):859–860

    Article  CAS  PubMed  Google Scholar 

  18. Haagsma EB, van den Berg AP, Porte RJ, Benne CA, Vennema H, Reimerink JH et al (2008) Chronic hepatitis E virus infection in liver transplant recipients. Liver Transpl 14(4):547–553

    Article  PubMed  Google Scholar 

  19. Koning L, Pas SD, de Man RA, Balk AH, de Knegt RJ, ten Kate FJ et al (2013) Clinical implications of chronic hepatitis E virus infection in heart transplant recipients. J Heart Lung Transplant 32(1):78–85

    Article  PubMed  Google Scholar 

  20. Kenfak-Foguena A, Schoni-Affolter F, Burgisser P, Witteck A, Darling KE, Kovari H et al (2011) Hepatitis E virus seroprevalence and chronic infections in patients with HIV, Switzerland. Emerg Infect Dis 17(6):1074–1078

    Article  PubMed  PubMed Central  Google Scholar 

  21. Halac U, Beland K, Lapierre P, Patey N, Ward P, Brassard J et al (2012) Cirrhosis due to chronic hepatitis E infection in a child post-bone marrow transplant. J Pediatr 160(5):871–874

    Article  PubMed  Google Scholar 

  22. Tan HH, Leong HN, Tan BH, Oon LL, Lim KH, Chang JP et al (2011) Chronic hepatitis e infection resulting in graft failure in a liver transplant tourist. Case Rep Transpl 2011:654792

    Google Scholar 

  23. Kamar N, Garrouste C, Haagsma EB, Garrigue V, Pischke S, Chauvet C et al (2011) Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology 140(5):1481–1489

    Article  PubMed  Google Scholar 

  24. Scobie L, Dalton HR (2013) Hepatitis E: source and route of infection, clinical manifestations and new developments. J Viral Hepat 20(1):1–11

    Article  CAS  PubMed  Google Scholar 

  25. Fousekis FS, Mitselos IV, Christodoulou DK (2020) Extrahepatic manifestations of hepatitis E virus: an overview. Clin Mol Hepatol 26(1):16–23

    Article  PubMed  Google Scholar 

  26. Wu J, Xiang Z, Zhu C, Yao Y, Bortolanza M, Cao H et al (2021) Extrahepatic manifestations related to hepatitis E virus infection and their triggering mechanisms. J Infect 83(3):298–305

    Article  PubMed  Google Scholar 

  27. Chalupa P, Holub M (2010) Jaundice complicated by an atypical form of Guillain-Barre syndrome. J Clin Virol 49(4):229–230

    Article  PubMed  Google Scholar 

  28. Cronin S, McNicholas R, Kavanagh E, Reid V, O’Rourke K (2011) Anti-glycolipid GM2-positive Guillain-Barre syndrome due to hepatitis E infection. Ir J Med Sci 180(1):255–257

    Article  CAS  PubMed  Google Scholar 

  29. Maddukuri VC, Russo MW, Ahrens WA, Emerson SU, Engle RE, Purcell RH et al (2013) Chronic hepatitis E with neurologic manifestations and rapid progression of liver fibrosis in a liver transplant recipient. Dig Dis Sci 58(8):2413–2416

    Article  PubMed  Google Scholar 

  30. Dixit VK, Abhilash VB, Kate MP, Jain AK (2006) Hepatitis E infection with Bell’s palsy. J Assoc Physicians India 54:418

    CAS  PubMed  Google Scholar 

  31. Fong F, Illahi M (2009) Neuralgic amyotrophy associated with hepatitis E virus. Clin Neurol Neurosurg 111(2):193–195

    Article  PubMed  Google Scholar 

  32. Rianthavorn P, Thongmee C, Limpaphayom N, Komolmit P, Theamboonlers A, Poovorawan Y (2010) The entire genome sequence of hepatitis E virus genotype 3 isolated from a patient with neuralgic amyotrophy. Scand J Infect Dis 42(5):395–400

    Article  CAS  PubMed  Google Scholar 

  33. Kausik M, Nidhi C (2006) Acute transverse myelitis following hepatitis E virus infection. Indian Pediatr 43(4):365

    Google Scholar 

  34. Despierres LA, Kaphan E, Attarian S, Cohen-Bacrie S, Pelletier J, Pouget J et al (2010) (2011) Neurologic disorders and hepatitis E, France. Emerg Infect Dis 17(8):1510–1512

