Hepatitis E is a form of liver inflammation caused by a virus. It is atypical of Europe and occurs primarily in Asia, Central and South America, and northeastern and northern Africa.
What is hepatitis E?
Hepatitis E is an acute inflammation of the liver. The causative agent is the hepatitis E virus. It attacks liver cells and is responsible for dysfunction of the organ. While hepatitis E is almost unknown in Europe and is largely considered a travel disease, hepatitis E epidemics occur time and again in North Africa, Central and South America, India, Sudan and Iraq. Apparently, younger people (under 20 years of age) rarely or rarely contract hepatitis E. Hepatitis E was first detected in 1980.
Causes
Hepatits E occurs primarily where food is contaminated or drinking water is contaminated with feces. The virus enters the body primarily through food ingestion. Smear infections are also a possible method of infection, while infection by droplet infection has not been proven. It is also suspected that the virus can be transmitted to the unborn child. People living in the flooded areas of the respective regions during the monsoon season fall ill particularly frequently, as the pathogen is transmitted through water to both humans and animals. Mammals such as mice, rats, pigs, sheep or monkeys are among the natural hosts of the virus. Therefore, eating the meat of an infected animal can also lead to the disease.
Symptoms, complaints, and signs
Hepatitis E is a viral disease of the liver that closely resembles hepatitis A in its course. As with the latter, nonspecific symptoms initially occur that may also be indicative of other diseases. These symptoms include nausea, vomiting, fever and flu-like symptoms. In the further course, jaundice may also occur. This is indicated by yellowing of the skin and eyes as well as unbearable itching. In addition, there is often a discoloration of the stool, which then takes on a light color. At the same time, a dark coloration of the urine occurs. However, not all affected individuals develop jaundice. Often a completely asymptomatic course of the disease is possible. In most cases, hepatitis E heals on its own without consequences. However, there are also more complicated courses. Hepatitis E is particularly dangerous for pregnant women. If the disease occurs in the last third of pregnancy, a fulminant course of the disease with liver failure and acute pancreatitis can develop, which is fatal in up to 20 percent of cases. Severe and sometimes fatal complications can also occur in liver-damaged or immunocompromised individuals. However, apart from pregnant women, overall complications and deaths from hepatitis E are very rare. Chronic courses also do not usually occur with the exception of organ transplant recipients, in whom chronic cases have also been observed in very rare cases.
Course
Hepatitis E has an incubation period of 30 to 40 days. The disease usually begins with nonspecific symptoms indistinguishable from those of hepatitis A. These include fatigue, tiredness, loss of appetite, fever, nausea, weight loss, headache, feeling of pressure in the upper abdomen, and muscle and joint discomfort. After that, the usual symptoms of jaundice appear. The urine turns dark, the stool is discolored, the skin or eyes turn yellowish, and in some cases there is severe itching. After about six weeks, these symptoms subside on their own. In children, hepatitis E is very often asymptomatic. Because of the same clinical course as hepatitis A, hepatitis E can be reliably detected only by blood testing and the presence of antibody particles.
Complications
Hepatitis E is a rather harmless hepatitis. Once infected, it heals after a few weeks without carrying any consequences. This is mainly the case in people with an intact immune system. If the immune system is not adequate, the patient may slip into liver failure. The liver can no longer perform its important tasks and serious consequences occur. On the one hand, not enough required proteins are produced. This leads to severe water retention in the body, the edema.Fewer proteins for clotting are also synthesized, the time of bleeding is thus prolonged and there is a risk of hemorrhage in the case of serious injuries. The function of detoxification is also disturbed in the liver. More ammonia accumulates in the body, which can lead to hepatic encephalopathy in the brain. Furthermore, blood is no longer transported properly through the liver. It is drained more in bypasses. These are located at the stomach, esophagus and rectum. Varicose veins in the stomach or esophagus and hemorrhoids are the consequences. Death due to hepatitis E infection is observed particularly in pregnant women. Approximately 20 percent of pregnant women with hepatitis E die due to the disease.
When should you see a doctor?
With hepatitis E, there is no self-healing and, in the worst case, the disease leads to the death of the affected person. A doctor should be consulted at the first signs of the disease. It should also be noted whether the affected person has been in an affected area in recent weeks. A doctor should be consulted if the patient suffers from jaundice. As a rule, this is easy to recognize from the outside. It is accompanied by weakness and fatigue. Weight loss or loss of appetite also indicate hepatitis E and should be investigated. Many patients also suffer from severe pain in the abdomen and head, but these are not particularly specific symptoms. The onset of hepatitis E is very similar to an ordinary cold. A doctor should be consulted no later than the onset of jaundice. Since hepatitis E must be reported, the disease should be treated in a hospital. Alternatively, the affected person can also contact a general practitioner. Early diagnosis has a positive effect on the further course of the disease.
