Hepatitis%20b Signs and Symptoms

Hepatitis B 

• Hepatitis B affects 240 million people worldwide
  
  • Intermediate to high prevalence in the Asia Pacific region that represents ¾ of chronic hepatitis B virus (HBV)-positive people worldwide
  • Nearly half of the people with chronic HBV infection globally is from the Western Pacific region [37 countries that include China, Japan, South Korea, Philippines and Vietnam according to the World Health Organization (WHO)]
  • Prevalence of HBV infection in Asia as of 2019 based on WHO are as follows:
    • East Asia: 2.95-10.47% (highest prevalence from North Korea)
    • South-East Asia: 1.26-8.66% (highest prevalence from Lao People's Democratic Republic)
    • South Asia: 1.12-2.93% (highest prevalence from India)
• Chronic hepatitis B is defined as chronic necroinflammatory liver disease due to persistent HBV infection
• Chronic HBV infection is when the patient is HBsAg seropositive for more than 6 months
  • Chronic infection may develop in nearly half of children infected with HBV before the age of 6 years and in <5% of individuals infected as adults
• Human HBV belongs to the family of Hepadnaviridae of small, enveloped, primarily hepatotropic DNA viruses
  
  • The virus replicates in the host and assembles exclusively in the hepatocytes and virions are released non-cytopathically through the cellular secretory pathway
• HBV coinfection with HIV affects 2.7 million globally
• Screening for HBV infection is recommended for the following: Household members, sex partners and drug-sharing partners of a person with chronic HBV infection, men who have sex with men (MSM), human immunodeficiency virus (HIV)-positive individuals, HCV-positive individuals, pregnant women, blood/plasma/organ/tissue/semen donors, infants born to HBsAg-positive mothers, patients on hemodialysis/chemotherapy/immunosuppressive therapy, patients with elevated aspartate transaminase (AST)/alanine aminotransferase (ALT) of unknown etiology, correctional facility inmates, individuals born in countries with HBV prevalence of ≥2%

Hepatitis D

• Hepatitis D requires hepatitis B infection for replication
• Disease caused by HDV can be acute or chronic, as a coinfection or as a superinfection
• Acute HBV/hepatitis D virus (HDV) coinfection may resolve spontaneously
• Superinfection can lead to rapid disease progression to liver cirrhosis and hepatic failure within 5-10 years in 70-80% or 1-2 years in 15% of patients with chronic HBV/HDV infection
• Affects nearly 5% of patients with chronic HBV infection globally
• High prevalence rates for HDV infection were reported from countries in Western and Central Africa, Eastern and Southern Europe, Middle East, and East Asia

• 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 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 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 day

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