Hepatitis E most commonly manifests as self-limiting,

acute icteric hepatitis, indistinguishable from that caused by other hepatotropic viruses. The illness usually lasts for a few weeks and improves spontaneously. A few patients have a prolonged illness with cholestatic manifestations including troublesome itching, though the outcome is usually good. Some patients http://www.selleckchem.com/ferroptosis.htmll have a particularly severe illness, presenting as FHF (acute liver failure); as indicated above, this is particularly common in pregnant women. Frequent detection of anti-HEV antibodies among residents of high-endemic regions who do not recall prior acute hepatitis indicates that asymptomatic or inapparent HEV infection is common. During hepatitis E outbreaks, some persons show evidence of anicteric hepatitis (elevated liver enzymes with normal serum bilirubin) and HEV infection (HEV viremia and seroconversion). Factors that determine disease severity are poorly understood. In animal

studies, the viral inoculum dose determines severity of liver injury, and lower doses are associated with subclinical infection;81 the role of this factor in humans has not been studied. In areas where hepatitis E is common, HEV superinfection can occur in patients with pre-existing chronic liver disease of viral or non-viral etiology, leading to superimposed acute liver injury and clinical Selleck SB203580 presentation with acute on chronic liver disease. We found evidence of recent HEV infection in nearly one-half of Indian patients with chronic liver disease and recent decompensation.88 Such patients may be at a higher risk of a poor outcome. In some patients, chronic liver disease had been clinically silent till the time of HEV superinfection. Case-fatality rates of hepatitis E have been reported as 0.5% to 4%. However, these data are derived from hospitalized cases with more severe disease. In population surveys during disease outbreaks, much lower mortality rates of 0.07% to 0.6% have been find more observed.61,62 In

low-endemicity areas, the disease is most often recognized when serological tests are undertaken in patients with unexplained liver injury. Clinical illness in these patients is generally similar to that in high-endemicity regions, except that most patients have been middle aged or elderly men, who often had another coexistent disease.89,90 Common clinical presentations have included icteric hepatitis, anicteric illness with non-specific symptoms, and asymptomatic transaminase elevation;75 some cases were initially suspected to have drug-induced liver injury.91 Prognosis of HEV infection appears to be worse in patients in these areas than those in high-endemicity areas, mainly because of their older age and higher frequency of coexistent illnesses. Persistent HEV infection was reported for the first time in 2008, by a French group.