| Abstract | Hepatitis E virusna infekcija je globalni javno-zdravstveni problem. Hepatitis E virus (HEV) ima više različitih genotipova; genotip 1 je odgovoran za pojavu endemskog i epidemijskog hepatitisa E u Aziji, a genotip 2 u Središnjoj Americi, Meksiku i Africi. Oba genotipa prenose se feko-oralnim putem, češće zahvaćaju mlađu populaciju i predstavljaju opasnost za trudnice jer mogu dovesti do smrtnog ishoda. Genotip 3 je većinom prepoznat kao uzročnik hepatitisa u razvijenim zemljama svijeta (Zapadna Europa, SAD, Japan, Australija), dok se genotip 4 najviše pojavljuje u Jugoistočnoj Aziji. Smatra se kako su genotipovi 3 i 4 zoonoze, a najvažniji izvori su im domaća i divlja svinja. Osim prijenosa hranom, ovi genotipovi se mogu prenositi krvnim derivatima te transplantacijom solidnih organa. Najčešće zahvaćena skupina su stariji bolesnici te bolesnici s kroničnom jetrenom bolesti. Većina infekcija uzrokovana HEV-om je klinički asimptomatska, a u manjem broju može dovesti do fulminatnog hepatitisa. Kod zdravih pojedinaca infekcija je uglavnom samoograničavajuća, dok kod imunokompromitiranih pacijenata infekcija može poprimiti kroničan oblik te dovesti do ciroze. HEV infekcija se međutim može prezentirati i ekstrahepatalnim poremećajima kao što su Guillain-Barre sindrom, meningoencefalitis, pareza okulomotornog živca, akutni pankreatitis, glomerulonefritis i drugi. Dijagnoza se postavlja na temelju dokaza IgM i IgG protutijela te virusne RNA. U Europi ne postoji specifično registrirano cjepivo. Najdjelotvorniji način prevencije zasad je dobra termička obrada mesa te redovita higijena ruku. Kod kroničnih oblika bolesti preporuča se monoterapija ribavirinom u trajanju od 12 tjedana. Ovaj pregledni rad prikazuje dosadašnja saznanja o epidemiologiji, kliničkoj slici, dijagnostici, liječenju te prevenciji infekcije uzrokovane virusom hepatitisa E. |
| Abstract (english) | Hepatitis E viral infection is a global public health problem. Hepatitis E virus (HEV) has several different genotypes; genotype 1 that is responsible for the occurrence of endemic and epidemic hepatitis E in Asia, and genotype 2 is most common in Central America, Mexico and Africa. Both genotypes are transmitted feco-orally, affect younger patients and represent a danger to pregnant women, as they can lead to death. Genotype 3 is mostly recognized as a causative agent of hepatitis in developed countries (Western Europe, USA, Japan, Australia), while genotype 4 is most prevalent in Southeast Asia. Genotypes 3 and 4 are zoonotic, the most important sources being domestic pigs, wild boar and deer. In addition to food transmission, these genotypes can be transmitted through blood derivatives and transplantation of solid organs. The most commonly affected group are elderly patients and patients with chronic liver disease. Most HEV infections are clinically asymptomatic but may lead to fulminant hepatitis in a smaller number of cases. In healthy individuals, infection is generally self-limiting, whereas in immunocompromised patients infection can take a chronic form and lead to cirrhosis. HEV infection can also have extrahepatic manifestations, such as Guillain-Barre syndrome, meningoencephalitis, oculomotorius nerve paresis, acute pancreatitis, glomerulonephritis and others. The diagnosis is based on evidence of IgM and IgG antibodies and viral RNA. There is no registered vaccine in Europe. The most effective way of prevention is adequate thermal preparation of food and regular hand hygiene. Ribavirin monotherapy for 12 weeks is recommended for chronic forms of the disease. This review paper summarizes current knowledge about the epidemiology, clinical course, diagnosis, treatment and prevention of HEV infection. |
