A highly contagious liver infection caused by the hepatitis A virus. Hepatitis A is preventable by vaccine. It spreads from contaminated food or water or contact with someone who is infected. Symptoms include fatigue, nausea, abdominal pain, loss of appetite and low-grade fever. The condition clears up on its own in one or two months. Rest and adequate hydration can help. The hepatitis E virus is mainly transmitted through drinking water contaminated with faecal matter. Symptoms include jaundice, lack of appetite and nausea. In rare cases, it may progress to acute liver failure. Hepatitis E usually resolves on its own within four to six weeks. Treatment focuses on supportive care, rehydration and rest.

1. HEPATITIS A, E

2. Hepatitis A
• Pathogen: hepatitis A virus
• Belongs to the family of Picornaviridae and the genus Hepatoviridae.
• It is a small (27 nm in diameter), non-enveloped virus
• single-stranded, positive-sense RNA
Route of transmission: fecal-oral
• Contaminated water and food (e.g., raw shellfish)
• Risk groups: nursing home residents, international travelers, prison inmates, men who have
sex with men, IV drug users.
• Infectious period: 2 weeks before to 1 week after the onset of the illness

3. Clinical features
A.Incubation period: 2–6 weeks
A.Acute viral hepatitis: three phases
a. Prodromal phase: ∼ 1–2 weeks
i. Fever, malaise
ii. Anorexia, nausea, vomiting
iii.Right upper quadrant pain and tender hepatomegaly
a. Icteric phase: ∼ 2 weeks
i. Jaundice
ii. Dark urine and pale stools
iii.Pruritus
a. Resolution of symptoms
A.Patients do not become carriers nor develop chronic hepatitis (unlike in hepatitis B and C)

4. Laboratory findings
• ↑↑ Serum transaminase (AST, ALT)
• Mixed hyperbilirubinemia
• Possibly ↑ ALP, ↑ γ-GT
• Urine analysis: ↑ urine bilirubin, ↑ urobilinogen
Confirmatory test
• ↑ Anti-HAV IgM: active infection Anti-HAV IgM can be found in serum 3–6
months after the infection
• ↑ Anti-HAV IgG: past infection or vaccination
• HAV RNA can be detected by PCR in stool and serum samples.
• Liver biopsy: Periportal inflammation, ballooning degeneration, bridging necrosis,
and Councilman bodies (apoptotic hepatocytes)
Tretament - Supportive

5. Hepatitis E
Pathogen:
• hepatitis E virus (HEV)
• belongs to the family of Hepeviridae
• is a small (34 nm in diameter), non-enveloped virus ,single-stranded, positive-sense RNA.
Route of transmission: fecal-oral
Clinical features:
• Incubation period: 2–8 weeks
• Clinical features are similar to those of hepatitis A
• In the majority of cases, the disease is self-limiting with complete recovery.
• Fulminant hepatitis among pregnant women
• Patients do not become carriers nor develop chronic hepatitis (unlike in hepatitis B and C).

6. Diagnostics
• Laboratory findings are the same as in hepatitis A.
• Confirmatory test
• Anti-HEV IgM: active infection
• Anti-HEV IgG: past infection
• HEV RNA can be detected by PCR in stool and serum samples.
• Treatment: supportive care
• Prevention: no vaccine available