Treatment and therapy
In the case of hepatitis E, only the symptoms accompanying the disease can be treated. There is no vaccine against the disease. Because it is a viral disease, the use of antibiotics is also not useful. As a rule, bed rest is prescribed, as well as painkillers if needed. Alcohol should be avoided so as not to put additional strain on the liver. In most cases, hepatitis E heals on its own and runs its course without complications. Severe courses of the disease, including death, are extremely rare, but can occur in pregnant women in the last third of pregnancy. In these cases, hepatitis E can cause acute liver failure and acute inflammation of the lungs, heart or pancreas. Hepatitis E always runs an acute course; chronic diseases are not known to date. In the case of suspected hepatitis E, an existing disease or a death, a report must be made by the attending physician in accordance with the Infection Protection Act, as it is a notifiable disease.
Outlook and prognosis
The prognosis of hepatitis E is considered favorable. The course of the disease is not chronic, unlike the other forms of hepatitis disease. The symptoms that occur are minor in direct comparison with the other courses of the viral disease. In almost all documented cases, the patient recovers completely after a few weeks of infection. The mild symptoms usually heal independently and without medical assistance. Therefore, treatment is usually not required. Moreover, no consequential damages or permanent impairments are to be expected with hepatitis E disease. This also applies in the event of a new outbreak of the disease. In rare cases, there is a severe course of the disease with a fatal outcome. The dramatic developments exclusively affect patients who belong to a risk group. Pregnant women who are in the last trimester of their pregnancy receive a very unfavorable prognosis. They may experience a sudden and unexpected premature birth. This is associated with the usual dangers for the newborn and can lead to the death of the child, in addition to lifelong health impairments. In addition, pregnant women can suffer a miscarriage. In particularly severe developments, the expectant mother dies. In 1/5 of all known cases, the pregnant woman does not survive the consequences of hepatitis E.
Prevention
Preventive vaccination against hepatitis E is not possible, as research on a vaccine is currently ongoing.When traveling to countries where there is a possibility of infection, hygienic measures in particular can help to protect against hepatitis E. In principle, only boiled water or packaged mineral water should be drunk and used. It is also advised to thoroughly rinse and brush fruits and vegetables with boiled water. If there is no possibility to do so, it should be used only gpeeled. Consumption of food from snack stands is considered a concern. Appropriate information on areas at risk can be obtained from the Foreign Office or any tropical institute. If an illness is suspected, a doctor should definitely be consulted.
Aftercare
To allow the disease to heal as completely as possible and to prevent further incidents, a gentle lifestyle should be aimed for. Alcohol consumption should be curbed whenever possible. Smoking is also harmful to the liver, which is already overstressed by the disease. Drugs that affect the liver, such as paracetamol, should only be taken sparingly, rarely and only after medical clarification. Hormonal contraceptive medication can also put additional strain on the liver. Therefore, previous hepatitis E disease should be pointed out before taking them. In addition, sports and strenuous activities should be avoided until the disease is completely healed. Bed rest is not obligatory, but it is advisable depending on the need and condition. With regard to diet, a liver-sparing diet should be aimed for. This means that high-fat foods should be avoided and carbohydrate-rich foods should be replaced. Fatty sausage and fatty meat are particularly sensitive and should therefore not be consumed. In addition, to avoid further hepatitis E outbreaks, meat intended for consumption should always be cooked sufficiently. Limiting sugar consumption has been shown to promote healing. This is because too much sugar is converted to fat in the body, which damages the liver. Omega-3 fats such as linseed oil are particularly good for the liver. Regular blood work to clarify liver values is also part of careful follow-up care.
What you can do yourself
Hepatitis E is extremely rare in Europe and is considered a travel disease. Widespread is this form of hepatitis especially in Southeast Asia, Iraq and Sudan. In Asia, most cases of the disease occur during the monsoon season. Private travel to Southeast Asia should therefore be undertaken at a different time of year. Those traveling to high-risk areas on business can take a number of precautions. Hepatits E pathogens enter the body primarily through food intake. Drinking water contaminated with feces and contaminated food are particularly dangerous. Since the disease can be transmitted not only from person to person but also from mammals, especially rodents, pigs, sheep and monkeys, the meat of these animals should not be consumed. In addition to infection through contaminated food, there is also the risk of smear infection. Regular, thorough hand washing can have a preventive effect here. In addition, utensils such as pens, cell phones or computer keyboards should not be shared. Anyone who has to use an Internet café should disinfect the keyboard and mouse, not touch their face or mouth under any circumstances while working, and clean their hands very thoroughly immediately afterwards. Since a hepatitis E infection is less likely to lead to an acute illness in persons with an intact immune system and, moreover, usually heals quickly and without problems, a healthy lifestyle also contributes to self-help.