Hepatitis E in immunocompromised individuals

Table 1 Hepatitis E epidemiology according to genotypes

	HEV1, HEV2	HEV3, HEV4
Geography	Developing countries (Asia, Africa, and South America)	Developed countries (Europe, United states, Japan, and Hong Kong)
Disease pattern	Endemic	Sporadic
Seasonal pattern	Yes	No
Reservoir	Only human	Animals (Pigs, wild boars, deer)
Transmission	Fecal-oral	Food-born, blood products, transplantation
Age	More common among young adult	More common among older adults
Risk factor	Chronic liver disease, pregnancy	Chronic liver disease, immunocompromised
Safety measure	Clean water, sanitation, and hygiene	Avoid contact with high-risk animals, cook meat adequately
Chronic infection	Not reported	In immunocompromised patients.

HEV1: Hepatitis E virus genotype 1; HEV2: Hepatitis E virus genotype 2; HEV3: Hepatitis E virus genotype 3; HEV4: Hepatitis E virus genotype 4.

Table 2 Extrahepatic manifestations of hepatitis E viral infection

Organ/System	Manifestation
Neurological	Guillain- Barré syndrome, Bell’s palsy, myelitis, peripheral neuropathy, neuralgic amyotrophy, encephalitis, meningitis vestibular neuritis, mononeuritis multiplex, seizure, pseudotumor cerebri, oculomotor palsy, polyradiculoneuropathy
Hematological	Thrombocytopenia, hemolytic anemia, aplastic anemia, hemophagocytic syndrome, thrombotic thrombocytopenic purpura, Cutaneous T cell lymphoproliferative disorder, monoclonal gammopathy of uncertain significance
Cardiovascular	Myocarditis, Henoch-Schönlein purpura
Renal	Reduction in glomerular filtration rate, IgA nephropathy, cryoglobulinemia, membranoproliferative glomerulonephritis, membranous glomerulonephritis
Musculoskeletal	Myositis, polyarthritis
Thyroid	Autoimmune thyroiditis, subacute thyroiditis
Pancreas	Acute pancreatitis