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

Hepatitis A

• Occurs sporadically and in epidemics, in prolonged periods, commonly in low- and middle-income countries with poor sanitary conditions and hygienic practices
• Estimated annual mortality rate is at 11,000 globally

Hepatitis E

• Worldwide, mortality has been reported at 44,000 in 2015, accounting for 3.3% mortality rate due to viral hepatitis
• More common in East and South Asia especially in low- and middle-income countries with limited access to essential water, sanitation, hygiene and health services

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

Hepatitis A

• Caused by a nonenveloped RNA virus belonging to the family Picornaviridae, hepatitis A virus (HAV), that is usually self-limiting and does not become a chronic illness

Hepatitis E

• Caused by hepatitis E virus (HEV), an RNA virus which is a member of the Hepeviridae family

• 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
  • Patient usually presents with abrupt onset of nausea, vomiting, anorexia, fever, malaise, and abdominal pain
  • 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
  • Clinical presentation is similar to other viral hepatitis, which includes fever, anorexia, nausea, vomiting, abdominal pain, skin rash, and arthralgia
  • Extrahepatic manifestations [eg Guillain-Barré syndrome, 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 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)

• 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)