    Google Scholar 

  35. Del Bello A, Arne-Bes MC, Lavayssiere L, Kamar N (2012) Hepatitis E virus-induced severe myositis. J Hepatol 57(5):1152–1153

    Article  PubMed  Google Scholar 

  36. Kamar N, Izopet J, Cintas P, Garrouste C, Uro-Coste E, Cointault O et al (2010) Hepatitis E virus-induced neurological symptoms in a kidney-transplant patient with chronic hepatitis. Am J Transplant 10(5):1321–1324

    Article  CAS  PubMed  Google Scholar 

  37. Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC (2014) Diagnosis of Guillain-Barre syndrome and validation of Brighton criteria. Brain 137(Pt 1):33–43

    Article  PubMed  Google Scholar 

  38. van den Berg B, van der Eijk AA, Pas SD, Hunter JG, Madden RG, Tio-Gillen AP et al (2014) Guillain-Barre syndrome associated with preceding hepatitis E virus infection. Neurology 82(6):491–497

    Article  PubMed  Google Scholar 

  39. van Alfen N (2011) Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol 7(6):315–322

    Article  PubMed  Google Scholar 

  40. van Eijk JJ, Madden RG, van der Eijk AA, Hunter JG, Reimerink JH, Bendall RP et al (2014) Neuralgic amyotrophy and hepatitis E virus infection. Neurology 82(6):498–503

    Article  PubMed  PubMed Central  Google Scholar 

  41. Dalton HR, Kamar N, van Eijk JJ, McLean BN, Cintas P, Bendall RP et al (2016) Hepatitis E virus and neurological injury. Nat Rev Neurol 12(2):77–85

    Article  CAS  PubMed  Google Scholar 

  42. Colson P, Payraudeau E, Leonnet C, De Montigny S, Villeneuve L, Motte A et al (2008) Severe thrombocytopenia associated with acute hepatitis E virus infection. J Clin Microbiol 46(7):2450–2452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Thapa R, Mallick D, Ghosh A (2009) Childhood hepatitis E infection complicated by acute immune thrombocytopenia. J Pediatr Hematol Oncol 31(2):151

    Article  PubMed  Google Scholar 

  44. Woolson KL, Forbes A, Vine L, Beynon L, McElhinney L, Panayi V et al (2014) Extra-hepatic manifestations of autochthonous hepatitis E infection. Aliment Pharmacol Ther 40(11-12):1282–1291

    Article  CAS  PubMed  Google Scholar 

  45. Singh NK, Gangappa M (2007) Acute immune thrombocytopenia associated with hepatitis E in an adult. Am J Hematol 82(10):942–943

    Article  PubMed  Google Scholar 

  46. Au WY, Ngai CW, Chan WM, Leung RY, Chan SC (2011) Hemolysis and methemoglobinemia due to hepatitis E virus infection in patient with G6PD deficiency. Ann Hematol 90(10):1237–1238

    Article  PubMed  PubMed Central  Google Scholar 

  47. Davis TV, Keeffe EB (1992) Acute pancreatitis associated with acute hepatitis A. Am J Gastroenterol 87(11):1648–1650

    CAS  PubMed  Google Scholar 

  48. de Oliveira LC, Rezende PB, Ferreira AL, de Freitas AA, de Carvalho AM, Guedes CA et al (1998) Concurrent acute hepatitis and pancreatitis associated with hepatitis B virus: case report. Pancreas 16(4):559–561

    Article  PubMed  Google Scholar 

  49. Alvares-Da-Silva MR, Francisconi CF, Waechter FL (2000) Acute hepatitis C complicated by pancreatitis: another extrahepatic manifestation of hepatitis C virus? J Viral Hepat 7(1):84–86

    Article  CAS  PubMed  Google Scholar 

  50. Bhagat S, Wadhawan M, Sud R, Arora A (2008) Hepatitis viruses causing pancreatitis and hepatitis: a case series and review of literature. Pancreas 36(4):424–427

    Article  PubMed  Google Scholar 

  51. Jain P, Nijhawan S, Rai RR, Nepalia S, Mathur A (2007) Acute pancreatitis in acute viral hepatitis. World J Gastroenterol 13(43):5741–5744

    Article  PubMed  PubMed Central  Google Scholar 

  52. Jaroszewicz J, Flisiak R, Kalinowska A, Wierzbicka I, Prokopowicz D (2005) Acute hepatitis E complicated by acute pancreatitis: a case report and literature review. Pancreas 30(4):382–384

