USMLE

Hepevirus (Hepatitis E Virus)

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Viruses - RNA Viruses
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Key Points

  • Hepeviruses (FA 2019 p167, MB)
    • Characteristics
      • RNA viruses
        • replicate in the cytoplasm of cells
        • Single-stranded
      • + sense
      • Linear chromosome
      • No envelope
        • Are not destroyed by the gut
      • Icosahedral capsid
    • Presentation and Key Viruses
      • Hepatitis E virus (HEV)
        • Transmission
          • Fecal-oral (esp. waterborne)
          • Enteric, epidemic (e.g. in parts of Asia, sub-Saharan Africa, Middle East, Mexico)
            • No carrier state
        • Presentation
          • Acute hepatitis
            • Occurs after short incubation period (5-6 weeks)
            • Fever, jaundice, elevated ALT and AST
            • Usually mild and self-limiting in adults
            • Fulminant hepatitis in pregnant women
              • High mortality in pregnancy
        • Diagnosis
          • Liver Biopsy
            • All viral hepatitis produce a similar histopathological pattern
            • Hepatocyte swelling (necrosis)
              • “Ballooning degeneration”, thought to be caused by ATP depletion and disruption of cytoskeleton
              • Hyperplasia may also occur due to regeneration of tissue (active cell replication) lost to viral damage
            • Monocyte infiltration
              • Occurs due to viral infection and hepatocyte necrosis
            • Councilman bodies
              • Apoptotic bodies form round pink (eosinophilic) bodies known as Councilman bodies
          • HEVAg can be detected by ELISA, or HEV RNA by RT-PCR
          • Anti-HEV antibodies may be seen in blood
        • Treatment
          • Supportive