Hepatitis E; Symptoms, Diagnosis, Prevention, & Treatment Options

Signs and symptoms of hepatitis E

As noted above, there are two phases after an individual is infected with the hepatitis E virus. Before the infection starts, there’s an incubation period that lasts a variable number of days (a minimum of 15 days and no more than 60 days). Then, patients start displaying symptoms according to each phase.

In the prodromal phase, the symptoms are usually mild and include the following:

• Myalgias and arthralgias: This is articular and muscular pain, and it is often associated with muscle weakness.
• Loss of appetite: This is an early change in the gastrointestinal system due to systemic inflammation.
• Nausea and vomiting: Not all patients have these symptoms, and they are usually mild. But when it is present, loss of appetite is generally triggered as well.
• Weight loss: In this initial phase, patients typically lose around 2 and 4 kilograms of weight.
• Fever: It is a mild elevation of the body temperature, and it is often dismissed or neglected by patients.
• Dehydration: This is especially the case in patients who are experiencing nausea and vomiting from an early stage.
• Abdominal pain: It is located in the right upper quadrant and aggravated with exercise and physical strain.

After these initial symptoms, the icteric phase of the disease ensues. These symptoms are maintained for a few days or several weeks, depending on the patient:

• Jaundice: It happens when the bilirubin levels in the blood rise over 3 mg/dL. The accumulated bilirubin is deposited in the skin and mucosa, and they adopt a yellowish color. It usually starts to be noticeable the fifth week after the infection.
• Dark urine: Since there is no clearance of bilirubin in the blood, and it is not eliminated in the stools, the kidney is now in charge and eliminates the excess in the urine. Thus, it adopts a brownish color instead of the usual yellow.
• Pale stools: Some patients (20-40% of them) also have pale stools for the same reason: there’s no bilirubin coloring the stools to their usual brownish appearance.
• Pruritus: This is a common symptom in patients with jaundice. Even when jaundice is not noticeable due to the patient’s natural skin color, they are likely to develop generalized pruritus all over the body. However, this symptom is only found in around half of the patients infected with the hepatitis E virus.
• Malaise: It is probably the most common symptom and usually goes on from the disease’s prodromal phase. It is a general sense of “not feeling well” that is present in many infectious diseases.
• Swollen liver: There’s an enlarged liver in a variable proportion of patients. Many of them report abdominal pain in the upper right quadrant and tenderness when a doctor examines the area.

Besides these symptoms, a limited number of patients develop complications and severe health problems. For example, some patients develop acute liver failure or neurologic problems such as Guillain-Barré syndrome, mental confusion, Bell palsy, or serious renal complications such as membranous glomerulonephritis. In the event of such complications, patients report additional signs and symptoms.