VIRAL HEPATITIS is a topic covered in the Harrison's Manual of Medicine.

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Acute viral hepatitis is a systemic infection predominantly affecting the liver. Clinically characterized by malaise, nausea, vomiting, diarrhea, and low-grade fever followed by dark urine, jaundice, and tender hepatomegaly; may be subclinical and detected on basis of elevated aspartate and alanine aminotransferase (AST and ALT) levels. Hepatitis B may be associated with immune-complex phenomena, including arthritis, serum sickness-like illness, glomerulonephritis, and a polyarteritis nodosa–like vasculitis. Hepatitis-like illnesses may be caused not only by hepatotropic viruses (A, B, C, D, E) but also by other viruses (Epstein-Barr, CMV, coxsackievirus, etc.), alcohol, drugs, hypotension and ischemia, and biliary tract disease (Table 152-1).

TABLE 152-1: CLINICAL AND EPIDEMIOLOGIC FEATURES OF VIRAL HEPATITIS
FeatureHAVHBVHCVHDVHEV
Incubation (days)15–45, mean 3030–180, mean 60–9015–160, mean 5030–180, mean 60–9014–60, mean 40
OnsetAcuteInsidious or acuteInsidiousInsidious or acuteAcute
Age preferenceChildren, young adultsYoung adults (sexual and percutaneous), babies, toddlersAny age, but more common in adultsAny age (similar to HBV)Epidemic cases: young adults (20–40 years); sporadic cases: older adults (>60)

Transmission

  Fecal-oral

  Percutaneous

  Perinatal

  Sexual

 

+++

Unusual

±

 

+++

+++

++

 

+++

±a

±a

 

+++

+

++

 

+++

Clinical

  Severity

  Fulminant

  Progression to chronicity

  Carrier

  Cancer

  Prognosis

 

Mild

0.1%

None

None

None

Excellent

 

Occasionally severe

0.1–1%

Occasional (1–10%) (90% of neonates)

0.1–30%c

+ (neonatal infection)

Worse with age, debility

 

Moderate

0.1%

Common (85%)

1.5–3.2%

+

Moderate

 

Occasionally severe

5–20%b

Commond

Variableg

±

Acute good, Chronic poor

 

Mild

1–2%e

Nonef

None

None

Good

ProphylaxisIg, inactivated vaccineHBIG, recombinant vaccineNoneHBV vaccine (none for HBV carriers)Vaccine
aPrimarily with HIV co-infection and high-level viremia in index case; risk ~5%.
bUp to 5% in acute HBV/HDV co-infection; up to 20% in HDV superinfection of chronic HBV infection.
cVaries considerably throughout the world and in subpopulations within countries; see text.
dIn acute HBV/HDV co-infection, the frequency of chronicity is the same as that for HBV; in HDV superinfection, chronicity is invariable.
e10–20% in pregnant women.
fExcept as observed in immunosuppressed liver allograft recipients or other immunosuppressed hosts.
gCommon in Mediterranean countries; rare in North America and western Europe.
Abbreviation: HBIG, hepatitis B immunoglobulin. See text for other abbreviations.

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TY - ELEC T1 - VIRAL HEPATITIS ID - 623375 Y1 - 2017 PB - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623375/all/VIRAL_HEPATITIS ER -