Hepatitis e Virus infection During pregnancy: WHy is tHe Disease stormy?

Acute viral hepatitis (AVH) is a systemic infection affecting the liver predominantly. It is caused by six distinct types of viruses A, B, C, D, E and G.1 Acute viral hepatitis is defined as those cases which have acute self limited disease and a serum aspartate aminotransferase elevation of at least five fold or clinical jaundice or both.2 Acute liver failure (ALF) is considered when the patient after having a typical acute hepatitis, develops hepatic encephalopathy within four weeks. It is characterized by mental changes progressing from confusion to stupor and coma as a result of severe impairment of hepatic function, without any history of pre-existing liver disease.3 Viral hepatitis in pregnancy has been a subject of continuing interest and controversy. Reports from Europe and United States and a recent report from India4 have shown the course of viral hepatitis during pregnancy to be in no way different from non pregnant women.5,6 However, studies carried out in India, Iran, Africa and Middle East have found the incidence of fulminant hepatitis to be higher in pregnancy.7,8 Malnutrition superimposed on the normal demands of pregnancy and inversion of T and B lymphocytes in early pregnancy have been postulated to be the contributing factors.9