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Review
. 2014 Jan;27(1):116-38.
doi: 10.1128/CMR.00057-13.

Hepatitis E virus infection

Nassim Kamar  1 , Harry R Dalton, Florence Abravanel, Jacques Izopet
Affiliations
Review

Hepatitis E virus infection

Nassim Kamar et al. Clin Microbiol Rev. 2014 Jan.

Abstract

Hepatitis E virus (HEV) infection is a worldwide disease. An improved understanding of the natural history of HEV infection has been achieved within the last decade. Several reservoirs and transmission modes have been identified. Hepatitis E is an underdiagnosed disease, in part due to the use of serological assays with low sensitivity. However, diagnostic tools, including nucleic acid-based tests, have been improved. The epidemiology and clinical features of hepatitis E differ between developing and developed countries. HEV infection is usually an acute self-limiting disease, but in developed countries it causes chronic infection with rapidly progressive cirrhosis in organ transplant recipients, patients with hematological malignancy requiring chemotherapy, and individuals with HIV. HEV also causes extrahepatic manifestations, including a number of neurological syndromes and renal injury. Acute infection usually requires no treatment, but chronic infection should be treated by reducing immunosuppression in transplant patients and/or the use of antiviral therapy. In this comprehensive review, we summarize the current knowledge about the virus itself, as well as the epidemiology, diagnostics, natural history, and management of HEV infection in developing and developed countries.

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Figures

FIG 1
FIG 1
Hepatitis E virus genome.
FIG 2
FIG 2
Phylogenetic tree based on full-length sequences of HEV strains. Sequences were aligned by using ClustalW (MEGA5 [www.megasoftware.net] and BioEdit, version 7.0 [www.mbio.ncsu.edu/bioedit/bioedit]). The phylogenetic tree was created by the neighbor-joining (Kimura two-parameter) method, with a bootstrap of 1,000 replicates. GenBank accession numbers are shown for each HEV strain used in the phylogenetic analysis. The scale bar indicates the number of nucleotide substitutions per site.
FIG 3
FIG 3
Anti-hepatitis E virus IgG distribution in Midi-Pyrenees area of France, according to age.
FIG 4
FIG 4
Flow diagram for diagnosis of acute hepatitis E virus infection.
FIG 5
FIG 5
Different patterns of hepatitis E virus infection.
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