EXTRAHEPATIC MANIFESTATIONS IN PATIENTS WITH ACUTE HEPATITIS E – PAZARDZHIK, BULGARIA 2014 – 2022

BACKGROUND: Hepatitis E is a global health issue, only partially understood. Bulgarian record started in 2019 and data is not sufficient. AIM: This research aims to analyze extrahepatic manifestation of acute hepatitis E in patients with hepatitis E from Pazardzhik region, between 2014 – 2022. MATERIALS AND METHODS: The analysis includes 247 patients with acute hepatitis E, treated at the Department of Infectious Diseases of Pazardzhik Multiprofile Hospital for Active Treatment, Bulgaria between 2014 – 2022. The methodology includes clinical observation, laboratory tests and medical imaging. The diagnosis was established by serological /ELISA for anti-HEV IgM, IgG detection/and molecular-biological tests /RT-PCR for HEV RNA detection/. RESULTS: We observed extrahepatic manifestations in 19% (47/247) of the cases. In 60% (28/47) comorbidities were present, and 9% (4/47) were with underlying acute/chronic coinfection with another hepatotropic virus. Thrombocytopenia was found in 83% (39/47) of the patients; asymptomatic creatine kinase elevation – in 13% (6/47), acute pancreatitis – in 9% (4/47), transitory renal impairent – in 6% (3/47); 2% (1/47) had Guillain-Barré syndrome (GBS), 2% (1/47) – arrhythmia and 13% (6/47) – multiorgan involvement. While 91% (43/47) of the patients recovered, in 9% (4/47) the outcome was fatal. CONCLUSION: Extrahepatic manifestations might prevail, potentially delaying diagnosis of HEV-infection. Symptoms associated with comorbidities might also impede the final diagnosis. A diagnostic algorithm is needed to enhance the accurate diagnosis of HEV in patients with dubious symptoms.