Chronic Hepatitis E: A Review of the Literature

S. Fujiwara; Y. Yokokawa; K. Morino; K. Hayasaka; M. Kawabata; T. Shimizu


J Viral Hepat. 2014;21(2):78-89. 

In This Article

Clinical Manifestation

Clinical features of HEV infection range from asymptomatic to acute hepatitis and even to acute or subacute liver failure.[5,29] HEV infection often follows a silent clinical course.[31] In symptomatic cases, jaundice, asthenia, fever, joint and muscle pain, and abdominal pain are observed. Headache, nausea, vomiting, loss of appetite, loss of weight, bowel disturbances and purpuric skin rash are also observed in some cases.[45] These symptoms are usually self-limiting and resolve in 4–6 weeks.[29] Some patients, however, have a severe course; pregnant women, individuals with pre-existing chronic liver diseases and those with active alcohol abuse are at a significantly higher risk of HEV-associated acute liver failure.[46,47]

Chronic hepatitis E infection can result in progressive liver fibrosis, cirrhosis and subsequent liver failure,[6,8,13,15,30,33,36,40] which occasionally require liver transplantation.[13,36] Clinical manifestations of CHE are often nonspecific symptoms; most patients are asymptomatic, and few show jaundice, fatigue, abdominal pain, fever and asthenia.[6–8,19,33,39,41] Several extrahepatic manifestations associated with HEV infection have been reported. Individuals with acute HEV infection have developed neurological manifestations such as Guillain–Barré syndrome, bilateral brachial neuritis, polyradiculoneuropathy, peripheral neuralgia with meningitis, transverse myelitis, neuralgic amyotrophy, seizure, pseudotumor cerebri and nerve palsies.[15] On the other hand, CHE infection is associated with bilateral pyramidal syndrome, peripheral neuropathy, inflammatory polyradiculopathy, encephalitis and proximal myopathy.[29,48] Nassim Kamar et al. reported that 6% of solid organ transplant recipients with CHE infection showed neurological signs and symptoms.[48] Other complications of HEV infection have also been reported, including pancreatitis, thrombocytopenia, haemolysis, membranous glomerulonephritis and Henoch–Schönlein purpura.[45] Among these complications, membranous glomerulonephritis was observed in patients with CHE infection.[19] The pathological mechanisms responsible for these associations remain unclear, and further investigation should be conducted.