{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:28:46Z","timestamp":1790026126362,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections often present as acute hepatitis with prodromal symptoms. These infections, transmitted via the oral\u2013enteral route, constitute significant public health challenges, particularly in developing countries with subpar sanitary systems. The aim of the study was to describe the clinical manifestations, laboratory findings, and outcomes of hepatitis A and hepatitis E infections in Thailand. We conducted a retrospective chart review and analysis of 152 patients diagnosed with acute hepatitis A or hepatitis E from January 2007 to August 2018 at Siriraj Hospital. The hepatitis E cohort was older with a greater prevalence of comorbidities (hypertension, diabetes mellitus, chronic kidney disease, chronic hepatitis B, and post-kidney transplantation status) than the hepatitis A cohort. While the majority of hepatitis A patients presented with fever (98%) and jaundice (96%), these symptoms were less pronounced in hepatitis E patients. Furthermore, hepatitis A patients exhibited significantly higher aminotransferase and total bilirubin levels. However, clinical outcomes, such as hospitalization rates, progression to acute liver failure, and mortality, were comparable across both groups. In conclusion, although the clinical manifestations of hepatitis A and hepatitis E were similar, fever and jaundice were more prevalent and aminotransferase and bilirubin levels were higher in the HAV-infected group.<\/jats:p>","DOI":"10.3390\/v15091888","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T09:56:36Z","timestamp":1694080596000},"page":"1888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Comparison of Clinical Manifestations and Outcomes between Acute Sporadic Hepatitis A and Hepatitis E Infections in Thailand"],"prefix":"10.3390","volume":"15","author":[{"given":"Sirajuk","family":"Khongviwatsathien","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-9077","authenticated-orcid":false,"given":"Wajana","family":"Thaweerat","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7177-1068","authenticated-orcid":false,"given":"Thanapat","family":"Atthakitmongkol","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Watcharasak","family":"Chotiyaputta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7634-0843","authenticated-orcid":false,"given":"Tawesak","family":"Tanwandee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1002\/jmv.24168","article-title":"Molecular epidemiology of hepatitis A virus infection in Northeast India","volume":"87","author":"Bose","year":"2015","journal-title":"J. Med. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/jvh.12282","article-title":"Hepatitis A virus in the Middle East and North Africa region: A new challenge","volume":"21","author":"Melhem","year":"2014","journal-title":"J. Viral Hepat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/tme.12405","article-title":"Hepatitis E: The current state of play","volume":"27","author":"Ankcorn","year":"2017","journal-title":"Transfus. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.jhep.2019.05.011","article-title":"Hepatitis A and E\u2014Differences and commonalities","volume":"72","author":"Gotlieb","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4149\/av_2020_103","article-title":"The investigation of hepatitis A virus and hepatitis E virus co-infection in humans and animals in China","volume":"64","author":"Li","year":"2020","journal-title":"Acta Virol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000252779","article-title":"Hepatitis A: Clinical manifestations and management","volume":"53","author":"Jeong","year":"2010","journal-title":"Intervirology"},{"key":"ref_7","first-page":"650","article-title":"Seroepidemiology of hepatitis A virus antibody in primary school children in Khon Kaen Province, northeastern Thailand","volume":"27","author":"Kosuwan","year":"1996","journal-title":"Southeast Asian J. Trop. Med. Public. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.gtc.2020.01.002","article-title":"Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention","volume":"49","author":"Abutaleb","year":"2020","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1093\/infdis\/171.Supplement_1.S15","article-title":"Clinical manifestations of hepatitis A: Recent experience in a community teaching hospital","volume":"171","author":"Tong","year":"1995","journal-title":"J. Infect. Dis."},{"key":"ref_10","unstructured":"Advisory Committee on Immunization Practices, Fiore, A.E., Wasley, A., and Bell, B.P. (2006). Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep., 55(RR-7), 1\u201323."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"a031708","DOI":"10.1101\/cshperspect.a031708","article-title":"Natural History, Clinical Manifestations, and Pathogenesis of Hepatitis A","volume":"8","author":"Shin","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/oxfordjournals.aje.a114093","article-title":"Frequency of illness associated with epidemic hepatitis A virus infections in adults","volume":"122","author":"Lednar","year":"1985","journal-title":"Am. J. Epidemiol."},{"key":"ref_13","unstructured":"World Health Organization (2010). The Global Prevalence of Hepatitis A Virus Infection and Susceptibility: A Systematic Review, World Health Organization."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1056\/NEJMra1204512","article-title":"Hepatitis E","volume":"367","author":"Hoofnagle","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.virusres.2011.03.017","article-title":"Clinical presentation of hepatitis E","volume":"161","author":"Aggarwal","year":"2011","journal-title":"Virus Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7030","DOI":"10.3748\/wjg.v22.i31.7030","article-title":"Hepatitis E: Discovery, global impact, control and cure","volume":"22","author":"Khuroo","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8657","DOI":"10.1007\/s11033-020-05908-3","article-title":"Phylogenetic analysis of two new complete genomes of the hepatitis E virus (HEV) genotype 3 from Thailand","volume":"47","author":"Chanmanee","year":"2020","journal-title":"Mol. Biol. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1007\/s00705-010-0751-8","article-title":"Swine as the possible source of hepatitis E virus transmission to humans in Thailand","volume":"155","author":"Suwannakarn","year":"2010","journal-title":"Arch. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1002\/jmv.24011","article-title":"Occurrence of hepatitis E virus infection in acute hepatitis in Thailand","volume":"86","author":"Siripanyaphinyo","year":"2014","journal-title":"J. Med. