Typically, Hepatitis E virus (HEV) is not considered a frequent pathogen in the U.S.; however, anti-HEV antibody has been detected in 21% of U.S. in population-based surveys between 1988-94 and the prevalence increases with age. It has been associated with acute-on-chronic liver disease and has been overlooked in some individuals labeled as having drug-induced liver disease.  Thus, HEV is a significant cause of hepatitis and a useful review has been published (NEJM 2012; 367: 1237-44).  As such, see if your knowledge is up to the test.

Questions:

• 1. True or False: Worldwide, HEV is probably the second most common form of acute hepatitis
• 2. True or False: The autochthonous form is more common in developed countries and can be present in developing countries.  Extra credit, what does “autochthonous” mean?
• 3. Best test to order to diagnose acute HEV?
• 4. Animal(s) most likely associated with the autochthonous form of HEV: shellfish, swine,  or wild game
• 5. True or False: there are 4 genotypes
• 6. True or False: antibodies (IgG and IgM) appear at the time of clinical onset, just before elevations in serum aminotransferases and symptoms
• 7. How long do these antibodies remain detectable?
• 8. Which population is most prone to fulminant epidemic HEV?  Pregnant women, immunocompromised hosts, or infants
• 9. Incubation period? a. 1-2 weeks    b. 3-8 weeks    c. 9-12 weeks
• 10. Case fatality rate? a. 1%    b. 2-4%   c. 5%    d. 7-10%
• 11. Name extrahepatic manifestations
• 12. Best treatments for chronic HEV?

Answers:

• 1. False, probably the most common cause of acute hepatitis
• 2. True.  Autochthonous refers to locally-acquired or endemic HEV
• 3. IgM for anti-HEV
• 4, Swine, but the other two have been associated with cases as well
• 5. True.  Types 1 and 2 are more common in developing countries and associated with waterborne outbreak/fecal-oral transmission
• 6. True.
• 7. IgM anti-HEV for only 3-12 months, IgG anti-HEV persists for “years, if not for life”
• 8. Pregnant women. Nutritional and immunologic features may increase the risk of fulminant HEV in pregnant women.  Rates of HEV are lower in many immunocompromised groups.  Elderly patients are more at risk for mortality due to endemic form.
• 9. b.
• 10. c.
• 11. Arthritis, pancreatitis, aplastic anemia, Guillain-Barre syndrome, Bell’s palsy, peripheral neuropathy, ataxia, and confusion
• 12. Ribavirin alone for 12 weeks yields sustained virologic response in at least two-thirds; combination with peginterferon may increase the response.  Both are considered experimental at this time.

Previous quiz blog:

Test your knowledge of Clostridium difficile