hepatitis%20a%20-and-%20e
HEPATITIS A & E

Hepatitis A route of transmission is through oral-fecal route while in hepatitis E, aside from the oral-fecal route, it is also transmitted through blood transfusion in endemic areas.

Hepatitis A incubation period is 15-50 days and hepatitis E incubation period is 15-60 days.

Hepatitis A & E viruses cause epidemics.

 

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

Risk Factors for Hepatitis A Virus (HAV) Infection

  • 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)

Signs and Symptoms

  • 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)

Pathogenesis

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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Audrey Abella, 25 Nov 2020
Reductions in liver fat and adipose tissue volumes were sustained in patients with type 2 diabetes (T2D) with the addition of the SGLT-2* inhibitor dapagliflozin (DAPA) and the DPP-4** inhibitor saxagliptin (SAXA) to metformin (MET), compared with a regimen comprising glimepiride (GLIM)+MET, according to the extension period results of a phase IIIb trial.