Hepatitis E natural history: Difference between revisions
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*'''Symptomatic period''' | *'''Symptomatic period''' | ||
:*Lasts days to weeks | :*Lasts days to weeks | ||
:*Initial symptoms are unspecific and may include: | :*Initial [[symptoms]] are unspecific and may include: | ||
::*[[Myalgia]] | ::*[[Myalgia]] | ||
::*[[Arthralgia]] | ::*[[Arthralgia]] | ||
Line 22: | Line 22: | ||
::*[[Nausea]] | ::*[[Nausea]] | ||
::*[[Vomiting]] | ::*[[Vomiting]] | ||
:*More specific symptoms may include: | :*More specific [[symptoms]] may include: | ||
::*[[Jaundice]] | ::*[[Jaundice]] | ||
::*[[Itching]] | ::*[[Itching]] | ||
Line 28: | Line 28: | ||
::*Dark-colored urine | ::*Dark-colored urine | ||
Pregnant women, and patients with end-stage [[liver disease]] may experience more severe cases of hepatitis, possibly progressing into [[hepatic failure]]. | Pregnant women, and patients with end-stage [[liver disease]] may experience more severe cases of hepatitis, possibly progressing into [[hepatic failure]]. The worst course of the disease in pregnant women is thought to be due to characteristic immunity and hormonal changes that occur during pregnancy.<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448 }} </ref> | ||
===Chronic Hepatitis E=== | ===Chronic Hepatitis E=== | ||
==Complications== | ==Complications== | ||
*"Acute-on-chronic disease" | *"Acute-on-chronic disease" | ||
*[[Chronic hepatitis]] | *[[Chronic hepatitis]] | ||
*[[Liver failure]]: | *[[Liver failure]]: |
Revision as of 21:42, 25 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Natural History
Children with hepatitis E are often asymptomatic.[1] Hepatitis E may be classified in acute and chronic disease.[2]
Acute Hepatitis E
The clinical course of acute hepatitis E progresses according to the following phases:[3][4][5][6]
- Incubation period
- Lasts 3 to 8 weeks, with a mean of 40 days
- Prodromal phase
- Symptomatic period
- Lasts days to weeks
- Initial symptoms are unspecific and may include:
- More specific symptoms may include:
- Jaundice
- Itching
- Acholic stools
- Dark-colored urine
Pregnant women, and patients with end-stage liver disease may experience more severe cases of hepatitis, possibly progressing into hepatic failure. The worst course of the disease in pregnant women is thought to be due to characteristic immunity and hormonal changes that occur during pregnancy.[7]
Chronic Hepatitis E
Complications
- "Acute-on-chronic disease"
- Chronic hepatitis
- Liver failure:
Extra-Hepatic
- Peripheral neuropathy
- Confusion
- Ataxia
- Bell's palsy
- Guillain-Barré syndrome
- Polyradiculopathy
- Arthritis
- Pancreatitis
- Aplastic anemia
Prognosis
In most immunocompetent patients, hepatitis E is self-limited. In these cases the prognosis is often good. Immunocompromised patients, and those with end-stage liver disease are at higher risk of developing chronic hepatitis and other complications. This last group of patients have a poor prognosis.[3]
References
- ↑ Buti M, Plans P, Domínguez A, Jardi R, Rodriguez Frias F, Esteban R; et al. (2008). "Prevalence of hepatitis E virus infection in children in the northeast of Spain". Clin Vaccine Immunol. 15 (4): 732–4. doi:10.1128/CVI.00014-08. PMC 2292657. PMID 18321881.
- ↑ Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
- ↑ 3.0 3.1 Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J; et al. (2012). "Hepatitis E." Lancet. 379 (9835): 2477–88. doi:10.1016/S0140-6736(11)61849-7. PMID 22549046.
- ↑ 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): 784–90. doi:10.1097/MEG.0b013e3282f5195a. PMID 18617784.
- ↑ Borgen K, Herremans T, Duizer E, Vennema H, Rutjes S, Bosman A; et al. (2008). "Non-travel related Hepatitis E virus genotype 3 infections in the Netherlands; a case series 2004 - 2006". BMC Infect Dis. 8: 61. doi:10.1186/1471-2334-8-61. PMC 2413240. PMID 18462508.
- ↑ Zhang S, Wang J, Yuan Q, Ge S, Zhang J, Xia N; et al. (2011). "Clinical characteristics and risk factors of sporadic Hepatitis E in central China". Virol J. 8: 152. doi:10.1186/1743-422X-8-152. PMC 3082222. PMID 21453549.
- ↑ Wedemeyer H, Pischke S, Manns MP (2012). "Pathogenesis and treatment of hepatitis e virus infection". Gastroenterology. 142 (6): 1388–1397.e1. doi:10.1053/j.gastro.2012.02.014. PMID 22537448.