    Article  PubMed  Google Scholar 

  53. Majumder AK, Halder A, Talapatra DS, Bhaduri S (1999) Hepatitis E associated with acute pancreatitis with pseudocyst. J Assoc Physicians India 47(12):1207

    CAS  PubMed  Google Scholar 

  54. Mishra A, Saigal S, Gupta R, Sarin SK (1999) Acute pancreatitis associated with viral hepatitis: a report of six cases with review of literature. Am J Gastroenterol 94(8):2292–2295

    Article  CAS  PubMed  Google Scholar 

  55. Deniel C, Coton T, Brardjanian S, Guisset M, Nicand E, Simon F (2011) Acute pancreatitis: a rare complication of acute hepatitis E. J Clin Virol 51(3):202–204

    Article  PubMed  Google Scholar 

  56. Al-Shukri I, Davidson E, Tan A, Smith DB, Wellington L, Johannessen I et al (2013) Rash and arthralgia caused by hepatitis E. Lancet 382(9907):1856

    Article  PubMed  Google Scholar 

  57. Thapa R, Biswas B, Mallick D (2010) Henoch-Schonlein purpura triggered by acute hepatitis E virus infection. J Emerg Med 39(2):218–219

    Article  PubMed  Google Scholar 

  58. Pischke S, Behrendt P, Manns MP, Wedemeyer H (2014) HEV-associated cryoglobulinaemia and extrahepatic manifestations of hepatitis E. Lancet Infect Dis 14(8):678–679

    Article  PubMed  Google Scholar 

  59. Kamar N, Weclawiak H, Guilbeau-Frugier C, Legrand-Abravanel F, Cointault O, Ribes D et al (2012) Hepatitis E virus and the kidney in solid-organ transplant patients. Transplantation 93(6):617–623

    Article  PubMed  Google Scholar 

  60. Shah SA, Lal A, Idrees M, Hussain A, Jeet C, Malik FA et al (2012) Hepatitis E virus-associated aplastic anaemia: the first case of its kind. J Clin Virol 54(1):96–97

    Article  PubMed  Google Scholar 

  61. Brown KE, Tisdale J, Barrett AJ, Dunbar CE, Young NS (1997) Hepatitis-associated aplastic anemia. N Engl J Med 336(15):1059–1064

    Article  CAS  PubMed  Google Scholar 

  62. Rauff B, Idrees M, Shah SA, Butt S, Butt AM, Ali L et al (2011) Hepatitis associated aplastic anemia: a review. Virol J 8(1):87

    Article  PubMed  PubMed Central  Google Scholar 

  63. Nargis B, Gyaneshwori DS (2009) Seroprevalence of subclinical HEV infection in pregnant women from north India: a hospital based study. Indian J Med Res 130(6):709

    Google Scholar 

  64. Stoszek SK, Abdel-Hamid M, Saleh DA, El Kafrawy S, Narooz S, Hawash Y et al (2006) High prevalence of hepatitis E antibodies in pregnant Egyptian women. Trans R Soc Trop Med Hyg 100(2):95–101

    Article  PubMed  Google Scholar 

  65. Cong W, Sui JC, Zhang XY, Qian AD, Chen J, Zhu XQ (2015) Seroprevalence of hepatitis E virus among pregnant women and control subjects in China. J Med Virol 87(3):446–450

    Article  CAS  PubMed  Google Scholar 

  66. Caron M, Kazanji M (2008) Hepatitis E virus is highly prevalent among pregnant women in Gabon, central Africa, with different patterns between rural and urban areas. Virol J 5(1):158

    Article  PubMed  PubMed Central  Google Scholar 

  67. Adjei AA, Tettey Y, Aviyase JT, Adu-Gyamfi C, Obed S, Mingle JA et al (2009) Hepatitis E virus infection is highly prevalent among pregnant women in Accra, Ghana. Virol J 6:108

    Article  PubMed  PubMed Central  Google Scholar 

  68. Rostamzadeh Khameneh Z, Sepehrvand N, Khalkhali HR (2013) Seroprevalence of hepatitis e among pregnant women in Urmia, Iran. Hepat Mon 13(11):e10931

    Article  PubMed  PubMed Central  Google Scholar 

  69. Pischke S, Heim A, Bremer B, Raupach R, Horn-Wichmann R, Ganzenmueller T et al (2011) Hepatitis E: an emerging infectious disease in Germany? Z Gastroenterol 49(9):1255–1257

