Hepatitis%20a%20-and-%20e Signs and Symptoms

• International travel
• Men who have sex with men (MSM)
• Illegal drug use
• Occupational risk: Persons working with clinical or nonclinical material containing HAV in a research laboratory setting
• Homelessness, institutionalized individuals
• Immunosuppression (eg HIV-positive individuals, chronic liver disease): With increased risk for severe disease
• Old age (>40 years old)

• The majority of acute viral hepatitis infections are asymptomatic or they can cause an anicteric illness that may not be diagnosed as hepatitis
• Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic
  
  • Adults are more likely to produce clinical symptoms
  • Symptoms usually last for <2 months; some patients may have prolonged infection or may experience disease relapse
• Hepatitis B, C and D may also be asymptomatic
• Symptomatic hepatitis B will depend on the mode and time of transmission
  
  • Vertical transmission from mother to child is almost always asymptomatic
  • Other routes of transmission are more likely to produce symptomatic disease (30% of cases transmitted by IV drug use are icteric)
• Hepatitis E is usually asymptomatic; patients with symptoms are usually older adolescents or young adults
  • Extrahepatic manifestations [eg Guillain-Barré Parsonage-Turner syndrome, neuralgic amyotrophy, bilateral brachial neuritis, peripheral neuropathy, encephalitis, membranoproliferative glomerulonephritis with or without cryoglobulinemia, membranous glomerulonephritis, acute pancreatitis, other autoimmune manifestations (eg myocarditis, arthritis, thyroiditis), thrombocytopenia] have been observed
  • Some patients may experience persistent hepatitis E virus (HEV) replication and immunocompromised patients or those with chronic liver disease are at risk for chronic HEV infection with prolonged viremia (>6 months)

Preicteric Phase

• Nonspecific systemic symptoms (eg myalgia, nausea, vomiting, fatigue, malaise with discomfort in the right upper quadrant of the abdomen)
• Altered sense of smell or taste, coryza, photophobia, headache, cough, diarrhea, dark urine and serum sickness-like syndrome
• Hepatomegaly, splenomegaly and lymphadenopathy may be seen on physical exam

Icteric Phase

• Jaundice, usually noted after onset of fever or upon lysis of fever

Fulminant Hepatitis

• Development of symptoms of hepatic encephalopathy (eg confusion, drowsiness within 8 weeks of symptoms or within 2 weeks of onset of jaundice)
• Hypoglycemia, prolonged prothrombin time (PT)

Routes of Transmission of Hepatitis

• Hepatitis A: Oral-fecal (eg ingestion of contaminated food or water), person-to-person contact, sexual contact
• Hepatitis B: Perinatal, percutaneous, sexual, close person-to-person contact ie by open cuts and sores
• Hepatitis C: Blood transfusions, organ transplants, percutaneous (especially IV drug use), sexual, perinatal
• Hepatitis D: Sexual, percutaneous especially IV drug use, mucous membrane contact with infectious blood or body fluids
  • Found only in patients with hepatitis B since it requires the hepatitis B outer coat 
• Hepatitis E: Oral-fecal (ingestion of contaminated food or water), blood transfusion in endemic areas

Incubation Period

• Hepatitis A: 15-50 days
• Hepatitis B: 30-180 days
• Hepatitis C: 14-180 days
• Hepatitis D: 30-180 days
• Hepatitis E: 15-60 days

Other Characteristics of Hepatitis Viruses

• Hepatitis B virus (HBV) contains a DNA nucleic acid while A, C, and E viruses have an RNA nucleic acid
  
  • Hepatitis D has an incomplete RNA and needs the B virus to replicate
• Hepatitis A and E viruses cause epidemics
• Hepatitis B, C, and D viruses may predispose to chronic disease and hepatic malignancy