Questions and Answers
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?
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?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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What is a notable extrahepatic manifestation of hepatitis E infection?
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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?
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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?
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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?
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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.
