🦠 Hepatitis E (HEV)

Nelson Textbook of Pediatrics 22nd Edition — Hepatitis E virus (HEV) is an RNA virus (Hepeviridae). Major cause of waterborne hepatitis in developing countries (genotypes 1,2). Zoonotic (genotypes 3,4) in developed countries via undercooked meat. Self-limited acute hepatitis, but 20-30% mortality in pregnant women (third trimester). Chronic HEV in immunocompromised (organ transplant recipients). Diagnosis: anti-HEV IgM, HEV RNA. No licensed vaccine in US.

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📋 30 Clinical Scenarios — Hepatitis E

📇 High‑Yield Review Cards (Hepatitis E)

🩺 Clinical Presentations: Hepatitis E

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Hepatitis E

🔑 Key Principles — Hepatitis E (Nelson Ch.406)
• Virology: HEV is a non-enveloped RNA virus. 4 major genotypes: 1 & 2 (human, waterborne, endemic in Asia/Africa), 3 & 4 (zoonotic, pigs/wild boar, Europe/US).
• Clinical features: Incubation 2-9 weeks. Acute hepatitis similar to HAV. Self-limited in children/adults except pregnant women (20-30% mortality, third trimester).
• Chronic HEV: Occurs in immunocompromised (organ transplant, HIV, hematologic malignancy) → genotypes 3/4. Can progress to cirrhosis.
• Diagnosis: Anti-HEV IgM (acute), HEV RNA (active infection, gold standard).
• Treatment: Supportive. Severe acute: ribavirin (off-label) for pregnant women or immunocompromised. Chronic: reduce immunosuppression, ribavirin.

    ⚡ Reflex Prompts — Hepatitis E Clinical Decisions

    📖 Hepatitis E — Core Summary (Nelson Ch.406)