Hepatitis E Beyond the Liver

Testing limitations and atypical presentations hinder clinical recognition

To discuss the diagnostic challenges of hepatitis E virus (HEV) and the need for detection beyond liver-related symptoms.

HEV is often misdiagnosed due to the perception that it is primarily a disease of developing countries.
Extrahepatic manifestations of HEV include neurological disorders, renal issues, hematological conditions, and more.
Men over 60 who consume meat are at the highest risk for HEV infection.
Diagnostic challenges include the timing of antibody response and the limitations of serological and molecular assays.
Improving clinician education and establishing specialized laboratories could enhance HEV detection.

HEV should be considered a systemic disease, and its detection requires awareness of its diverse manifestations and improved diagnostic practices.

Limited clinician awareness of zoonotic HEV risk factors and presentations.
Challenges in standardizing HEV RNA testing and the short viremia period in zoonotic infections.

A coordinated One Health strategy is essential for effective control and potential eradication of HEV.