Pathogen. An infectious inflammation of the liver endemic to Asia, Central America, and parts of Africa is apparently transmitted by the fecal-oral route. The RNA genome of the culprit agent has now been sequenced and the virus in question, the hepatitis E virus, has been classified with the caliciviruses. It occurs in at least 13 variants divided into three groups. In-vitro culturing of HEV has not succeeded to date.
Pathogenesis and clinical picture. The clinical course of hepatitis E infections tends to be benign and resembles that of hepatitis A. It shows no chronicity. However, infections in the third trimester of pregnancy have a lethality rate of 10-40%.
Diagnosis. The antibodies can be detected by means of an enzyme immu-noassay. Apparently due to cross-reactions with other caliciviruses, the specificity of the results is uncertain. A diagnosis is often arrived at based on clinical evidence and medical history (travel to endemic areas).
Epidemiology. HEV causes repeated outbreaks of considerable dimensions in the parts of the world mentioned above. The infections can be traced to contaminated drinking water. Hepatitis E is imported to central Europe as a traveler's infection, although apparently less frequently than hepatitis A. No specific prophylactic measures exist.
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