Podcast
Questions and Answers
What is the recommended dosage of ribavirin for treating chronic hepatitis E?
What is the recommended dosage of ribavirin for treating chronic hepatitis E?
In the case of chronic hepatitis E treatment failure, what is the alternative option to ribavirin?
In the case of chronic hepatitis E treatment failure, what is the alternative option to ribavirin?
What percentage of patients is expected to achieve a sustained virological response with ribavirin treatment?
What percentage of patients is expected to achieve a sustained virological response with ribavirin treatment?
What is a key reason for caution when using PEG-IFN alpha in transplant recipients?
What is a key reason for caution when using PEG-IFN alpha in transplant recipients?
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What is the treatment protocol for patients requiring a combination therapy for chronic hepatitis E?
What is the treatment protocol for patients requiring a combination therapy for chronic hepatitis E?
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What is a significant risk associated with ribavirin use in pregnant women with acute HEV infection?
What is a significant risk associated with ribavirin use in pregnant women with acute HEV infection?
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After completing ribavirin treatment, when should HEV RNA ideally be undetectable to indicate a sustained virological response?
After completing ribavirin treatment, when should HEV RNA ideally be undetectable to indicate a sustained virological response?
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What is the suggested administration frequency for PEG-IFN alpha in patients with chronic hepatitis E?
What is the suggested administration frequency for PEG-IFN alpha in patients with chronic hepatitis E?
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In which group is reducing immunosuppressive medication typically necessary when treating chronic hepatitis E?
In which group is reducing immunosuppressive medication typically necessary when treating chronic hepatitis E?
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What is the duration of PEG-IFN alpha treatment for chronic hepatitis E?
What is the duration of PEG-IFN alpha treatment for chronic hepatitis E?
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Which of the following statements about the structure of Hepatitis E virus is correct?
Which of the following statements about the structure of Hepatitis E virus is correct?
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Which genotypes of Hepatitis E virus are primarily transmitted through the fecal-oral route?
Which genotypes of Hepatitis E virus are primarily transmitted through the fecal-oral route?
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Which mode of transmission is responsible for the spread of HEV-3, HEV-4, and HEV-7?
Which mode of transmission is responsible for the spread of HEV-3, HEV-4, and HEV-7?
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What is the typical incubation period for Hepatitis E virus infection?
What is the typical incubation period for Hepatitis E virus infection?
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What type of hepatitis does Hepatitis E virus produce morphologic changes that resemble?
What type of hepatitis does Hepatitis E virus produce morphologic changes that resemble?
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Which statement correctly describes the variants of Hepatitis E virus responsible for zoonotic transmission?
Which statement correctly describes the variants of Hepatitis E virus responsible for zoonotic transmission?
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What is a potential parenteral route for Hepatitis E virus transmission?
What is a potential parenteral route for Hepatitis E virus transmission?
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Which mode of transmission is NOT associated with Hepatitis E virus?
Which mode of transmission is NOT associated with Hepatitis E virus?
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Which component of the Hepatitis E virus protects its RNA genome?
Which component of the Hepatitis E virus protects its RNA genome?
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What percentage of patients may progress to acute liver failure during the acute icteric phase of hepatitis E?
What percentage of patients may progress to acute liver failure during the acute icteric phase of hepatitis E?
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Which of the following populations is most commonly affected by HEV-3, HEV-4, and HEV-7 infections?
Which of the following populations is most commonly affected by HEV-3, HEV-4, and HEV-7 infections?
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In immunocompromised patients, why is testing for HEV RNA preferred over serological antibody tests?
In immunocompromised patients, why is testing for HEV RNA preferred over serological antibody tests?
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What is a notable extrahepatic manifestation of hepatitis E infection?
What is a notable extrahepatic manifestation of hepatitis E infection?
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What does the presence of anti-HEV IgG antibodies indicate?
What does the presence of anti-HEV IgG antibodies indicate?
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What is the main preventive measure to reduce the risk of hepatitis E infection?
What is the main preventive measure to reduce the risk of hepatitis E infection?
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What virus is associated with chronic hepatitis E primarily in solid organ transplant recipients?
What virus is associated with chronic hepatitis E primarily in solid organ transplant recipients?
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What treatment is often recommended for patients who develop fulminant liver failure from acute hepatitis E?
What treatment is often recommended for patients who develop fulminant liver failure from acute hepatitis E?
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Which recombinant vaccine is used to prevent hepatitis E and is licensed in China?
Which recombinant vaccine is used to prevent hepatitis E and is licensed in China?
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How long does HEV RNA typically remain detectable in immunocompetent patients after the onset of infection?
How long does HEV RNA typically remain detectable in immunocompetent patients after the onset of infection?
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Study Notes
Virology
- Hepatitis E virus (HEV) is a nonenveloped, single-stranded RNA virus, 27 to 34 nm in diameter, classified in the genus Orthohepevirus of the Hepeviridae family.
- The virus has an outer capsid of a single protein and exists in both enveloped and non-enveloped forms.
- Five genotypes exist: HEV-1, HEV-2, HEV-3, HEV-4, and HEV-7, each with distinct epidemiology and clinical course.
Mode of Transmission
- HEV is enterically transmitted, mainly through the fecal-oral route by sewage-contaminated water, especially for HEV-1 and HEV-2.
- HEV-3, HEV-4, and HEV-7 are primarily zoonotic, transmitted via direct contact with infected animals or consumption of undercooked meat.
- Transmission can also occur parenterally via blood transfusions, organ transplants, and intravenous drug use.
- Incubation period ranges from 28 to 40 days.
Clinical Presentations
- HEV-1 and HEV-2 infections are often seen in young adults; symptoms may include asymptomatic or symptomatic hepatitis, cholestasis, or acute liver failure particularly in pregnant women.
- HEV-3, HEV-4, and HEV-7 typically result in mild sporadic cases, mostly impacting older adults.
- Immunocompromised individuals face a higher risk for chronic hepatitis and severe disease.
Extrahepatic Manifestations
- Neurological issues: Guillain-Barré syndrome, encephalitis, and myelitis.
- Renal issues: Pre-renal failure and glomerulonephritis.
- Hematological issues: Thrombocytopenia, hemolysis, and aplastic anemia.
Diagnosis
- Acute infection diagnosed via serological tests for anti-HEV IgM/IgA; IgG indicates past infection and immunity.
- HEV RNA detected by RT-PCR in serum or feces before symptoms onset; transient viraemia in immunocompetent patients but persistent in immunocompromised patients.
Prognosis
- Self-limited infections common in immunocompetent individuals.
- Severe acute hepatitis in pregnant women and patients with liver disease is possible, risking fulminant liver failure.
- Transplant recipients may develop chronic hepatitis E, leading to cirrhosis or death.
Prevention
- Focus on clean water and sanitation, proper hygiene education, and avoiding undercooked food.
- HEV vaccine (Hecolin) available in China, showing 87% efficacy after three doses; establishes long-lasting immunity.
Treatment
- Supportive treatment generally needed for acute hepatitis E; liver transplantation may be required in fulminant cases.
- Chronic hepatitis E in immunocompromised patients may necessitate reduced immunosuppression and antiviral treatments, including ribavirin or PEG-IFNα.
- Ribavirin monotherapy recommended for at least three months, with notable efficacy.
- PEG-IFNα can be used if ribavirin fails, but caution is advised in transplant patients to avoid graft rejection.
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Description
Test your knowledge on Hepatitis E virus, a member of the Hepeviridae family. This quiz covers its structure, classification, and genotypes. Perfect for students and professionals in the field of virology.
