الفهرس 
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Abstract
Hepatitis E virus (HEV) infection is a worldwide disease.
It is mainly transmitted through contaminated water supplies which make the virus endemic in developing countries .
Within the last decade there is an improving in understanding of the natural history of the infection where in the majority of patients who become infected with HEV remain asymptomatic with spontaneous clearance of the virus.
Nevertheless, in certain groups of patients such as those with pre-existent chronic liver disease can develop acute on chronic liver failure , in immunocompromised patients can develop chronic infection and progressive fibrosis.
Infection can also be associated with extrahepatic manifestations. In our study we aimed to detect the prevalence and presentation of HEV infection in special groups of patients;
Patients with chronic liver diseases with unexplained acute exacerbations and deterioration in liver functions.
Patients with neurological illness where HEV can be the cause of these insult as an extrahepatic manifestations of the infection .
Patients with autoimmune or inflammatory arthritis currently treated with DMARDs.
Our study has found that HEV infection is a common in our country with different presentation in various groups of patients ,also Egypt has high seroprevalence for HEV infection indicating past infection , where we found that anti HEV IgG was 42 out of 100 (42%) in all studied groups totally .
Also we found HEV can be a cause of acute decompensation in patients with chronic liver disease leading to ACLF where its prevalence was 4 /30
(13.3% ) , also HEV infection could be suspected in patients with inflammatory arthritis treated with immunosuppressants with its prevalence was 4/38 (10.5%) that found in patients with elevated liver enzymes and unexpectedly in other who are not elevated but the main limitation in our study was limited number of patients and its cross-sectional nature where one sample only taken so large number and longer-term follow up is recommended also to determine the risk for developing chronicity in those patients .
As regarding the extrahepatic effect we demonstrated HEV infection in 2/32 (6.3%) patients with acute non-traumatic neurological injury and the most striking observation of the current study is the asymptomatic nature , none of them were jaundiced and serum ALT was normal , so we can recommend HEV testing, irrespective of LFT results in those.
Finally it is increasingly clear that we have been slow to recognize the threat posed by HEV so it is vital that we must continue to improving our knowledge about its prevalence , nature ,diagnosis , its transmission and its extra hepatic effect , by increasing both awareness and knowledge of the disease amongst clinicians.