    Article  CAS  PubMed  Google Scholar 

  70. Renou C, Moreau X, Pariente A, Cadranel JF, Maringe E, Morin T et al (2008) A national survey of acute hepatitis E in France. Aliment Pharmacol Ther 27(11):1086–1093

    Article  CAS  PubMed  Google Scholar 

  71. Arends JE, Ghisetti V, Irving W, Dalton HR, Izopet J, Hoepelman AI et al (2014) Hepatitis E: an emerging infection in high income countries. J Clin Virol 59(2):81–88

    Article  CAS  PubMed  Google Scholar 

  72. Renou C, Gobert V, Locher C, Moumen A, Timbely O, Savary J et al (2014) Prospective study of Hepatitis E virus infection among pregnant women in France. Virol J 11(1):68

    Article  PubMed  PubMed Central  Google Scholar 

  73. Lindemann ML, Gabilondo G, Romero B, de la Maza OM, Perez-Gracia MT (2010) Low prevalence of hepatitis E infection among pregnant women in Madrid, Spain. J Med Virol 82(10):1666–1668

    Article  PubMed  Google Scholar 

  74. Khuroo MS, Teli MR, Skidmore S, Sofi MA, Khuroo MI (1981) Incidence and severity of viral hepatitis in pregnancy. Am J Med 70(2):252–255

    Article  CAS  PubMed  Google Scholar 

  75. Shinde N, Patil T, Deshpande A, Gulhane R, Patil M, Bansod Y (2014) Clinical profile, maternal and fetal outcomes of acute hepatitis E in pregnancy. Ann Med Health Sci Res 4(2):133–139

    Google Scholar 

  76. Shang T, Ma Y (2004) The clinical features and treatment in pregnant women with hepatitis E. Chin J Gynecol Obst 20(2):75–76

    Google Scholar 

  77. Jilani N, Das BC, Husain SA, Baweja UK, Chattopadhya D, Gupta RK et al (2007) Hepatitis E virus infection and fulminant hepatic failure during pregnancy. J Gastroenterol Hepatol 22(5):676–682

    Article  PubMed  Google Scholar 

  78. Pal R, Aggarwal R, Naik SR, Das V, Das S, Naik S (2005) Immunological alterations in pregnant women with acute hepatitis E. J Gastroenterol Hepatol 20(7):1094–1101

    Article  CAS  PubMed  Google Scholar 

  79. Ramdasi AY, Arya RP, Arankalle VA (2014) Effect of pregnancy on anti-HEV antibody titres, plasma cytokines and the corresponding gene expression levels in the PBMCs of patients presenting with self-recovering clinical and subclinical hepatitis E. PLoS One 9(8):e103257

    Article  PubMed  PubMed Central  Google Scholar 

  80. Bansal J, He J, Yarbough PO, Sen S, Constantine NT, Sen D (1998) Hepatitis E virus infection in eastern India. Am J Trop Med Hyg 59(2):258–260

    Article  CAS  PubMed  Google Scholar 

  81. Hamid SS, Jafri SM, Khan H, Shah H, Abbas Z, Fields H (1996) Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis? J Hepatol 25(1):20–27

    Article  CAS  PubMed  Google Scholar 

  82. Khuroo MS, Kamili S, Jameel S (1995) Vertical transmission of hepatitis E virus. Lancet 345(8956):1025–1026

    Article  CAS  PubMed  Google Scholar 

  83. Saleem K (2002) Immunity to hepatitis E virus: new insights and future challenges. Indian J Gastroenterol 21(4):136

    Google Scholar 

  84. El Sayed ZM, El Aal AA, Badawy A, El-Deeb DR, El-Kheir NY (2013) Clinicolaboratory study of mother-to-neonate transmission of hepatitis E virus in Egypt. Am J Clin Pathol 140(5):721–726

    Article  Google Scholar 

  85. Matsubayashi K, Nagaoka Y, Sakata H, Sato S, Fukai K, Kato T et al (2004) Transfusion-transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan. Transfusion 44(6):934–940

    Article  PubMed  Google Scholar 

  86. Haim-Boukobza S, Ferey MP, Vetillard AL, Jeblaoui A, Pelissier E, Pelletier G et al (2012) Transfusion-transmitted hepatitis E in a misleading context of autoimmunity and drug-induced toxicity. J Hepatol 57(6):1374–1378

    Article  CAS  PubMed  Google Scholar 

  87. Peters van Ton AM, Gevers TJ, Drenth JP (2015) Antiviral therapy in chronic hepatitis E: a systematic review. J Viral Hepat 22(12):965–973

