Hepatitis E virus (HEV) is a single-stranded, non-enveloped, positive-stranded RNA virus that can be classified into four genotypes with distinct geographical distributions. Several reservoirs and transmission routes have been identified. The clinical symptoms of acute hepatitis caused by the different genotypes cannot be distinguished from each other and are similar to those caused by other types of hepatitis. In developed countries, fulminant hepatitis can develop in patients with underlying (liver) disease. Chronic HEV infections are reported in immunocompromised patients and can eventually result in fibrosis and even cirrhosis. Due to the nonspecific presentation, HEV infection is often misdiagnosed. Extrahepatic manifestations, mainly neurological syndromes and renal injury, have been reported. HEV infection can be diagnosed either by serological testing or by detecting HEV RNA in serum or faeces. Acute infections normally do not require treatment, but chronic infections should be treated by reducing immunosuppressive drugs, if possible, and/or using antiviral therapy. Recently, the efficacy and safety of an HEV vaccine has been studied. This review gives an overview of the current knowledge about the virus as well as the different clinical presentations, differential diagnoses, diagnostic strategies, and treatments of this infection.
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