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41426-017-0009-6","article-title":"Origin and dispersal of Hepatitis E virus","volume":"7","author":"Forni","year":"2018","journal-title":"Emerg. Microbes Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1128\/CMR.14.1.38-58.2001","article-title":"Hepatitis A: Old and new","volume":"14","author":"Cuthbert","year":"2001","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17086","DOI":"10.1038\/nrdp.2017.86","article-title":"Hepatitis E virus infection","volume":"3","author":"Kamar","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/978-94-024-0942-0_10","article-title":"Clinical Manifestations of Hepatitis E","volume":"948","author":"Xin","year":"2016","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1128\/CMR.19.1.63-79.2006","article-title":"Diagnosis of hepatitis a virus infection: A molecular approach","volume":"19","author":"Nainan","year":"2006","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5543","DOI":"10.3748\/wjg.v26.i37.5543","article-title":"Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment","volume":"26","author":"Aslan","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"105219","DOI":"10.1016\/j.jcv.2022.105219","article-title":"Comparative evaluation of four commercial analyzers for the serological screening of hepatitis A, B, C and HIV","volume":"153","author":"Kutvonen","year":"2022","journal-title":"J. Clin. Virol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1099\/jmm.0.000706","article-title":"Laboratory challenges in the diagnosis of hepatitis E virus","volume":"67","author":"Majdalawieh","year":"2018","journal-title":"J. Med. Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hernandez-Suarez, G., Saha, D., Lodrono, K., Boonmahittisut, P., Taniwijaya, S., Saha, A., Badur, S., and Poovorawan, Y. (2021). Seroprevalence and incidence of hepatitis A in Southeast Asia: A systematic review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258659"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sintusek, P., Sa-Nguanmoo, P., Posuwan, N., Jaroonvanichkul, V., Vorayingyong, A., and Poovorawan, Y. (2018). Changes in hepatitis A virus (HAV) seroprevalence in medical students in Bangkok, Thailand, from 1981 to 2016. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3733-7"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1089\/vim.2018.0146","article-title":"A Nationwide Survey of the Seroprevalence of Hepatitis E Virus Infections Among Blood Donors in Thailand","volume":"32","author":"Jupattanasin","year":"2019","journal-title":"Viral Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s12985-021-01616-x","article-title":"Prevalence and clinical correlation of hepatitis E virus antibody in the patients\u2019 serum samples from a tertiary care hospital in Thailand during 2015\u20132018","volume":"18","author":"Boonyai","year":"2021","journal-title":"Virol. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.hepres.2005.01.014","article-title":"Hepatitis A viral genotypes and clinical relevance: Clinical and molecular characterization of hepatitis A virus isolates from northern India","volume":"32","author":"Hussain","year":"2005","journal-title":"Hepatol. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S1665-2681(19)31438-3","article-title":"Clinical course and management of acute hepatitis A infection in adults","volume":"11","author":"Uribe","year":"2012","journal-title":"Ann. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/0255-0857.150908","article-title":"Prevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) in the patients presenting with acute viral hepatitis","volume":"33","author":"Joon","year":"2015","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1099\/jmm.0.072249-0","article-title":"Prevalence of hepatitis E virus infection in West Bengal, India: A hospital-based study","volume":"63","author":"Chandra","year":"2014","journal-title":"J. Med. Microbiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1097\/MEG.0b013e3282f5195a","article-title":"Autochthonous hepatitis E in Southwest England: Natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease","volume":"20","author":"Dalton","year":"2008","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.meegid.2012.12.022","article-title":"Hepatitis E virus genotype 3 in humans and swine, Cuba","volume":"14","author":"Owot","year":"2013","journal-title":"Infect. Genet. Evol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1002\/jmv.23601","article-title":"Epidemiological and molecular analyses of a non-seasonal outbreak of acute icteric hepatitis E in Bangladesh","volume":"85","author":"Akbar","year":"2013","journal-title":"J. Med. Virol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000024985","article-title":"Hepatitis E virus: An update on its molecular, clinical and epidemiological characteristics","volume":"42","author":"Irshad","year":"1999","journal-title":"Intervirology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ijid.2019.06.027","article-title":"Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil","volume":"86","author":"Oliveira","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1800141","DOI":"10.2807\/1560-7917.ES.2019.24.10.1800141","article-title":"Epidemiology and genotype 3 subtype dynamics of hepatitis E virus in Belgium, 2010 to 2017","volume":"24","author":"Suin","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Minosse, C., Biliotti, E., Lapa, D., Rianda, A., Marchili, M., Luzzitelli, I., Capobianchi, M.R., McPhee, F., Garbuglia, A.R., and D\u2019offizi, G. (2020). Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy. Pathogens, 9.","DOI":"10.3390\/pathogens9100832"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1440-1746.2007.04913.x","article-title":"Hepatitis E virus infection and fulminant hepatic failure during pregnancy","volume":"22","author":"Jilani","year":"2007","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/0002-9343(81)90758-0","article-title":"Incidence and severity of viral hepatitis in pregnancy","volume":"70","author":"Khuroo","year":"1981","journal-title":"Am. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7326\/0003-4819-147-1-200707030-00005","article-title":"Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection","volume":"147","author":"Patra","year":"2007","journal-title":"Ann. Intern. Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/9\/1888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:46:29Z","timestamp":1760129189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/9\/1888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["v15091888"],"URL":"https:\/\/doi.org\/10.3390\/v15091888","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]}}}