Hepatitis, Acute

 

Clinical Background

Hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) cause 95% of viral hepatitis cases in the U.S. 

Epidemiology

  • Transmission – variable according to virus
    • HAV, hepatitis E (HEV) – fecal-oral
    • HBV, HCV, HDV – IV drug abuse, sexual transmission, blood transfusions

Organism

  • Diverse group of viruses that share a common ability to cause inflammation and necrosis of the liver
  • Virus may persist in a chronic state (HBV, HCV, HDV)
    • Patients may remain chronic carriers
    • May cause the development of cirrhosis

Risk Factors

  • Children in daycare settings (HAV)
  • Sexual transmission from HBV- or HCV-positive partner
  • HIV-positive patients (HBV, HCV)
  • IV drug abusers (HBV, HCV)
  • Hemophiliacs (HCV)
  • Travel to endemic area (especially Central Asia, Middle East, parts of South America and Africa) (HEV)

Clinical Presentation

  • May be difficult to diagnose clinically
  • Frequently asymptomatic
    • May only have mild rise in aminotransferases (ALT, AST)
  • Mild symptoms (malaise, fever, chills, depressed appetite)
  • Similar symptoms among viral hepatitis types
  • Jaundice is not a predominant symptom in most patients
  • Complications – acute liver failure

Treatment

  • Acute disease – supportive
  • Chronic disease – reduce or eliminate viral loads

Prevention

  • Chronic hepatitis is a public health concern for transmission, as well as the development of cirrhosis and hepatocellular carcinoma
  • Vaccines are available to immunize against HAV and HBV