Hepatitis A vs Hepatitis E
How to tell Hepatitis A and Hepatitis E apart when a board question makes them look alike.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
Acute hepatitis in a pregnant patient with contaminated-water exposure should immediately raise concern for hepatitis E.
Side by side
Self-limited acute viral hepatitis after travel or food exposure with positive IgM anti-HAV suggests hepatitis A.
Waterborne acute hepatitis with high risk of fulminant liver failure in pregnancy suggests hepatitis E.
Enteric HAV causes hepatocellular inflammation without chronic persistence in immunocompetent hosts.
HEV infection causes acute hepatocellular injury and can trigger severe hepatic failure during late pregnancy.
Acute HAV shows AST and ALT often above 1000 U/L, positive serum IgM anti-HAV, and no chronic viremia; bilirubin elevation is variable.
Acute HEV shows marked transaminase elevation with positive IgM anti-HEV or HEV RNA; third-trimester infection carries maternal mortality risk from fulminant hepatitis.
The trap
Both are fecal-oral and can present with jaundice and very high transaminases, so exposure history alone can blur them. The resolving clue is pregnancy risk profile, because HEV can deteriorate rapidly in late gestation and needs close maternal-fetal monitoring.
The repair move
Next best step: confirm acute viral hepatitis serology, admit pregnant patients with suspected HEV for close monitoring of INR, glucose, and mental status, and provide supportive care while escalating to transplant center evaluation if acute liver failure criteria develop.
Try a free question
CoreA 30-year-old pregnant woman in her third trimester develops jaundice, nausea, and malaise after drinking untreated water during travel. AST and ALT are both above 1400 U/L. What is the most likely diagnosis?
Show answer and explanation
Answer: D. Hepatitis E. Waterborne fecal-oral hepatitis with severe risk in pregnancy is most consistent with hepatitis E.
Why the other choices are tempting
- A. Wrong because hepatitis A is fecal-oral but is less strongly associated with fulminant disease risk in late pregnancy.
- B. Wrong because hepatitis B is blood-borne and diagnosed with HBsAg and core antibody patterns rather than this exposure profile.
- C. Wrong because hepatitis C is usually blood-borne and less likely to present as this classic waterborne outbreak pattern.
- E. Wrong because autoimmune hepatitis typically shows autoantibodies and hypergammaglobulinemia rather than outbreak-linked fecal-oral exposure.
Flashcards
Tap a card to flip it.
Which epidemiologic setting most strongly points toward hepatitis E rather than hepatitis A?
Waterborne outbreak exposure, especially in a pregnant patient, strongly points to hepatitis E.
What serologic marker confirms acute hepatitis A infection?
Positive serum IgM anti-HAV confirms acute hepatitis A.
Quick answers
What is the fastest way to tell Hepatitis A from Hepatitis E?
Acute hepatitis in a pregnant patient with contaminated-water exposure should immediately raise concern for hepatitis E.
What is the key clue for Hepatitis A?
Self-limited acute viral hepatitis after travel or food exposure with positive IgM anti-HAV suggests hepatitis A.
What is the key clue for Hepatitis E?
Waterborne acute hepatitis with high risk of fulminant liver failure in pregnancy suggests hepatitis E.
What is the common trap with Hepatitis A vs Hepatitis E?
Both are fecal-oral and can present with jaundice and very high transaminases, so exposure history alone can blur them. The resolving clue is pregnancy risk profile, because HEV can deteriorate rapidly in late gestation and needs close maternal-fetal monitoring.