HEV in Patients With Acute Non-A, Non-B, Non-C Hepatitis in Al-Rajhy University Hospital for Liver
HEV in Patients With Acute Non-A, Non-B, Non-C Hepatitis in Al-Rajhy University Hospital for Liver
Hepatitis E is the fifth known human viral hepatitis and is probably the most common cause of
 acute viral hepatitis in the world. The incidence of acute hepatitis E is estimated at 3
 million human cases per year worldwide, with around 70,000 deaths. Most cases occur in
 endemic countries, but the number of cases in low-endemic areas has increased. HEV
 seroprevalence is high in developing countries, such as India and Southeast Asia, ranging
 from 27-80%. Acute disease mortality is 1-4%, with risk being higher in pregnant women and
 immunodeficient patients.

 The four more prevalent genotypes are allocated into two groups. Epidemic hepatitis E
 includes genotypes 1 and 2, which are considered human viruses and have caused the epidemics
 of hepatitis. These forms are transmitted mainly by contaminated water and the fecal-oral
 route. endemic hepatitis E includes genotypes 3 and 4, which are considered swine viruses
 (common in domestic and wild pigs), capable of infecting humans as an accidental host and
 therefore considered zoonotics.

 The course and clinical presentation of hepatitis E is highly variable. The detailed
 mechanisms that lead to the different clinical outcomes in hepatitis E are only partially
 understood. It is known that both viral factors (genotype and dose of inoculum) and host
 factors (presence of previous liver disease, pregnancy and distinct genetic polymorphisms)
 determine the course of infection. In most cases, hepatitis E causes self-limited illness,
 lasting from a few days to weeks, with an average of 4-6 weeks. However, in developed
 countries it can cause chronic disease with rapid progression to cirrhosis, especially in
 patients who are transplanted, have hematological malignancies requiring chemotherapy, or
 have infection with HIV.

 Hepatitis E is an underdiagnosed disease, partly due to the use of serological tests with low
 sensitivity. Diagnosis can be made indirectly by detecting antibodies against HEV in the
 serum, or directly by detecting the genome of the virus in blood or other body fluids. The
 tests for anti-hepatitis E antibody screening are commercially available, but none of them
 has been approved by the Food and Drug Administration (FDA). Unfortunately, the sensitivity
 and specificity of these tests vary greatly and this could explain the discrepancies in rates
 of anti-hepatitis E antibodies published for the various populations studied. The tests for
 viral RNA in serum and feces are confirmatory, but still experimental.
Inclusion Criteria:

 -  • Patients have clinical diagnosis of acute viral hepatitis as (recent onset of
 nausea, fever, fatigue, abdominal pain , hepatomegaly and abnormal transaminases (at
 least 2 fold higher than the upper normal level))

 -  Post-transplant acute hepatitis

 Exclusion Criteria:

 -  hepatitis A, B and C patients

 -  autoimmune hepatitis

 -  Alcoholism

 -  Treatment with hepatotoxic drugs

 -  Biliary disease

 -  Infection with CMV or EBV

 -  Taken ribavirin therapy