HEALTH-AFFAIRS

Volume 9 Issue 1

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

Prashanth Rawla,Jeffrey Pradeep Raj,Alan Jose Kannemkuzhiyil,John Sukumar Aluru,Krishna Chaitanya Thandra andMahesh Gajendran

1
Department of Medicine, Sovah Health, Martinsville, VA 24112, USA
2Department of Clinical Pharmacology, Seth G.S. Medical College & King Edward Memorial Hospital, Mumbai 400012, India
3St. Johns Medical College, St. John’s National Academy of Health Sciences, Bengaluru, Karnataka 560034, India
4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02212, USA
5Department of Pulmonary and Critical Care Medicine, Sentara Virginia Beach General Hospital, Virginia Beach, VA 23454, USA
6Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
 
Author to whom correspondence should be addressed.

Abstract

Hepatitis E virus (HEV) is a non-enveloped, positive-sense, single-stranded RNA icosahedral virus belongs to the genus Orthohepevirus within the Hepeviridae family. HEV infection can be asymptomatic, or it can cause icteric or fulminant hepatitis. Off late, there have been a number of publications reporting the extra-hepatic manifestations of HEV infection, and this systematic review is aimed at summarizing the available evidence in this regard. Two independent investigators searched PubMed, PubMed Central and Embase databases using the search string “(((hepatitis E) AND (Extrahepatic OR Extra-Hepatic))) OR ((Hepatitis E) AND (Neurology OR Cardiology OR Respiratory OR Lung OR Gastrointestinal OR musculoskeletal OR immunology OR pulmonary)) Filters: Abstract availability, English language, and Human studies”. The extra-hepatic manifestations reported in each of the selected articles were classified and reported as neurological, cardiovascular, and hematological and miscellaneous manifestations. The total number of various manifestations reported in our study were n = 324. These include neurological manifestations (n = 178/324 (54.94%)), cardiovascular and hematological manifestations (n = 113/324 (34.88%)), gastro-intestinal/pancreaticobiliary manifestations (n = 24/324 (7.41%)) and other rarer manifestations involving systems such as renal (n = 4/324; 1.24%), endocrine (n = 1/324; 0.31%), dermatology (n = 1/324; 0.31%), respiratory (n = 1/324; 0.31%), muscular (n = 1/324; 0.31%) and immune system (n = 1/324; 0.31%). Thus, HEV can have extra-hepatic manifestations affecting any system of the human body. Further research is needed to elucidate the underlying pathophysiological manifestations of these extra-hepatic manifestations and to prove causal association with HEV.
Keywords: hepatitis EHEVviral hepatitisextra-hepatic manifestations
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