Objective:

To discuss the diagnostic challenges of hepatitis E virus (HEV) and the need for detection beyond liver-related symptoms.

Key Findings:

• HEV is often misdiagnosed due to the perception that it is primarily a disease of developing countries.
• Extrahepatic manifestations of HEV include neurological disorders, renal issues, hematological conditions, and more.
• Men over 60 who consume meat are at the highest risk for HEV infection.
• Diagnostic challenges include the timing of antibody response and the limitations of serological and molecular assays.
• Improving clinician education and establishing specialized laboratories could enhance HEV detection.

Interpretation:

HEV should be considered a systemic disease, and its detection requires awareness of its diverse manifestations and improved diagnostic practices.

Limitations:

• Limited clinician awareness of zoonotic HEV risk factors and presentations.
• Challenges in standardizing HEV RNA testing and the short viremia period in zoonotic infections.

Conclusion:

A coordinated One Health strategy is essential for effective control and potential eradication of HEV.