    Article  CAS  PubMed  Google Scholar 

  88. Satake M, Matsubayashi K, Hoshi Y, Taira R, Furui Y, Kokudo N et al (2017) Unique clinical courses of transfusion-transmitted hepatitis E in patients with immunosuppression. Transfusion 57(2):280–288

    Article  CAS  PubMed  Google Scholar 

  89. Fang L, Zhang J, Chen H, Lv F, Yu Y, Du X (2021) Epidemiological characteristics and clinical manifestations of hepatitis E in a tertiary hospital in China: a retrospective study. Front Microbiol 12:831968

    Article  PubMed  Google Scholar 

  90. Dalton HR, Stableforth W, Thurairajah P, Hazeldine S, Remnarace R, Usama W et al (2008) Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol 20(8):784–790

    Article  CAS  PubMed  Google Scholar 

  91. European Association for the Study of the Liver (2018) EASL clinical practice guidelines on hepatitis E virus infection. J Hepatol 68(6):1256–1271

    Article  Google Scholar 

  92. Kumar Acharya S, Kumar Sharma P, Singh R, Kumar Mohanty S, Madan K, Kumar Jha J et al (2007) Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol 46(3):387–394

    Article  PubMed  Google Scholar 

  93. Kumar A, Saraswat VA (2013) Hepatitis E and acute-on-chronic liver failure. J Clin Exp Hepatol 3(3):225–230

    Article  PubMed  PubMed Central  Google Scholar 

  94. Dalton HR, Bendall RP, Rashid M, Ellis V, Ali R, Ramnarace R et al (2011) Host risk factors and autochthonous hepatitis E infection. Eur J Gastroenterol Hepatol 23(12):1200–1205

    Article  PubMed  Google Scholar 

  95. Tseng TC, Liu CJ, Chang CT, Su TH, Yang WT, Tsai CH et al (2020) HEV superinfection accelerates disease progression in patients with chronic HBV infection and increases mortality in those with cirrhosis. J Hepatol 72(6):1105–1111

    Article  CAS  PubMed  Google Scholar 

  96. Manka P, Bechmann LP, Coombes JD, Thodou V, Schlattjan M, Kahraman A et al (2015) Hepatitis E virus infection as a possible cause of acute liver failure in Europe. Clin Gastroenterol Hepatol 13(10):1836–1842; quiz e1157-1838.

    Article  PubMed  Google Scholar 

  97. Shalimar A, Kedia S, Gunjan D, Sonika U, Mahapatra SJ, Nayak B et al (2017) Acute liver failure due to hepatitis E virus infection is associated with better survival than other etiologies in Indian patients. Dig Dis Sci 62(4):1058–1066

    Article  CAS  PubMed  Google Scholar 

  98. You S, Rong Y, Zhu B, Zhang A, Zang H, Liu H et al (2013) Changing etiology of liver failure in 3,916 patients from northern China: a 10-year survey. Hepatol Int 7(2):714–720

    Article  PubMed  Google Scholar 

  99. Terziroli Beretta-Piccoli B, Ripellino P, Gobbi C, Cerny A, Baserga A, Di Bartolomeo C et al (2018) Autoimmune liver disease serology in acute hepatitis E virus infection. J Autoimmun 94:1–6

    Article  CAS  PubMed  Google Scholar 

  100. Eder M, Strassl R, Beinhardt S, Stattermayer AF, Kozbial K, Lagler H et al (2019) High seroprevalence of anti-Hepatitis E antibodies in Austrian patients with autoimmune hepatitis. Liver Int 39(4):640–645

    Article  CAS  PubMed  Google Scholar 

  101. van Gerven NM, van der Eijk AA, Pas SD, Zaaijer HL, de Boer YS, Witte BI et al (2016) Seroprevalence of hepatitis E virus in autoimmune hepatitis patients in the Netherlands. J Gastrointestin Liver Dis 25(1):9–13

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China

    Shaoli You, Bing Zhu & Shaojie Xin

Authors
  1. Shaoli You
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bing Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaojie Xin
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, China

    Youchun Wang

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

You, S., Zhu, B., Xin, S. (2023). Clinical Manifestations of Hepatitis E. In: Wang, Y. (eds) Hepatitis E Virus. Advances in Experimental Medicine and Biology, vol 1417. Springer, Singapore. https://doi.org/10.1007/978-981-99-1304-6_13

Download citation

Publish with us

Policies and ethics

Search

Navigation