Hepatitis E – a Frequently Overlooked Differential Diagnosis
DOI: 10.3238/zfa.2015.0084-0088german translation / full article
Background: Hepatitis-E-infection is often not considered as a differential diagnosis in patients presenting with acute hepatitis. Since a positive hepatitis-E serology is relatively frequently found in blood donors in Germany, the infection should therefore be taken into account as a possible diagnosis in cases with acute hepatitis. In this context it has to be considered, that in up to 13 % of patients with a suspected drug induced acute hepatitis, a hepatitis-E-infection is the real cause of the hepatitis.
Methods: Pragmatic PubMed literature search.
Results: Infection with the hepatitis-E-virus (HEV) genotype 3 by ingestion of insufficiently heated pork or wild boar is the main mode of transmission of hepatitis E in Germany. Overall it has a benign subclinical course with complete healing. On the other hand acute HEV-infection can take a severe course in patients with preexisting liver disease. In developing countries HEV-genotype-1-infection can cause fulminant liver failure in pregnant women. Immunosuppressed patients are at high risk of developing chronic HEV-infection, progressing to liver cirrhosis. The „off label” use of ribavirin can be considered both in patients with a severe acute course as well as in chronic HEV-infection. A vaccine against HEV is available in China.
Conclusions: The hepatitis-E-virus is endemic in Germany; and the frequency of HEV-infection is underestimated. For patients at risk for a severe or chronic course of the disease ribavirin might be a therapeutic option for some patients.