## Distinguishing Hepatitis A from Hepatitis E ### Clinical Presentation Comparison | Feature | Hepatitis A | Hepatitis E | |---------|-------------|-------------| | **Fulminant hepatic failure** | Rare (<0.1%) | Common in pregnant women (15–25%) | | **Chronicity** | Never chronic | Never chronic | | **Transmission** | Fecal-oral | Fecal-oral (waterborne) | | **Anti-HAV IgM** | Present in acute phase | Not applicable | | **Cholestasis** | Mild | Can be prominent | | **Mortality in pregnancy** | Not increased | Markedly increased | ### Key Point: **Fulminant hepatic failure in pregnancy is the hallmark discriminator of hepatitis E.** While both HAV and HEV are non-enveloped RNA viruses transmitted by fecal-oral route and cause acute hepatitis without chronicity, HEV has a unique predilection for severe disease in pregnant women, particularly in the third trimester, with mortality rates reaching 15–25%. ### High-Yield: Hepatitis E is endemic in areas with poor sanitation (India, Africa, Central Asia). Pregnant women with HEV infection face dramatically higher risk of fulminant hepatic failure compared to non-pregnant individuals and compared to HAV-infected pregnant women. ### Clinical Pearl: In an Indian patient with acute hepatitis, if the patient is a pregnant woman with rapidly progressive liver failure, think HEV first. If the patient is a child or non-pregnant adult with self-limited acute hepatitis, HAV is more likely. [cite:Robbins 10e Ch 18]
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