Hepatitis E, A and other hepatotropic viruses

Hepatotropic viruses are extremely common worldwide and among the most common causes of acute hepatitis and acute liver failure. Seroprevalence rates are high and higher rates are increasingly being found as assays become more sensitive. Most commonly, they present with a viral prodrome and an acute increase in liver enzymes but atypical presentations can occur. Whereas the majority of infections are benign and self-limiting, chronic states do occur, and in the case of Epstein–Barr virus and cytomegalovirus latency occurs after primary infection, with reactivation occurring at later times of illness. Vaccination programmes for hepatitis A, where available, have led to a significant reduction in incidence. Our knowledge of these viruses continues to expand, especially with regard to hepatitis E and its genotypes. Hepatitis E virus has recently been found in donated human blood and the causative agent in some cases of patients presenting with neurology signs and symptoms; it is now considered a significant health burden in both developing and developed countries.