A hepatitis E viral hepatitis may be subclinical or present with clinical hepatitis. In most cases the diagnosis is considered only after the more common causes of hepatitis have been excluded, unless the case occurs during an epidemic.
Clinical features:
(1) malaise or feeling ill
(2) abdominal pain or tenderness
(3) nausea and vomiting
(4) fever
(5) variable jaundice
Laboratory findings:
(1) elevations of serum AST and ALT
(2) variable elevation of the serum total bilirubin
(3) presence of IgM to HEV with or without IgG antibodies
(4) PCR of blood or feces (virus may be shed in stool for weeks after infection)
(5) negative tests for hepatitis A virus, hepatitis B virus and hepatitis C
(6) negative tests for acetaminophen and other drugs associated with toxic hepatitis
(7) negative tests for autoimmune hepatitis
(8) negative tests for Wilson's disease
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