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
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