Characteristics of Hepatitis E Virus Infection in Children Attending a Tertiary Care Teaching Hospital in Upper Egypt

Introduction: Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in developing countries resulting in self-limited acute illness in the majority of patients but fulminant hepatic failure may occur. Oral-fecal contamination is the main route of infection in endemic areas and parenteral route and transmission through animal contact has been reported. In Egypt, most cases of AVH are caused mainly by the enteric hepatitis viruses A and E. Methods: Pediatric patients presented to Assiut University Children Hospital and/or Assiut Fever Hospital with a picture of AVH were included in the study. Patients were exposed for thorough history taking, physical examination, liver function tests and serologic studies for hepatotropic viruses (A, B, C, and E), cytomegalovirus, anti-smooth muscle & anti-nuclear antibody for autoimmune hepatitis. Results: We identified 123 patients, 73 (59.3%) males and 50 (40.7%) females, age range was 2-18 years. Out of them; 33 (26.8%) had isolated HEV, 17 (13.8%) had HAV, 10 (8.1%) had HBV, 14 (11.4%) had cytomegalovirus (CMV), 5 (4.1%) had autoimmune hepatitis (AIH), 11 (8.9%) had mixed hepatitis infection, and 33 (26.8%) diagnosed as none A through E (NANB) hepatitis. Patients with HEV infection showed higher prevalence of underground wells as a water source (p < 0.001). No significant differences were found in the clinical symptoms and signs among HEV and non-HEV patients. Liver enzymes (ALT and AST) were significantly higher among non-HEV patients (p < 0.001). Conclusion: Hepatitis E virus (HEV) infection is a common cause of acute viral hepatitis (AVH) among children especially in tropical countries with poor sanitary and hygienic conditions. This study aimed to recognize the sociodemographic, clinical, and laboratory characteristics of AVH due to HEV among children attending a tertiary care teaching hospital at Upper Egypt. In conclusion, hepatitis E virus is representing a significant cause of acute viral hepatitis among children at Upper Egypt. Drinking water contamination seems to be a major source of infection. Asymptomatic presentation with benign disease course and outcome in the vast majority of patients.Table 1: Characteristics of studied patients with acute viral hepatitis