Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 16-04: Acute Hepatitis C & Other Causes of Acute Viral Hepatitis + Key Features Download Section PDF Listen +++ ++ A major cause of acute hepatitis throughout Central and Southeast Asia, the Middle East, and North Africa, where it is responsible for waterborne hepatitis outbreaks Uncommon in the United States (although up to 20% of the population have antibodies to the virus) but should be considered in patients with acute hepatitis after a trip to an endemic area In rare cases, hepatitis E can be mistaken for drug-induced liver injury In other countries, it may be spread by swine Risk factors Presence of a pet in the home Consumption of undercooked organ meats or infected cow's milk + Clinical Findings Download Section PDF Listen +++ ++ Illness generally is self-limited (no carrier state) Instances of chronic hepatitis with rapid progression to cirrhosis have been reported in Liver transplant recipients (particularly when tacrolimus rather than cyclosporine is used as the main immunosuppressant) Persons with HIV infection or with preexisting liver disease or receiving cancer chemotherapy (albeit rarely) Extrahepatic manifestations include Arthritis Pancreatitis Monoclonal gammopathy Thrombocytopenia Neurologic complications, including Guillain-Barré syndrome and peripheral neuropathy Hemophagocytic lymphohistiocytosis The risk of hepatic decompensation is increased in patients with underlying chronic liver disease + Diagnosis Download Section PDF Listen +++ ++ Hepatitis E antibodies Anti-HEV IgM is positive in acute hepatitis E Anti-HEV IgG is positive in convalescence from hepatitis E + Treatment Download Section PDF Listen +++ ++ A 3-month course of oral ribavirin has been reported to induce sustained clearance of HEV RNA from the serum in 78% of patients with persistent HEV infection and may be considered in patients with severe acute hepatitis E Improved public hygiene reduces the risk of infection in endemic areas A recombinant vaccine (Hecolin, or HEV 329) is approved for use in China