Clinical presentation in an outbreak of hepatitis E

ABSTRACT

In many cases of acute hepatitis, hepatitis E virus [HEV] is a common cause. Hepatitis E is a self limiting disease which shares many epidemiological, clinical and morphological similarities with hepatitis A. Both are enterically transmitted. The purpose of this study was to evaluate the clinical presentation of hepatitis E during an epidemic and correlate the clinical features with liver function tests [LFTs]. It is a cross sectional retrospective study. The study was conducted at Army Medical College [National University of Sciences and Technology] and Military hospitals Rawalpindi from July to December 2009. One hundred patients admitted to the hospital with clinical features of acute hepatitis including anorexia, nausea, vomiting, pain epigastrium, jaundice, raised serum total bilirubin [TBil] and serum aminotransferase [ALT] were included in the study. Hepatitis E in these patients was confirmed by detecting the presence of anti HEV IgM. The patients were monitored during their stay in the hospital and changes in their clinical condition were correlated with liver function tests [LFTs]. The most prominent symptoms in all patients were fatigue, nausea, anorexia, jaundice and dark urine, followed by pain epigastrium [50%], low grade fever [48%] and hiccups [2-3%]. Jaundice developed when mean total bilirubin was 127micromol/L, mean ALT was 1527 U/L and mean ALP 127 U/L. Serum bilirubin correlates with the development of jaundice. Hepatitis E presents with varying clinical features. The presentation is acute with marked anorexia, nausea and fatigue coupled with sharp rise in LFTs. Any adult presenting with acute onset of these symptoms should be investigated for LFTs and anti HEV IgM